davinci_pas_test_kit 0.12.2 → 0.13.0

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Files changed (106) hide show
  1. checksums.yaml +4 -4
  2. data/config/presets/pas_server_subscription_creation_against_pas_client.json +32 -0
  3. data/lib/davinci_pas_test_kit/certs/InfernoCA.key +52 -0
  4. data/lib/davinci_pas_test_kit/certs/InfernoCA.pem +35 -0
  5. data/lib/davinci_pas_test_kit/certs/TestKit.pem +32 -0
  6. data/lib/davinci_pas_test_kit/certs/TestKitPrivateKey.key +28 -0
  7. data/lib/davinci_pas_test_kit/client_suite.rb +141 -100
  8. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_registration/configuration_other_display_test.rb +46 -0
  9. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_registration/configuration_smart_display_test.rb +37 -0
  10. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_registration/configuration_udap_display_test.rb +37 -0
  11. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_registration/other_auth_attest_test.rb +36 -0
  12. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_approval_submit_test.rb +21 -10
  13. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_denial_submit_test.rb +20 -10
  14. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_inquire_must_support_test.rb +21 -9
  15. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_submit_test.rb +24 -14
  16. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_response_attest.rb +4 -9
  17. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_submit_must_support_test.rb +21 -9
  18. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_create_test.rb +23 -13
  19. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_pas_conformance_test.rb +5 -24
  20. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/error_tests/pas_inquiry_error_test.rb +1 -0
  21. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/error_tests/pas_submission_error_test.rb +3 -1
  22. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/notification/pas_subscription_notification_test.rb +24 -20
  23. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_approval_group.rb +6 -4
  24. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_auth_smart_group.rb +32 -0
  25. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_auth_udap_group.rb +31 -0
  26. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_denial_group.rb +10 -4
  27. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_must_support_group.rb +29 -0
  28. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_options.rb +25 -0
  29. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_pended_group.rb +11 -4
  30. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_registration_group.rb +63 -0
  31. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_subscription_setup_group.rb +23 -0
  32. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_workflows_group.rb +21 -0
  33. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_server_subscription_input_conformance.rb +35 -0
  34. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_server_subscription_setup.rb +43 -0
  35. data/lib/davinci_pas_test_kit/descriptions.rb +10 -0
  36. data/lib/davinci_pas_test_kit/docs/client_suite_description_v201.md +203 -79
  37. data/lib/davinci_pas_test_kit/docs/demo/PAS Client Suite Demonstration.postman_collection.json +246 -0
  38. data/lib/davinci_pas_test_kit/docs/server_suite_description_v201.md +21 -10
  39. data/lib/davinci_pas_test_kit/endpoints/claim_endpoint.rb +13 -1
  40. data/lib/davinci_pas_test_kit/endpoints/subscription_create_endpoint.rb +13 -1
  41. data/lib/davinci_pas_test_kit/endpoints/subscription_status_endpoint.rb +10 -1
  42. data/lib/davinci_pas_test_kit/endpoints/token_endpoint.rb +29 -15
  43. data/lib/davinci_pas_test_kit/generated/v2.0.1/beneficiary/metadata.yml +2 -1
  44. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim/claim_operation_test.rb +1 -2
  45. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim/metadata.yml +28 -17
  46. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_inquiry/claim_inquiry_operation_test.rb +1 -2
  47. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_inquiry/client_inquire_request_claim_inquiry_must_support_test.rb +4 -1
  48. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_inquiry/metadata.yml +7 -1
  49. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_inquiry/server_inquire_request_claim_inquiry_must_support_test.rb +3 -1
  50. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_update/client_submit_request_claim_update_must_support_test.rb +9 -3
  51. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_update/metadata.yml +28 -17
  52. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim_update/server_submit_request_claim_update_must_support_test.rb +9 -3
  53. data/lib/davinci_pas_test_kit/generated/v2.0.1/claiminquiryresponse/metadata.yml +6 -0
  54. data/lib/davinci_pas_test_kit/generated/v2.0.1/claiminquiryresponse/server_inquire_response_claiminquiryresponse_must_support_test.rb +1 -1
  55. data/lib/davinci_pas_test_kit/generated/v2.0.1/claimresponse/metadata.yml +8 -0
  56. data/lib/davinci_pas_test_kit/generated/v2.0.1/claimresponse/server_submit_response_claimresponse_must_support_test.rb +1 -1
  57. data/lib/davinci_pas_test_kit/generated/v2.0.1/communication_request/metadata.yml +4 -0
  58. data/lib/davinci_pas_test_kit/generated/v2.0.1/coverage/metadata.yml +11 -5
  59. data/lib/davinci_pas_test_kit/generated/v2.0.1/device_request/metadata.yml +2 -0
  60. data/lib/davinci_pas_test_kit/generated/v2.0.1/encounter/metadata.yml +6 -0
  61. data/lib/davinci_pas_test_kit/generated/v2.0.1/insurer/metadata.yml +4 -2
  62. data/lib/davinci_pas_test_kit/generated/v2.0.1/medication_request/metadata.yml +2 -0
  63. data/lib/davinci_pas_test_kit/generated/v2.0.1/metadata.yml +153 -53
  64. data/lib/davinci_pas_test_kit/generated/v2.0.1/nutrition_order/metadata.yml +2 -0
  65. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_request_bundle/metadata.yml +2 -1
  66. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_request_bundle/server_pas_inquiry_request_bundle_validation_test.rb +0 -2
  67. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_response_bundle/metadata.yml +2 -1
  68. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_response_bundle/server_pas_inquiry_response_bundle_validation_test.rb +2 -3
  69. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_request_bundle/metadata.yml +2 -1
  70. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_request_bundle/server_pas_request_bundle_validation_test.rb +0 -2
  71. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_response_bundle/metadata.yml +2 -1
  72. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_response_bundle/server_pas_response_bundle_validation_test.rb +2 -3
  73. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_server_approval_use_case_group.rb +0 -1
  74. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_server_denial_use_case_group.rb +0 -1
  75. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_server_must_support_use_case_group.rb +3 -0
  76. data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_server_pended_use_case_group.rb +10 -3
  77. data/lib/davinci_pas_test_kit/generated/v2.0.1/practitioner/metadata.yml +2 -1
  78. data/lib/davinci_pas_test_kit/generated/v2.0.1/practitioner_role/metadata.yml +4 -0
  79. data/lib/davinci_pas_test_kit/generated/v2.0.1/requestor/metadata.yml +4 -2
  80. data/lib/davinci_pas_test_kit/generated/v2.0.1/server_suite.rb +8 -5
  81. data/lib/davinci_pas_test_kit/generated/v2.0.1/service_request/metadata.yml +2 -0
  82. data/lib/davinci_pas_test_kit/generated/v2.0.1/task/metadata.yml +4 -0
  83. data/lib/davinci_pas_test_kit/generator/group_generator.rb +20 -4
  84. data/lib/davinci_pas_test_kit/generator/group_metadata_extractor.rb +2 -2
  85. data/lib/davinci_pas_test_kit/generator/ig_resources.rb +4 -0
  86. data/lib/davinci_pas_test_kit/generator/must_support_test_generator.rb +14 -3
  87. data/lib/davinci_pas_test_kit/generator/operation_test_generator.rb +16 -3
  88. data/lib/davinci_pas_test_kit/generator/templates/group.rb.erb +10 -3
  89. data/lib/davinci_pas_test_kit/generator/templates/must_support.rb.erb +3 -0
  90. data/lib/davinci_pas_test_kit/generator/templates/operation.rb.erb +4 -1
  91. data/lib/davinci_pas_test_kit/generator/templates/suite.rb.erb +8 -5
  92. data/lib/davinci_pas_test_kit/generator/templates/validation.rb.erb +5 -4
  93. data/lib/davinci_pas_test_kit/generator/validation_test_generator.rb +12 -1
  94. data/lib/davinci_pas_test_kit/must_support_test.rb +2 -202
  95. data/lib/davinci_pas_test_kit/pas_subscription_verification.rb +30 -0
  96. data/lib/davinci_pas_test_kit/requirements/generated/davinci-pas-test-kit_requirements_coverage.csv +58 -58
  97. data/lib/davinci_pas_test_kit/session_identification.rb +45 -0
  98. data/lib/davinci_pas_test_kit/tags.rb +1 -0
  99. data/lib/davinci_pas_test_kit/urls.rb +61 -9
  100. data/lib/davinci_pas_test_kit/version.rb +2 -2
  101. data/lib/requirements_config.yaml +1 -1
  102. metadata +54 -8
  103. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_token_request_test.rb +0 -31
  104. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_token_validation_test.rb +0 -18
  105. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_authentication_group.rb +0 -49
  106. data/lib/davinci_pas_test_kit/generator/must_support_metadata_extractor.rb +0 -327
data/lib/davinci_pas_test_kit/requirements/generated/davinci-pas-test-kit_requirements_coverage.csv CHANGED
@@ -3,7 +3,7 @@ hl7.fhir.us.davinci-pas_2.0.1,1,https://hl7.org/fhir/us/davinci-pas/STU2/index.h
3
3
  hl7.fhir.us.davinci-pas_2.0.1,2,https://hl7.org/fhir/us/davinci-pas/STU2/index.html#cms-exception,"When using PAS under the CMS granted exception (Request Number: HL7 FHIR Exception #2021031001), the ... defined PAS FHIR request bundles **SHALL** be transmitted intact between the provider and payer.",SHALL,Server,,true,NA,NA,,
4
4
  hl7.fhir.us.davinci-pas_2.0.1,3,https://hl7.org/fhir/us/davinci-pas/STU2/index.html#cms-exception,"When using PAS under the CMS granted exception (Request Number: HL7 FHIR Exception #2021031001), the ... PAS FHIR response bundles **SHALL** be transmitted intact between the payer and the provider.",SHALL,Server,,true,NA,NA,,
5
5
  hl7.fhir.us.davinci-pas_2.0.1,4,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#scope-of-work-flow,[The processes described in this IG] **SHOULD** not be used for any Medication that is covered under a prescription drug program benefit where PA is provided by another electronic exchange process (e.g. NCPCP SCRIPT),SHOULD NOT,Client,,true,,,NA,NA
6
- hl7.fhir.us.davinci-pas_2.0.1,5,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#prior-authorization-process,The intermediary **SHALL** always exchange a FHIR bundle with the EHR,SHALL,Server,,false,NA,NA,,
6
+ hl7.fhir.us.davinci-pas_2.0.1,5,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#prior-authorization-process,The intermediary **SHALL** always exchange a FHIR bundle with the EHR,SHALL,Server,,false,NA,NA,"2.1.1.02, 2.2.1.02, 2.3.1.02, 2.3.2.05, 3.1.1.02, 3.2.1.02","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_v201_claim_operation_test_approval, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_v201_claim_operation_test_denial, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_v201_claim_operation_test_pended, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group02-pas_v201_claim_inquiry_operation_test_pended, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_v201_claim_operation_test_must_support, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group02-Group01-pas_v201_claim_inquiry_operation_test_must_support"
7
7
  hl7.fhir.us.davinci-pas_2.0.1,6,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#prior-authorization-process,The intermediary **SHALL** convert the FHIR bundle to and from an X12 278 (and optionally to an X12 275) if necessary to meet the HIPAA transaction requirements,SHALL,Server,,false,NA,NA,,
8
8
  hl7.fhir.us.davinci-pas_2.0.1,7,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#prior-authorization-process,The intermediary is responsible for obtaining a status of the PA request from the Payer (may use the X12 278 Inquiry) when requested by the EHR,SHALL,Server,,false,NA,NA,,
9
9
  hl7.fhir.us.davinci-pas_2.0.1,8,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#prior-authorization-process,The intermediary **MAY** convert the X12 278 to and from a FHIR bundle and exchange it with a payer as long as the PA request and response are in an X12 278 format at some time between the exchange with the EHR and the payer,MAY,Server,,false,NA,NA,,
@@ -31,14 +31,14 @@ hl7.fhir.us.davinci-pas_2.0.1,29,https://hl7.org/fhir/us/davinci-pas/STU2/additi
31
31
  hl7.fhir.us.davinci-pas_2.0.1,30,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,The Task.input … ‘attachmentsNeeded’ slice communicates which attachments are needed using LOINC attachment or PWK01 codes,SHALL,Server,,true,NA,NA,,
32
32
  hl7.fhir.us.davinci-pas_2.0.1,31,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,The Task.input … ‘attachmentsNeeded’ slice contains an extension point to the prior authorization line number.,SHALL,Server,,true,NA,NA,,
33
33
  hl7.fhir.us.davinci-pas_2.0.1,32,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,The Task.input … ‘questionnairesNeeded’ slice contains an extension point to the prior authorization line number.,SHALL,Server,,true,NA,NA,,
34
- hl7.fhir.us.davinci-pas_2.0.1,33,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,The HRex IG defines some [conformance expectations](http://hl7.org/fhir/us/davinci-hrex/conformance.html) that all Da Vinci IGs are expected to follow.,SHALL,Server,hl7.fhir.us.davinci-hrex_1.0.0@21-32,false,NA,NA,,
34
+ hl7.fhir.us.davinci-pas_2.0.1,33,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,The HRex IG defines some [conformance expectations](http://hl7.org/fhir/us/davinci-hrex/conformance.html) that all Da Vinci IGs are expected to follow.,SHALL,Server,hl7.fhir.us.davinci-hrex_1.0.0@21-32,false,NA,NA,3,davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case
35
35
  hl7.fhir.us.davinci-pas_2.0.1,34,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,The HRex IG defines some [conformance expectations](http://hl7.org/fhir/us/davinci-hrex/conformance.html) that all Da Vinci IGs are expected to follow.,SHALL,Client,hl7.fhir.us.davinci-hrex_1.0.0@21-32,false,,,NA,NA
36
- hl7.fhir.us.davinci-pas_2.0.1,35,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of processing all data elements that are marked as Must Support on the Claim Request,SHALL,Server,,false,NA,NA,,
37
- hl7.fhir.us.davinci-pas_2.0.1,36,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of processing all data elements that are marked as Must Support on the … Claim Inquiry,SHALL,Server,,false,NA,NA,,
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- hl7.fhir.us.davinci-pas_2.0.1,37,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of returning resource instances containing any of the data elements that are marked as Must Support on the Claim Response,SHALL,Server,,false,NA,NA,,
39
- hl7.fhir.us.davinci-pas_2.0.1,38,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of returning resource instances containing any of the data elements that are marked as Must Support on the Claim ... Inquiry Response.,SHALL,Server,,false,NA,NA,,
40
- hl7.fhir.us.davinci-pas_2.0.1,39,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Client Systems **SHALL** be capable of receiving all data elements that are marked as Must Support on the Claim Response,SHALL,Client,,false,"","",NA,NA
41
- hl7.fhir.us.davinci-pas_2.0.1,40,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Client Systems **SHALL** be capable of receiving all data elements that are marked as Must Support on the … Claim Inquiry Response,SHALL,Client,,false,"","",NA,NA
36
+ hl7.fhir.us.davinci-pas_2.0.1,35,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of processing all data elements that are marked as Must Support on the Claim Request,SHALL,Server,,false,NA,NA,3.1.2,davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group02
37
+ hl7.fhir.us.davinci-pas_2.0.1,36,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of processing all data elements that are marked as Must Support on the … Claim Inquiry,SHALL,Server,,false,NA,NA,3.2.2,davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group02-Group02
38
+ hl7.fhir.us.davinci-pas_2.0.1,37,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of returning resource instances containing any of the data elements that are marked as Must Support on the Claim Response,SHALL,Server,,false,NA,NA,3.1.3.02,davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group03-pas_server_submit_response_v201_claimresponse_must_support_test
39
+ hl7.fhir.us.davinci-pas_2.0.1,38,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Intermediary Systems **SHALL** be capable of returning resource instances containing any of the data elements that are marked as Must Support on the Claim ... Inquiry Response.,SHALL,Server,,false,NA,NA,3.2.3.02,davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group02-Group03-pas_server_inquire_response_v201_claiminquiryresponse_must_support_test
40
+ hl7.fhir.us.davinci-pas_2.0.1,39,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Client Systems **SHALL** be capable of receiving all data elements that are marked as Must Support on the Claim Response,SHALL,Client,,false,,,NA,NA
41
+ hl7.fhir.us.davinci-pas_2.0.1,40,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Client Systems **SHALL** be capable of receiving all data elements that are marked as Must Support on the … Claim Inquiry Response,SHALL,Client,,false,,,NA,NA
42
42
  hl7.fhir.us.davinci-pas_2.0.1,41,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Client Systems … **SHALL** not generate an error or cause the application to fail when receiving any data element that is marked as Must Support.,SHALL NOT,Client,,true,,,NA,NA
43
43
  hl7.fhir.us.davinci-pas_2.0.1,42,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,PA Client Systems **SHOULD NOT** send any data elements that are not marked as Must Support,SHOULD NOT,Client,,false,,,NA,NA
44
44
  hl7.fhir.us.davinci-pas_2.0.1,43,https://hl7.org/fhir/us/davinci-pas/STU2/background.html#must-support,"If these [non-must support] data elements are included in a Claim Request or Claim Inquiry, the receiving PA Intermediary System **MAY** ignore those elements.",MAY,Server,,true,NA,NA,,
@@ -56,38 +56,38 @@ hl7.fhir.us.davinci-pas_2.0.1,54,https://hl7.org/fhir/us/davinci-pas/STU2/specif
56
56
  hl7.fhir.us.davinci-pas_2.0.1,55,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,Servers supporting this implementation guide **SHOULD** also comply with the Da Vinci... [Documentation Templates and Rules (DTR)](http://www.hl7.org/fhir/us/davinci-dtr) implementation guide,SHOULD,Server,,false,NA,NA,,
57
57
  hl7.fhir.us.davinci-pas_2.0.1,56,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Servers] claiming conformance to this IG **SHALL** comply with the [Security and Privacy page in the Da Vinci HRex guide](http://hl7.org/fhir/us/davinci-hrex/security.html).,SHALL,Server,hl7.fhir.us.davinci-hrex_1.0.0@1-20,false,NA,NA,,
58
58
  hl7.fhir.us.davinci-pas_2.0.1,57,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Clients] claiming conformance to this IG **SHALL** comply with the [Security and Privacy page in the Da Vinci HRex guide](http://hl7.org/fhir/us/davinci-hrex/security.html).,SHALL,Client,hl7.fhir.us.davinci-hrex_1.0.0@1-20,false,,,NA,NA
59
- hl7.fhir.us.davinci-pas_2.0.1,58,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,The primary interaction supported by [clients in] this implementation guide is submitting a prior authorization request and receiving back a response.,SHALL,Client,,false,"2.2.1.01, 2.2.1.02, 2.2.2.01, 2.2.2.02, 2.2.3.1.01, 2.2.3.2.01, 2.3.1.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group03-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
60
- hl7.fhir.us.davinci-pas_2.0.1,59,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,"To perform this [prior authorization request submission], a [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) resource is constructed by the client (EHR) system.",SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
61
- hl7.fhir.us.davinci-pas_2.0.1,60,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,That [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [constructed by the client for prior authorization submission] will contain a [Claim](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claim.html) resource (which FHIR uses to submit prior authorization requests),SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
59
+ hl7.fhir.us.davinci-pas_2.0.1,58,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,The primary interaction supported by [clients in] this implementation guide is submitting a prior authorization request and receiving back a response.,SHALL,Client,,false,"3.1.01, 3.1.02, 3.2.01, 3.2.02, 3.3.1.01, 3.3.2.01, 4.1.01, 6.1.01, 6.1.02, 6.2.01, 6.2.02, 6.3.1.01, 6.3.2.01, 7.1.01, 9.1.01, 9.1.02, 9.2.01, 9.2.02, 9.3.1.01, 9.3.2.01, 10.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_smart-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_udap-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_no_auth-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
60
+ hl7.fhir.us.davinci-pas_2.0.1,59,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,"To perform this [prior authorization request submission], a [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) resource is constructed by the client (EHR) system.",SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
61
+ hl7.fhir.us.davinci-pas_2.0.1,60,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,That [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [constructed by the client for prior authorization submission] will contain a [Claim](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claim.html) resource (which FHIR uses to submit prior authorization requests),SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
62
62
  hl7.fhir.us.davinci-pas_2.0.1,61,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,That [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [constructed by the client for prior authorization submission] will contain … various referenced resources needed to support the population of the 5010 version of the ASC X12N 278 prior authorization request and the 6020 version of the ASC X12N 275 additional documentation transactions.,SHALL,Client,,false,,,NA,NA
63
- hl7.fhir.us.davinci-pas_2.0.1,62,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,This [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [constructed by the client for prior authorization submission] will then be sent as the sole payload of a [Claim submit](https://hl7.org/fhir/us/davinci-pas/STU2/OperationDefinition-Claim-submit.html) operation.,SHALL,Client,,false,"2.2.1.01, 2.2.2.01, 2.2.3.1.01, 2.3.1.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-Group02-Group03-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
63
+ hl7.fhir.us.davinci-pas_2.0.1,62,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,This [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [constructed by the client for prior authorization submission] will then be sent as the sole payload of a [Claim submit](https://hl7.org/fhir/us/davinci-pas/STU2/OperationDefinition-Claim-submit.html) operation.,SHALL,Client,,false,"3.1.01, 3.2.01, 3.3.1.01, 4.1.01, 6.1.01, 6.2.01, 6.3.1.01, 7.1.01, 9.1.01, 9.2.01, 9.3.1.01, 10.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_smart-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_udap-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_no_auth-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
64
64
  hl7.fhir.us.davinci-pas_2.0.1,63,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,The [server] system on which the [[Claim submit](https://hl7.org/fhir/us/davinci-pas/STU2/OperationDefinition-Claim-submit.html)] operation is invoked will convert the Bundle into an ASC X12N 278 and 0..* additional unsolicited 275 transactions and execute them all against the target payer system.,SHALL,Server,,false,NA,NA,,
65
- hl7.fhir.us.davinci-pas_2.0.1,64,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,[The server] will then take the resulting 278 response [from the X12 transactions created from the prior authorization submission] and convert it into a response FHIR [Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html) containing a [ClaimResponse](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claimresponse.html) and associated resources.,SHALL,Server,,false,NA,NA,,
65
+ hl7.fhir.us.davinci-pas_2.0.1,64,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,[The server] will then take the resulting 278 response [from the X12 transactions created from the prior authorization submission] and convert it into a response FHIR [Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html) containing a [ClaimResponse](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claimresponse.html) and associated resources.,SHALL,Server,,false,NA,NA,"2.1.1.03, 2.2.1.03, 2.3.1.03, 3.1.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_server_v201_pas_response_bundle_validation_test"
66
66
  hl7.fhir.us.davinci-pas_2.0.1,65,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,All of this [server processing of prior authorization requests] **SHOULD** happen synchronously with a maximum of 15 seconds between the user initiating the prior authorization request and seeing the resulting response - i.e. including network transmission time for request and response. (Less time is better.),SHOULD,Server,,false,NA,NA,,
67
- hl7.fhir.us.davinci-pas_2.0.1,66,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,"In the event that the prior authorization cannot be evaluated and a final response returned within the required timeframe, a response in which one or more of the requested authorization items are ‘pended’ will be returned.",SHALL,Server,,true,NA,NA,,
68
- hl7.fhir.us.davinci-pas_2.0.1,67,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,A subscription-based mechanism can then be used by the client to be informed of updates to the authorization.,SHALL,Client,,true,2.2.3.1.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test,NA,NA
67
+ hl7.fhir.us.davinci-pas_2.0.1,66,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,"In the event that the prior authorization cannot be evaluated and a final response returned within the required timeframe, a response in which one or more of the requested authorization items are ‘pended’ will be returned.",SHALL,Server,,true,NA,NA,"2.1.1.02, 2.2.1.02, 2.3.1.02, 3.1.1.02","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_v201_claim_operation_test_approval, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_v201_claim_operation_test_denial, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_v201_claim_operation_test_pended, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_v201_claim_operation_test_must_support"
68
+ hl7.fhir.us.davinci-pas_2.0.1,67,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,A subscription-based mechanism can then be used by the client to be informed of updates to the authorization.,SHALL,Client,,true,"3.3.1.01, 6.3.1.01, 9.3.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test",NA,NA
69
69
  hl7.fhir.us.davinci-pas_2.0.1,68,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,"As well, the client (or other interested systems - e.g. patient, caregiver or performing provider systems) can use the [Claim inquire operation](https://hl7.org/fhir/us/davinci-pas/STU2/OperationDefinition-Claim-inquiry.html) to query for the final results.",MAY,Client,,true,,,NA,NA
70
70
  hl7.fhir.us.davinci-pas_2.0.1,69,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#summary,"During this period of time, the same Claim submit operation can be used [by clients] to request cancellation or modification of the prior authorization.",MAY,Client,,true,,,NA,NA
71
- hl7.fhir.us.davinci-pas_2.0.1,70,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The Claim submit operation is executed by POSTing a FHIR Bundle to the [base url]/Claim/$submit endpoint.,SHALL,Client,,false,"2.2.1.01, 2.2.2.01, 2.2.3.1.01, 2.3.1.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-Group02-Group03-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
71
+ hl7.fhir.us.davinci-pas_2.0.1,70,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The Claim submit operation is executed by POSTing a FHIR Bundle to the [base url]/Claim/$submit endpoint.,SHALL,Client,,false,"3.1.01, 3.2.01, 3.3.1.01, 4.1.01, 6.1.01, 6.2.01, 6.3.1.01, 7.1.01, 9.1.01, 9.2.01, 9.3.1.01, 10.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_smart-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_udap-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_no_auth-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
72
72
  hl7.fhir.us.davinci-pas_2.0.1,71,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"When an EHR configures itself to support a payer’s PAS service, it will need to identify which Payer(s) the service supports such that it can ensure that the EHR only sends service calls to PAS services that the patient has current coverage for.",SHALL,Client,,false,,,NA,NA
73
73
  hl7.fhir.us.davinci-pas_2.0.1,72,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The payer endpoint is responsible for any internal routing based on which processing organization handles the decisions.,SHALL,Server,,false,NA,NA,,
74
74
  hl7.fhir.us.davinci-pas_2.0.1,73,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,Provider and EHR Vendor organizations MAY leverage the [payer registry] developed by PDex (which will eventually fold into the national directory under FAST) as a means of determining which endpoints exist for which payers as candidates for configuration.,MAY,Client,,false,,,NA,NA
75
- hl7.fhir.us.davinci-pas_2.0.1,74,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The Bundle **SHALL** be encoded in JSON,SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
76
- hl7.fhir.us.davinci-pas_2.0.1,75,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The first entry in the [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [for prior authorization submission] **SHALL** be a Claim resource complying with the [profile](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claim.html) defined in this IG to ensure the content is sufficient to appropriately populate an X12N 278 message.,SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01, 2.2.3.4.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
77
- hl7.fhir.us.davinci-pas_2.0.1,76,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Additional [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle entries [for prior authorization submission] **SHALL** be populated with any resources referenced by the Claim resource (and any resources referenced by those resources, fully traversing all references and complying with all identified profiles).",SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
78
- hl7.fhir.us.davinci-pas_2.0.1,77,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Note that even if a given resource instance is referenced multiple times [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission], it **SHALL** only appear in the Bundle once. E.g., if the same Practitioner information is referenced in multiple places, only one Practitioner instance should be created - referenced from multiple places as appropriate.",SHALL,Client,,true,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
75
+ hl7.fhir.us.davinci-pas_2.0.1,74,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The Bundle **SHALL** be encoded in JSON,SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
76
+ hl7.fhir.us.davinci-pas_2.0.1,75,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The first entry in the [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [for prior authorization submission] **SHALL** be a Claim resource complying with the [profile](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claim.html) defined in this IG to ensure the content is sufficient to appropriately populate an X12N 278 message.,SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 3.3.4.01, 6.1.02, 6.2.02, 6.3.2.01, 6.3.4.01, 9.1.02, 9.2.02, 9.3.2.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
77
+ hl7.fhir.us.davinci-pas_2.0.1,76,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Additional [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle entries [for prior authorization submission] **SHALL** be populated with any resources referenced by the Claim resource (and any resources referenced by those resources, fully traversing all references and complying with all identified profiles).",SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
78
+ hl7.fhir.us.davinci-pas_2.0.1,77,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Note that even if a given resource instance is referenced multiple times [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission], it **SHALL** only appear in the Bundle once. E.g., if the same Practitioner information is referenced in multiple places, only one Practitioner instance should be created - referenced from multiple places as appropriate.",SHALL,Client,,true,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
79
79
  hl7.fhir.us.davinci-pas_2.0.1,78,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Bundle.entry.fullUrl values [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission] **SHALL** be:
80
80
 
81
81
  - the URL at which the resource is available from the EHR if exposed via the client’s REST interface; or
82
- - the form “urn:uuid:[some guid]”",SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
82
+ - the form “urn:uuid:[some guid]”",SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
83
83
  hl7.fhir.us.davinci-pas_2.0.1,79,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"All GUIDs used [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) Bundle.entry.fullUrl element for prior authorization submission] **SHALL** be unique, including across independent prior authorization submissions - with the exception that the same resource instance being referenced in distinct prior authorization request Bundles can have the same GUID.",SHALL,Client,,false,,,NA,NA
84
84
  hl7.fhir.us.davinci-pas_2.0.1,80,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,[A]ny “supporting information” resources needed to process the prior authorization request (whether determined by DTR processes or by other means) must also be included in the [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle,SHALL,Client,,false,,,NA,NA
85
- hl7.fhir.us.davinci-pas_2.0.1,81,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,Relevant resources referenced by those “supporting information” resources **SHALL** also be included (e.g. prescriber Practitioner and Medication for a MedicationRequest) [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) Bundle.entry.fullUrl element for prior authorization submission].,SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
85
+ hl7.fhir.us.davinci-pas_2.0.1,81,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,Relevant resources referenced by those “supporting information” resources **SHALL** also be included (e.g. prescriber Practitioner and Medication for a MedicationRequest) [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) Bundle.entry.fullUrl element for prior authorization submission].,SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
86
86
  hl7.fhir.us.davinci-pas_2.0.1,82,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Any such [""supporting information""] resource [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) Bundle.entry.fullUrl element for prior authorization submission] that has a US Core profile SHALL comply with the relevant US Core profiles.",SHALL,Client,,false,,,NA,NA
87
87
  hl7.fhir.us.davinci-pas_2.0.1,83,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,All “supporting information” resources included in the [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [for prior authorization submission] **SHALL** be pointed to by the Claim resource using the Claim.supportingInfo.valueReference element.,SHALL,Client,,false,,,NA,NA
88
88
  hl7.fhir.us.davinci-pas_2.0.1,84,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"To attach PDFs, CDAs, JPGs, a DocumentReference instance should be used.",SHOULD,Client,,false,,,NA,NA
89
- hl7.fhir.us.davinci-pas_2.0.1,85,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The Claim.supportingInfo.sequence for each entry **SHALL** be unique within the Claim.,SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
90
- hl7.fhir.us.davinci-pas_2.0.1,86,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,All resources [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission] **SHALL** comply with their respective profiles.,SHALL,Client,,false,"2.2.1.02, 2.2.2.02, 2.2.3.2.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
89
+ hl7.fhir.us.davinci-pas_2.0.1,85,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The Claim.supportingInfo.sequence for each entry **SHALL** be unique within the Claim.,SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
90
+ hl7.fhir.us.davinci-pas_2.0.1,86,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,All resources [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission] **SHALL** comply with their respective profiles.,SHALL,Client,,false,"3.1.02, 3.2.02, 3.3.2.01, 6.1.02, 6.2.02, 6.3.2.01, 9.1.02, 9.2.02, 9.3.2.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group02-pas_client_v201_request_bundle_validation_test",NA,NA
91
91
  hl7.fhir.us.davinci-pas_2.0.1,87,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,FHIR elements not marked as ‘must support’ MAY be included in resources within the [[PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html)] Bundle [for prior authorization submission],MAY,Client,,false,,,NA,NA
92
92
  hl7.fhir.us.davinci-pas_2.0.1,88,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,[C]lient systems should have no expectation of such [non-must support] elements [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission] being processed by the payer unless prior arrangements have been made,SHOULD,Client,,true,,,NA,NA
93
93
  hl7.fhir.us.davinci-pas_2.0.1,89,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,Systems that do not process such [non-must support] elements [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission] **SHALL** ignore unsupported elements unless they are ‘modifier’ elements,SHALL,Server,,true,NA,NA,,
@@ -101,51 +101,51 @@ hl7.fhir.us.davinci-pas_2.0.1,96,https://hl7.org/fhir/us/davinci-pas/STU2/specif
101
101
  hl7.fhir.us.davinci-pas_2.0.1,97,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Translation/mapping systems should be aware that if the size of the attachments as part of a claims submission would exceed the size limitations of a particular recipient, the intermediary should split the attachments into separate 275s to remain within the overall limit.",SHALL,Server,,true,NA,NA,,
102
102
  hl7.fhir.us.davinci-pas_2.0.1,98,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,It is up to that black box [that processes submitted FHIR prior authorization Bundles] to ensure that any regulatory requirements are met and to perform all processing within the allowed timeframe.,SHALL,Server,,false,NA,NA,,
103
103
  hl7.fhir.us.davinci-pas_2.0.1,99,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,The response to the prior authorization is processed in the reverse order as the request. The [server] system is responsible for converting the ASC X12N 278 response into a FHIR [Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html).,SHALL,Server,,false,NA,NA,,
104
- hl7.fhir.us.davinci-pas_2.0.1,100,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,The [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle **SHALL** start with a ClaimResponse entry that contains information mapped from the 278 response.,SHALL,Server,,false,NA,NA,,
105
- hl7.fhir.us.davinci-pas_2.0.1,101,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,[A]dditional [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle entries must be present for all resources referenced by the ClaimResponse or descendent references.,SHALL,Server,,false,NA,NA,,
106
- hl7.fhir.us.davinci-pas_2.0.1,102,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"When converting additional [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle entries, the conversion process **SHALL** ensure that only one resource is created for a given combination of content. E.g. if the same Practitioner information is referenced in multiple places, only one Practitioner instance should be created - referenced from multiple places as appropriate.",SHALL,Server,,true,NA,NA,,
107
- hl7.fhir.us.davinci-pas_2.0.1,103,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"When echoing back resources [in the [PAS Response Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] that are the same as were present in the prior authorization request, the [payer] system **SHALL** ensure that the same fullUrl and resource identifiers are used in the response as appeared in the request.",SHALL,Server,,true,NA,NA,,
108
- hl7.fhir.us.davinci-pas_2.0.1,104,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"It is possible that the incoming prior authorization Bundle can not be processed due to validation errors or other non-business-errors. In these instances, the receiving system **SHALL** return OperationOutcome instances that detail why the Bundle could not be processed",SHALL,Server,,true,NA,NA,,
109
- hl7.fhir.us.davinci-pas_2.0.1,105,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"It is possible that the incoming prior authorization Bundle can not be processed due to validation errors or other non-business-errors. In these instances, the receiving system **SHALL** return ... no ClaimResponse",SHALL,Server,,true,NA,NA,,
110
- hl7.fhir.us.davinci-pas_2.0.1,106,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,These errors [communicated via OperationOutcome instances] are NOT the errors that are detected by the system processing the request and that can be conveyed in a ClaimResponse via the error capability.,SHALL NOT,Server,,true,NA,NA,,
111
- hl7.fhir.us.davinci-pas_2.0.1,107,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,The resulting [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle is returned as the HTTP body of the POST response.,SHALL,Server,,false,NA,NA,,
104
+ hl7.fhir.us.davinci-pas_2.0.1,100,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,The [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle **SHALL** start with a ClaimResponse entry that contains information mapped from the 278 response.,SHALL,Server,,false,NA,NA,"2.1.1.03, 2.2.1.03, 2.3.1.03, 3.1.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_server_v201_pas_response_bundle_validation_test"
105
+ hl7.fhir.us.davinci-pas_2.0.1,101,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,[A]dditional [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle entries must be present for all resources referenced by the ClaimResponse or descendent references.,SHALL,Server,,false,NA,NA,"2.1.1.03, 2.2.1.03, 2.3.1.03, 3.1.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_server_v201_pas_response_bundle_validation_test"
106
+ hl7.fhir.us.davinci-pas_2.0.1,102,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"When converting additional [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle entries, the conversion process **SHALL** ensure that only one resource is created for a given combination of content. E.g. if the same Practitioner information is referenced in multiple places, only one Practitioner instance should be created - referenced from multiple places as appropriate.",SHALL,Server,,true,NA,NA,"2.1.1.03, 2.2.1.03, 2.3.1.03, 3.1.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_server_v201_pas_response_bundle_validation_test"
107
+ hl7.fhir.us.davinci-pas_2.0.1,103,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"When echoing back resources [in the [PAS Response Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] that are the same as were present in the prior authorization request, the [payer] system **SHALL** ensure that the same fullUrl and resource identifiers are used in the response as appeared in the request.",SHALL,Server,,true,NA,NA,"2.1.1.03, 2.2.1.03, 2.3.1.03, 3.1.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_server_v201_pas_response_bundle_validation_test"
108
+ hl7.fhir.us.davinci-pas_2.0.1,104,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"It is possible that the incoming prior authorization Bundle can not be processed due to validation errors or other non-business-errors. In these instances, the receiving system **SHALL** return OperationOutcome instances that detail why the Bundle could not be processed",SHALL,Server,,true,NA,NA,4.01,davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_submission_error
109
+ hl7.fhir.us.davinci-pas_2.0.1,105,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,"It is possible that the incoming prior authorization Bundle can not be processed due to validation errors or other non-business-errors. In these instances, the receiving system **SHALL** return ... no ClaimResponse",SHALL,Server,,true,NA,NA,4.01,davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_submission_error
110
+ hl7.fhir.us.davinci-pas_2.0.1,106,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,These errors [communicated via OperationOutcome instances] are NOT the errors that are detected by the system processing the request and that can be conveyed in a ClaimResponse via the error capability.,SHALL NOT,Server,,true,NA,NA,4.01,davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_submission_error
111
+ hl7.fhir.us.davinci-pas_2.0.1,107,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-response,The resulting [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] Bundle is returned as the HTTP body of the POST response.,SHALL,Server,,false,NA,NA,"2.1.1.03, 2.2.1.03, 2.3.1.03, 3.1.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_server_v201_pas_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_server_v201_pas_response_bundle_validation_test"
112
112
  hl7.fhir.us.davinci-pas_2.0.1,108,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,Recipients of the transactions should respond as indicated,SHOULD,Server,,false,NA,NA,Not Tested,Not Tested
113
113
  hl7.fhir.us.davinci-pas_2.0.1,109,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,[S]enders of the transaction should look for the following responses and then take appropriate actions.,SHOULD,Client,,false,Not Tested,Not Tested,NA,NA
114
- hl7.fhir.us.davinci-pas_2.0.1,110,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,"Business errors that are a part of the processing of the 278 payload, eg. in the AAA segments, are represented in the mapping to the [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] response bundle.",SHALL,Server,,false,NA,NA,,
115
- hl7.fhir.us.davinci-pas_2.0.1,111,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,All transactions in PAS are synchronous and **SHALL** require one of the following HTTP responses: [including] … 2XX – transaction submission succeeded,SHALL,Server,,true,NA,NA,,
116
- hl7.fhir.us.davinci-pas_2.0.1,112,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,All transactions in PAS are synchronous and **SHALL** require one of the following HTTP responses: [including] … 4XX – transaction failed – bad request - failures are not recoverable by resubmission of the transaction.,SHALL,Server,,true,NA,NA,,
117
- hl7.fhir.us.davinci-pas_2.0.1,113,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,[When returning a 4XX HTTP response code t]here will be an OperationOutcome returned that can be reviewed to determine the actual failure,SHALL,Server,,true,NA,NA,,
114
+ hl7.fhir.us.davinci-pas_2.0.1,110,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,"Business errors that are a part of the processing of the 278 payload, eg. in the AAA segments, are represented in the mapping to the [[PAS Response](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-response-bundle.html)] response bundle.",SHALL,Server,,false,NA,NA,3.1.3.02,davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group03-pas_server_submit_response_v201_claimresponse_must_support_test
115
+ hl7.fhir.us.davinci-pas_2.0.1,111,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,All transactions in PAS are synchronous and **SHALL** require one of the following HTTP responses: [including] … 2XX – transaction submission succeeded,SHALL,Server,,true,NA,NA,"2.1.1.02, 2.2.1.02, 2.3.1.02, 2.3.2.05, 3.1.1.02, 3.2.1.02","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_v201_claim_operation_test_approval, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_v201_claim_operation_test_denial, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_v201_claim_operation_test_pended, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group02-pas_v201_claim_inquiry_operation_test_pended, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_v201_claim_operation_test_must_support, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group02-Group01-pas_v201_claim_inquiry_operation_test_must_support"
116
+ hl7.fhir.us.davinci-pas_2.0.1,112,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,All transactions in PAS are synchronous and **SHALL** require one of the following HTTP responses: [including] … 4XX – transaction failed – bad request - failures are not recoverable by resubmission of the transaction.,SHALL,Server,,true,NA,NA,"4.01, 4.02","davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_submission_error, davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_inquiry_error"
117
+ hl7.fhir.us.davinci-pas_2.0.1,113,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,[When returning a 4XX HTTP response code t]here will be an OperationOutcome returned that can be reviewed to determine the actual failure,SHALL,Server,,true,NA,NA,"4.01, 4.02","davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_submission_error, davinci_pas_server_suite_v201-pas_v201_error_group-prior_auth_inquiry_error"
118
118
  hl7.fhir.us.davinci-pas_2.0.1,114,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,All transactions in PAS are synchronous and **SHALL** require one of the following HTTP responses: [including] … 5XX – transaction failed – service unavailable or timeout - failures that may be temporary and resubmission may result in successful processing.,SHALL,Server,,true,NA,NA,,
119
119
  hl7.fhir.us.davinci-pas_2.0.1,115,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-transaction-error-handling,When returning a 5XX HTTP response code] no OperationOutcome will be returned in this instance,SHALL,Server,,true,NA,NA,,
120
120
  hl7.fhir.us.davinci-pas_2.0.1,116,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#http-responses,"If an OperationOutcome [from a server] is received, it may have information regarding errors that should be addressed in the future, but did not cause the transaction to fail.",MAY,Server,,true,NA,NA,,
121
121
  hl7.fhir.us.davinci-pas_2.0.1,117,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#http-responses,These errors [from a payer indicating non-fatal issues to be addressed in the future] should not be returned to the provider but should be reviewed and addressed by technical staff.,SHOULD,Client,,true,,,NA,NA
122
- hl7.fhir.us.davinci-pas_2.0.1,119,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The [prior authorization inquiry operation](https://hl7.org/fhir/us/davinci-pas/STU2/OperationDefinition-Claim-inquiry.html) allows for [clients to make] inquiries about prior authorization submissions.,SHALL,Client,,false,2.2.3.1.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test,NA,NA
123
- hl7.fhir.us.davinci-pas_2.0.1,120,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,Providers are expected to perform the same query-by-example inquiry even under the CMS exception. This Implementation Guide does not specify a different way of searching for prior authorizations in the exception case.,SHALL,Client,,true,2.2.3.1.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test,NA,NA
124
- hl7.fhir.us.davinci-pas_2.0.1,121,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The parameter to the inquiry operation is a [PAS Inquiry Request Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html),SHALL,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
125
- hl7.fhir.us.davinci-pas_2.0.1,122,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The [[PAS Inquiry Request Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html)] parameter to the inquiry operation ... has a Claim Inquiry profile instance,SHALL,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
126
- hl7.fhir.us.davinci-pas_2.0.1,123,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The [[PAS Inquiry Request Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html)] parameter to the inquiry operation ... has ... any referenced resources [from the claim],SHALL,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
122
+ hl7.fhir.us.davinci-pas_2.0.1,119,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The [prior authorization inquiry operation](https://hl7.org/fhir/us/davinci-pas/STU2/OperationDefinition-Claim-inquiry.html) allows for [clients to make] inquiries about prior authorization submissions.,SHALL,Client,,false,"3.3.1.01, 6.3.1.01, 9.3.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test",NA,NA
123
+ hl7.fhir.us.davinci-pas_2.0.1,120,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,Providers are expected to perform the same query-by-example inquiry even under the CMS exception. This Implementation Guide does not specify a different way of searching for prior authorizations in the exception case.,SHALL,Client,,true,"3.3.1.01, 6.3.1.01, 9.3.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test",NA,NA
124
+ hl7.fhir.us.davinci-pas_2.0.1,121,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The parameter to the inquiry operation is a [PAS Inquiry Request Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html),SHALL,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
125
+ hl7.fhir.us.davinci-pas_2.0.1,122,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The [[PAS Inquiry Request Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html)] parameter to the inquiry operation ... has a Claim Inquiry profile instance,SHALL,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
126
+ hl7.fhir.us.davinci-pas_2.0.1,123,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The [[PAS Inquiry Request Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html)] parameter to the inquiry operation ... has ... any referenced resources [from the claim],SHALL,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
127
127
  hl7.fhir.us.davinci-pas_2.0.1,124,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The operation is ... a query-by-example where the incoming Claim resource provides elements that will match existing prior authorizations. Any authorizations that match the incoming resource elements will be returned by the operation. The rules for how the included data elements are matched are specified in the X12 278 inquiry TR3 specification.,SHALL,Server,,false,NA,NA,Not Tested,Not Tested
128
- hl7.fhir.us.davinci-pas_2.0.1,125,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The inquiry operation must contain a requesting provider organization,SHALL,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
129
- hl7.fhir.us.davinci-pas_2.0.1,126,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The inquiry operation must contain ... a payer organization,SHALL,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
130
- hl7.fhir.us.davinci-pas_2.0.1,127,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The inquiry operation must contain ... a patient for the inquiry,SHALL,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
131
- hl7.fhir.us.davinci-pas_2.0.1,128,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,"The operation does not allow inquiries that do not identify a specific patient, such as an inquiry for all prior authorization requests submitted on a specific date.",SHALL NOT,Client,,false,2.2.3.4.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test,NA,NA
128
+ hl7.fhir.us.davinci-pas_2.0.1,125,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The inquiry operation must contain a requesting provider organization,SHALL,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
129
+ hl7.fhir.us.davinci-pas_2.0.1,126,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The inquiry operation must contain ... a payer organization,SHALL,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
130
+ hl7.fhir.us.davinci-pas_2.0.1,127,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The inquiry operation must contain ... a patient for the inquiry,SHALL,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
131
+ hl7.fhir.us.davinci-pas_2.0.1,128,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,"The operation does not allow inquiries that do not identify a specific patient, such as an inquiry for all prior authorization requests submitted on a specific date.",SHALL NOT,Client,,false,"3.3.4.01, 6.3.4.01, 9.3.4.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group04-pas_client_v201_inquire_request_bundle_validation_test",NA,NA
132
132
  hl7.fhir.us.davinci-pas_2.0.1,129,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The information in the [[PAS Inquiry Request](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-request-bundle.html)] Bundle is mapped to a 278 Health Care Services Review Information - Inquiry transaction (278i request).,SHALL,Server,,false,NA,NA,,
133
133
  hl7.fhir.us.davinci-pas_2.0.1,130,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,The 278 Health Care Services Review Information - Response (278i response) is then mapped to a [PAS Inquiry Response Bundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-inquiry-response-bundle.html) with the results of the inquiry contained in the Bundle.,SHALL,Server,,false,NA,NA,,
134
- hl7.fhir.us.davinci-pas_2.0.1,131,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,"the returned ClaimResponse [for an inquiry] **SHALL** include the current results for all submitted items, including any items changed or canceled since the original authoriation request.",SHALL,Server,,false,NA,NA,,
134
+ hl7.fhir.us.davinci-pas_2.0.1,131,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,"the returned ClaimResponse [for an inquiry] **SHALL** include the current results for all submitted items, including any items changed or canceled since the original authoriation request.",SHALL,Server,,false,NA,NA,"2.3.2.06, 3.2.1.03","davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group02-pas_server_v201_pas_inquiry_response_bundle_validation_test, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group02-Group01-pas_server_v201_pas_inquiry_response_bundle_validation_test"
135
135
  hl7.fhir.us.davinci-pas_2.0.1,132,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,[T]he returned ClaimResponse will be a subset if the request was for a subset of information,SHALL,Server,,true,NA,NA,Not Tested,Not Tested
136
136
  hl7.fhir.us.davinci-pas_2.0.1,133,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,"[I]f the authorizationresponseid submitted is not the ‘current’ authorization response identifier (because subsequent additions/changes/cancellations have been made to the prior authorization request), the returned record **SHALL** be the ‘current’ authorization response - even though it no longer has the same identifier. I.e. If a search is for a ‘replaced’ prior authorization, the search result **SHALL** include the ‘current’ prior authorization response for the most recent replacing prior authorization request.",SHALL,Server,,true,NA,NA,,
137
137
  hl7.fhir.us.davinci-pas_2.0.1,134,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,[Server] systems MAY withhold information about prior authorizations that are ‘open’ but are deemed to be not relevant to the provider (eg. prior authorization requests for sensitive care where the requesting provider is neither the ordering nor rendering provider) who is checking for the prior authorization status if not searching by a specific Claim.identifier.,MAY,Server,,true,NA,NA,,
138
138
  hl7.fhir.us.davinci-pas_2.0.1,135,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-inquiries,In such situations [when a server restricts access] the response SHOULD include an OperationOutcome warning that some prior authorizations have been suppressed and provide an alternative mechanism (e.g. telephone number) to provide further information if needed.,SHOULD,Server,,true,NA,NA,,
139
- hl7.fhir.us.davinci-pas_2.0.1,136,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#pended-authorization-responses,"When the ClaimResponse.reviewaction.code is the X12 code for ‘pended’, it means that the payer requires additional time to make a final determination on all items within the prior authorization request.",SHALL,Server,,true,NA,NA,,
140
- hl7.fhir.us.davinci-pas_2.0.1,137,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#pended-authorization-responses,"To retrieve the [prior authorization decision] response at a later point, [Client] implementers **SHALL** support subscriptions.",SHALL,Client,,false,2.1.01,davinci_pas_client_suite_v201-Group02-Group01-pas_client_v201_subscription_create_test,NA,NA
139
+ hl7.fhir.us.davinci-pas_2.0.1,136,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#pended-authorization-responses,"When the ClaimResponse.reviewaction.code is the X12 code for ‘pended’, it means that the payer requires additional time to make a final determination on all items within the prior authorization request.",SHALL,Server,,true,NA,NA,"2.1.1.02, 2.2.1.02, 2.3.1.02, 3.1.1.02","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_v201_claim_operation_test_approval, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_v201_claim_operation_test_denial, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_v201_claim_operation_test_pended, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_v201_claim_operation_test_must_support"
140
+ hl7.fhir.us.davinci-pas_2.0.1,137,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#pended-authorization-responses,"To retrieve the [prior authorization decision] response at a later point, [Client] implementers **SHALL** support subscriptions.",SHALL,Client,,false,"2.01, 5.01, 8.01","davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_smart-pas_client_v201_subscription_create_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_udap-pas_client_v201_subscription_create_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_no_auth-pas_client_v201_subscription_create_test",NA,NA
141
141
  hl7.fhir.us.davinci-pas_2.0.1,138,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#pended-authorization-responses,Servers **SHALL** permit access to the prior authorization response to systems other than the original submitter.,SHALL,Server,,false,NA,NA,,
142
142
  hl7.fhir.us.davinci-pas_2.0.1,139,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#pended-authorization-responses,"[Servers] **SHALL** require a match on the patient member or subscriber id (identifier on the Claim.patient) plus the ordering and/or rendering provider identifier, i.e. the provider’s NPI [before responding with prior authorzation details requested by non-submitters].",SHALL,Server,,true,NA,NA,,
143
- hl7.fhir.us.davinci-pas_2.0.1,140,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,[Clients] SHALL support the R4 Subscriptions referenced in the [Subscriptions for R5 Backport Implementation Guide](http://hl7.org/fhir/uv/subscriptions-backport/).,SHALL,Client,,false,2.1.01,davinci_pas_client_suite_v201-Group02-Group01-pas_client_v201_subscription_create_test,NA,NA
144
- hl7.fhir.us.davinci-pas_2.0.1,141,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,[Servers] SHALL support the R4 Subscriptions referenced in the [Subscriptions for R5 Backport Implementation Guide](http://hl7.org/fhir/uv/subscriptions-backport/).,SHALL,Server,,false,NA,NA,,
145
- hl7.fhir.us.davinci-pas_2.0.1,142,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,"When using the subscription retrieval mechanism, the Client will POST a new Subscription instance to the Server’s [base]/Subscription endpoint.",SHALL,Client,,false,2.1.01,davinci_pas_client_suite_v201-Group02-Group01-pas_client_v201_subscription_create_test,NA,NA
146
- hl7.fhir.us.davinci-pas_2.0.1,143,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,The subscription topic is created at the level of the requesting provider organization and not at the level of each individual prior authorization request. The Subscription parameters SHALL be identifier = [requesting provider organization id].,SHALL,Client,,false,2.1.03,davinci_pas_client_suite_v201-Group02-Group01-pas_client_v201_subscription_pas_conformance_test,NA,NA
143
+ hl7.fhir.us.davinci-pas_2.0.1,140,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,[Clients] SHALL support the R4 Subscriptions referenced in the [Subscriptions for R5 Backport Implementation Guide](http://hl7.org/fhir/uv/subscriptions-backport/).,SHALL,Client,,false,"2.01, 5.01, 8.01","davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_smart-pas_client_v201_subscription_create_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_udap-pas_client_v201_subscription_create_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_no_auth-pas_client_v201_subscription_create_test",NA,NA
144
+ hl7.fhir.us.davinci-pas_2.0.1,141,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,[Servers] SHALL support the R4 Subscriptions referenced in the [Subscriptions for R5 Backport Implementation Guide](http://hl7.org/fhir/uv/subscriptions-backport/).,SHALL,Server,,false,NA,NA,"1, 2.3.2.01","davinci_pas_server_suite_v201-pas_server_v201_subscription_setup, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group02-prior_auth_claim_response_update_notification_validation"
145
+ hl7.fhir.us.davinci-pas_2.0.1,142,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,"When using the subscription retrieval mechanism, the Client will POST a new Subscription instance to the Server’s [base]/Subscription endpoint.",SHALL,Client,,false,"2.01, 5.01, 8.01","davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_smart-pas_client_v201_subscription_create_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_udap-pas_client_v201_subscription_create_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_no_auth-pas_client_v201_subscription_create_test",NA,NA
146
+ hl7.fhir.us.davinci-pas_2.0.1,143,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,The subscription topic is created at the level of the requesting provider organization and not at the level of each individual prior authorization request. The Subscription parameters SHALL be identifier = [requesting provider organization id].,SHALL,Client,,false,"2.03, 5.03, 8.03","davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_smart-pas_client_v201_subscription_pas_conformance_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_udap-pas_client_v201_subscription_pas_conformance_test, davinci_pas_client_suite_v201-pas_client_v201_subscription_setup_no_auth-pas_client_v201_subscription_pas_conformance_test",NA,NA
147
147
  hl7.fhir.us.davinci-pas_2.0.1,144,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,PAS Clients ... **SHALL** support subscriptions with content=’id-only’,SHALL,Client,,false,,,NA,NA
148
- hl7.fhir.us.davinci-pas_2.0.1,145,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,PAS ... [Server] Intermediaries SHALL support subscriptions with content=’id-only’,SHALL,Server,,false,NA,NA,,
148
+ hl7.fhir.us.davinci-pas_2.0.1,145,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,PAS ... [Server] Intermediaries SHALL support subscriptions with content=’id-only’,SHALL,Server,,false,NA,NA,2.3.2.02,davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group02-subscriptions_r4_server_notification_conformance
149
149
  hl7.fhir.us.davinci-pas_2.0.1,146,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,PAS Clients ... **MAY** by mutual agreement [with Server partners] and with appropriate security arrangements in place for push notifications containing PHI also support content=’full-resource’.,MAY,Client,,false,,,NA,NA
150
150
  hl7.fhir.us.davinci-pas_2.0.1,147,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,PAS ... [Server] Intermediaries … **MAY** by mutual agreement [with client partners] and with appropriate security arrangements in place for push notifications containing PHI also support content=’full-resource’.,MAY,Server,,false,NA,NA,,
151
151
  hl7.fhir.us.davinci-pas_2.0.1,148,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,[Server i]ntermediaries **SHALL** ensure that subscriptions to monitor a particular organization’s prior authorizations are only created or modified by that organization.,SHALL,Server,,false,NA,NA,,
@@ -153,7 +153,7 @@ hl7.fhir.us.davinci-pas_2.0.1,149,https://hl7.org/fhir/us/davinci-pas/STU2/speci
153
153
  hl7.fhir.us.davinci-pas_2.0.1,150,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,Servers **SHOULD** support rest-hook … channels,SHOULD,Server,,false,NA,NA,,
154
154
  hl7.fhir.us.davinci-pas_2.0.1,151,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,Servers … **MAY** support websocket channels,MAY,Server,,false,NA,NA,,
155
155
  hl7.fhir.us.davinci-pas_2.0.1,152,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,"Once the subscription has been created, the Server **SHALL** send a notification over the requested channel indicating that a prior authorization response submitted by the requesting provider organization has changed. This may happen when the response is complete, but may also occur when information on one or more of the items has been adjusted but the overall response remains as ‘pended’.",SHALL,Server,,false,NA,NA,,
156
- hl7.fhir.us.davinci-pas_2.0.1,153,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,"Upon receiving a notification, the Client **SHALL** - when convenient and if necessary - execute a query.",SHALL,Client,,false,2.2.3.1.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test,NA,NA
156
+ hl7.fhir.us.davinci-pas_2.0.1,153,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,"Upon receiving a notification, the Client **SHALL** - when convenient and if necessary - execute a query.",SHALL,Client,,false,"3.3.1.01, 6.3.1.01, 9.3.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test",NA,NA
157
157
  hl7.fhir.us.davinci-pas_2.0.1,154,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#checking-status,Systems other than the requesting system may choose not to subscribe to the prior authorization response but instead to check the status at the request of a user,MAY,Client,,false,,,NA,NA
158
158
  hl7.fhir.us.davinci-pas_2.0.1,155,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#checking-status,There are no retry limits for user-initiated status checks.,SHALL,Server,,false,NA,NA,,
159
159
  hl7.fhir.us.davinci-pas_2.0.1,156,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"Since submitting an update for a new authorization is frequently player/plan-specific, this IG recommends that an update is attempted first. If that is rejected or the provider knows in advance that an update will not succeed, the a new authorization request should be made.",SHOULD,Client,,false,,,NA,NA
@@ -202,13 +202,13 @@ hl7.fhir.us.davinci-pas_2.0.1,198,https://hl7.org/fhir/us/davinci-pas/STU2/priva
202
202
  hl7.fhir.us.davinci-pas_2.0.1,199,https://hl7.org/fhir/us/davinci-pas/STU2/epaWorkflow.html#pas-epa-coordinator-information,[T]he exchanges between the provider HIT (including any ePA) and the payer HIT (including any ePA) SHALL replicate all of the defined exchanges between provider and intermediary or the intermediary and payer,SHALL,Server,,false,NA,NA,,
203
203
  hl7.fhir.us.davinci-pas_2.0.1,200,https://hl7.org/fhir/us/davinci-pas/STU2/epaWorkflow.html#pas-epa-coordinator-information,[T]he exchanges between the provider HIT (including any ePA) and the payer HIT (including any ePA) SHALL replicate all of the defined exchanges between provider and intermediary or the intermediary and payer,SHALL,Client,,false,,,NA,NA
204
204
  hl7.fhir.us.davinci-pas_2.0.1,201,https://hl7.org/fhir/us/davinci-pas/STU2/metrics.html#metric-data-model,PAS implementers **SHOULD** store [Metric] information for each PAS call in a manner that would allow them to respond to measures based on this logical model.,SHOULD,"Client, Server",,false,,,,
205
- hl7.fhir.us.davinci-pas_2.0.1,202,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Claim Submit Operation],SHALL,Client,,false,"2.2.1.01, 2.2.2.01, 2.2.3.1.01, 2.3.1.01","davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-Group02-Group03-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
206
- hl7.fhir.us.davinci-pas_2.0.1,203,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Claim Inquiry Operation],SHALL,Client,,false,2.2.3.1.01,davinci_pas_client_suite_v201-Group02-Group02-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test,NA,NA
205
+ hl7.fhir.us.davinci-pas_2.0.1,202,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Claim Submit Operation],SHALL,Client,,false,"3.1.01, 3.2.01, 3.3.1.01, 4.1.01, 6.1.01, 6.2.01, 6.3.1.01, 7.1.01, 9.1.01, 9.2.01, 9.3.1.01, 10.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_smart-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_udap-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_approval_group-pas_client_v201_approval_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_denial_group-pas_client_v201_denial_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_must_support_no_auth-pas_client_v201_submit_must_support_use_case-pas_client_submit_v201_must_support_test",NA,NA
206
+ hl7.fhir.us.davinci-pas_2.0.1,203,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Claim Inquiry Operation],SHALL,Client,,false,"3.3.1.01, 6.3.1.01, 9.3.1.01","davinci_pas_client_suite_v201-pas_client_v201_workflows_smart-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_udap-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test, davinci_pas_client_suite_v201-pas_client_v201_workflows_no_auth-pas_client_v201_pended_group-Group01-pas_client_v201_pended_submit_test",NA,NA
207
207
  hl7.fhir.us.davinci-pas_2.0.1,204,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Subscription Read interaction],SHALL,Client,,false,,,NA,NA
208
208
  hl7.fhir.us.davinci-pas_2.0.1,205,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Subscription Update interaction],SHALL,Client,,false,,,NA,NA
209
209
  hl7.fhir.us.davinci-pas_2.0.1,206,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-EHRCapabilities.html,[Clients **SHALL** support the Subscription Delete interaction],SHALL,Client,,false,,,NA,NA
210
- hl7.fhir.us.davinci-pas_2.0.1,207,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Claim Submit Operation],SHALL,Server,,false,NA,NA,,
211
- hl7.fhir.us.davinci-pas_2.0.1,208,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Claim Inquiry Operation],SHALL,Server,,false,NA,NA,,
210
+ hl7.fhir.us.davinci-pas_2.0.1,207,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Claim Submit Operation],SHALL,Server,,false,NA,NA,"2.1.1.02, 2.2.1.02, 2.3.1.02, 3.1.1.02","davinci_pas_server_suite_v201-Group02-pas_server_v201_approval_use_case-Group01-pas_v201_claim_operation_test_approval, davinci_pas_server_suite_v201-Group02-pas_server_v201_denial_use_case-Group01-pas_v201_claim_operation_test_denial, davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group01-pas_v201_claim_operation_test_pended, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group01-Group01-pas_v201_claim_operation_test_must_support"
211
+ hl7.fhir.us.davinci-pas_2.0.1,208,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Claim Inquiry Operation],SHALL,Server,,false,NA,NA,"2.3.2.05, 3.2.1.02","davinci_pas_server_suite_v201-Group02-pas_server_v201_pended_use_case-Group02-pas_v201_claim_inquiry_operation_test_pended, davinci_pas_server_suite_v201-pas_server_v201_must_support_use_case-Group02-Group01-pas_v201_claim_inquiry_operation_test_must_support"
212
212
  hl7.fhir.us.davinci-pas_2.0.1,209,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Subscription Create interaction],SHALL,Server,,false,NA,NA,,
213
213
  hl7.fhir.us.davinci-pas_2.0.1,210,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Subscription Update interaction],SHALL,Server,,false,NA,NA,,
214
214
  hl7.fhir.us.davinci-pas_2.0.1,211,https://hl7.org/fhir/us/davinci-pas/STU2/CapabilityStatement-IntermediaryCapabilities.html,[Servers **SHALL** support the Subscription Delete interaction],SHALL,Server,,false,NA,NA,,
data/lib/davinci_pas_test_kit/session_identification.rb ADDED
@@ -0,0 +1,45 @@
1
+ require 'udap_security_test_kit'
2
+ require_relative 'urls'
3
+
4
+ module DaVinciPASTestKit
5
+ module SessionIdentification
6
+ def session_wait_identifier(client_id, session_url_path)
7
+ # look at test config and determine the wait identifier to use
8
+ # at somepoint this would be an inferno type, for now, just two options
9
+ return client_id if client_id.present?
10
+ return session_url_path if session_url_path.present?
11
+
12
+ test_session_id
13
+ end
14
+
15
+ def session_endpont_url(endpoint, client_id, session_url_path)
16
+ path =
17
+ if client_id.present?
18
+ ''
19
+ elsif session_url_path.present?
20
+ session_url_path
21
+ else
22
+ test_session_id
23
+ end
24
+
25
+ case endpoint
26
+ when :submit
27
+ session_submit_url(path)
28
+ when :inquire
29
+ session_inquire_url(path)
30
+ when :subscription
31
+ session_fhir_subscription_url(path)
32
+ end
33
+ end
34
+
35
+ # interpret the bearer token structure to determine the wait identifer
36
+ # - if structured like a token returned by the simulated Auth server, return the client URI
37
+ # - otherwise, use the raw token (provided token)
38
+ def bearer_token_to_wait_identifier(token)
39
+ client_id = UDAPSecurityTestKit::MockUDAPServer.issued_token_to_client_id(token)
40
+ return client_id if client_id.present?
41
+
42
+ token
43
+ end
44
+ end
45
+ end
data/lib/davinci_pas_test_kit/tags.rb CHANGED
@@ -13,4 +13,5 @@ module DaVinciPASTestKit
13
13
  SUBSCRIPTION_STATUS_TAG = 'subscription_status'
14
14
  REST_HOOK_HANDSHAKE_NOTIFICATION_TAG = 'rest_hook_handshake_notification'
15
15
  REST_HOOK_EVENT_NOTIFICATION_TAG = 'rest_hook_event_notification'
16
+ OTHER_AUTH_TAG = 'other_auth'
16
17
  end
data/lib/davinci_pas_test_kit/urls.rb CHANGED
@@ -1,37 +1,73 @@
1
1
  # frozen_string_literal: true
2
2
 
3
+ require 'udap_security_test_kit'
4
+ require 'smart_app_launch_test_kit'
5
+
3
6
  module DaVinciPASTestKit
4
- TOKEN_PATH = '/mock_auth/token'
5
- SUBMIT_PATH = '/fhir/Claim/$submit'
6
- INQUIRE_PATH = '/fhir/Claim/$inquire'
7
- FHIR_SUBSCRIPTION_PATH = '/fhir/Subscription'
8
- FHIR_SUBSCRIPTION_INSTANCE_PATH = '/fhir/Subscription/:id'
9
- FHIR_SUBSCRIPTION_INSTANCE_STATUS_PATH = '/fhir/Subscription/:id/$status'
10
- FHIR_SUBSCRIPTION_RESOURCE_STATUS_PATH = '/fhir/Subscription/$status'
7
+ SESSION_PATH_PLACEHOLDER = '/:session_path'
8
+ FHIR_PATH = '/fhir'
9
+ SESSION_FHIR_PATH = SESSION_PATH_PLACEHOLDER + FHIR_PATH
10
+ SUBMIT_PATH = "#{FHIR_PATH}/Claim/$submit".freeze
11
+ SESSION_SUBMIT_PATH = SESSION_PATH_PLACEHOLDER + SUBMIT_PATH
12
+ INQUIRE_PATH = "#{FHIR_PATH}/Claim/$inquire".freeze
13
+ SESSION_INQUIRE_PATH = SESSION_PATH_PLACEHOLDER + INQUIRE_PATH
14
+ FHIR_SUBSCRIPTION_PATH = "#{FHIR_PATH}/Subscription".freeze
15
+ SESSION_FHIR_SUBSCRIPTION_PATH = SESSION_PATH_PLACEHOLDER + FHIR_SUBSCRIPTION_PATH
16
+ FHIR_SUBSCRIPTION_INSTANCE_PATH = "#{FHIR_SUBSCRIPTION_PATH}/:id".freeze
17
+ SESSION_FHIR_SUBSCRIPTION_INSTANCE_PATH = SESSION_PATH_PLACEHOLDER + FHIR_SUBSCRIPTION_INSTANCE_PATH
18
+ FHIR_SUBSCRIPTION_INSTANCE_STATUS_PATH = "#{FHIR_SUBSCRIPTION_INSTANCE_PATH}/$status".freeze
19
+ SESSION_FHIR_SUBSCRIPTION_INSTANCE_STATUS_PATH = SESSION_PATH_PLACEHOLDER + FHIR_SUBSCRIPTION_INSTANCE_STATUS_PATH
20
+ FHIR_SUBSCRIPTION_RESOURCE_STATUS_PATH = "#{FHIR_SUBSCRIPTION_PATH}/$status".freeze
21
+ SESSION_FHIR_SUBSCRIPTION_RESOURCE_STATUS_PATH = SESSION_PATH_PLACEHOLDER + FHIR_SUBSCRIPTION_RESOURCE_STATUS_PATH
11
22
  RESUME_PASS_PATH = '/resume_pass'
12
23
  RESUME_FAIL_PATH = '/resume_fail'
24
+ RESUME_SKIP_PATH = '/resume_skip'
13
25
 
14
26
  module URLs
15
27
  def base_url
16
28
  @base_url ||= "#{Inferno::Application['base_url']}/custom/#{suite_id}"
17
29
  end
18
30
 
19
- def token_url
20
- @token_url ||= base_url + TOKEN_PATH
31
+ def fhir_base_url
32
+ @fhir_base_url ||= base_url + FHIR_PATH
33
+ end
34
+
35
+ def session_fhir_base_url(session_path)
36
+ return fhir_base_url if session_path.blank?
37
+
38
+ base_url + SESSION_FHIR_PATH.gsub(SESSION_PATH_PLACEHOLDER, "/#{session_path}")
21
39
  end
22
40
 
23
41
  def submit_url
24
42
  @submit_url ||= base_url + SUBMIT_PATH
25
43
  end
26
44
 
45
+ def session_submit_url(session_path)
46
+ return submit_url if session_path.blank?
47
+
48
+ base_url + SESSION_SUBMIT_PATH.gsub(SESSION_PATH_PLACEHOLDER, "/#{session_path}")
49
+ end
50
+
27
51
  def inquire_url
28
52
  @inquire_url ||= base_url + INQUIRE_PATH
29
53
  end
30
54
 
55
+ def session_inquire_url(session_path)
56
+ return inquire_url if session_path.blank?
57
+
58
+ base_url + SESSION_INQUIRE_PATH.gsub(SESSION_PATH_PLACEHOLDER, "/#{session_path}")
59
+ end
60
+
31
61
  def fhir_subscription_url
32
62
  @fhir_subscription_url ||= base_url + FHIR_SUBSCRIPTION_PATH
33
63
  end
34
64
 
65
+ def session_fhir_subscription_url(session_path)
66
+ return fhir_subscription_url if session_path.blank?
67
+
68
+ base_url + SESSION_FHIR_SUBSCRIPTION_PATH.gsub(SESSION_PATH_PLACEHOLDER, "/#{session_path}")
69
+ end
70
+
35
71
  def resume_pass_url
36
72
  @resume_pass_url ||= base_url + RESUME_PASS_PATH
37
73
  end
@@ -40,6 +76,22 @@ module DaVinciPASTestKit
40
76
  @resume_fail_url ||= base_url + RESUME_FAIL_PATH
41
77
  end
42
78
 
79
+ def resume_skip_url
80
+ @resume_skip_url ||= base_url + RESUME_SKIP_PATH
81
+ end
82
+
83
+ def udap_discovery_url
84
+ @udap_discovery_url ||= base_url + UDAPSecurityTestKit::UDAP_DISCOVERY_PATH
85
+ end
86
+
87
+ def token_url
88
+ @token_url ||= base_url + UDAPSecurityTestKit::TOKEN_PATH
89
+ end
90
+
91
+ def registration_url
92
+ @registration_url ||= base_url + UDAPSecurityTestKit::REGISTRATION_PATH
93
+ end
94
+
43
95
  def suite_id
44
96
  self.class.suite.id
45
97
  end
data/lib/davinci_pas_test_kit/version.rb CHANGED
@@ -1,6 +1,6 @@
1
1
  # frozen_string_literal: true
2
2
 
3
3
  module DaVinciPASTestKit
4
- VERSION = '0.12.2'
5
- LAST_UPDATED = '2025-03-19'
4
+ VERSION = '0.13.0'
5
+ LAST_UPDATED = '2025-05-06'
6
6
  end