davinci_pas_test_kit 0.12.1 → 0.12.2

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Files changed (23) hide show
  1. checksums.yaml +4 -4
  2. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_approval_submit_test.rb +3 -0
  3. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_denial_submit_test.rb +3 -0
  4. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_inquire_request_bundle_validation_test.rb +4 -0
  5. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_submit_test.rb +6 -0
  6. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_request_bundle_validation_test.rb +6 -0
  7. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_submit_must_support_test.rb +3 -0
  8. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_create_test.rb +3 -0
  9. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_pas_conformance_test.rb +1 -0
  10. data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/error_tests/pas_submission_error_test.rb +1 -0
  11. data/lib/davinci_pas_test_kit/generated/v2.0.1/claim/claim_operation_test.rb +1 -0
  12. data/lib/davinci_pas_test_kit/generated/v2.0.1/claiminquiryresponse/server_inquire_response_claiminquiryresponse_must_support_test.rb +1 -0
  13. data/lib/davinci_pas_test_kit/generated/v2.0.1/claimresponse/server_submit_response_claimresponse_must_support_test.rb +1 -0
  14. data/lib/davinci_pas_test_kit/pas_bundle_validation.rb +4 -4
  15. data/lib/davinci_pas_test_kit/requirements/davinci-pas-test-kit_out_of_scope_requirements.csv +11 -0
  16. data/lib/davinci_pas_test_kit/requirements/davinci-pas-test-kit_requirements.csv +214 -0
  17. data/lib/davinci_pas_test_kit/requirements/generated/davinci-pas-test-kit_requirements_coverage.csv +214 -0
  18. data/lib/davinci_pas_test_kit/version.rb +2 -2
  19. data/lib/davinci_pas_test_kit.rb +1 -0
  20. data/lib/inferno_requirements_tools/ext/inferno_core/runnable.rb +22 -0
  21. data/lib/inferno_requirements_tools/tasks/requirements_coverage.rb +284 -0
  22. data/lib/requirements_config.yaml +17 -0
  23. metadata +10 -4
checksums.yaml CHANGED
@@ -1,7 +1,7 @@
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data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_approval_submit_test.rb CHANGED
@@ -14,6 +14,9 @@ module DaVinciPASTestKit
14
14
  from the client. Upon receipt, Inferno will generate and send a
15
15
  response with an approved status.
16
16
  )
17
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@58', 'hl7.fhir.us.davinci-pas_2.0.1@62',
18
+ 'hl7.fhir.us.davinci-pas_2.0.1@70', 'hl7.fhir.us.davinci-pas_2.0.1@202'
19
+
17
20
  input :access_token,
18
21
  title: 'Access Token',
19
22
  description: %(
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_denial_submit_test.rb CHANGED
@@ -14,6 +14,9 @@ module DaVinciPASTestKit
14
14
  from the client. Upon receipt, Inferno will respond with the
15
15
  provided denial response.
16
16
  )
17
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@58', 'hl7.fhir.us.davinci-pas_2.0.1@62',
18
+ 'hl7.fhir.us.davinci-pas_2.0.1@70', 'hl7.fhir.us.davinci-pas_2.0.1@202'
19
+
17
20
  input :access_token,
18
21
  title: 'Access Token',
19
22
  description: %(
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_inquire_request_bundle_validation_test.rb CHANGED
@@ -34,6 +34,10 @@ module DaVinciPASTestKit
34
34
  issue](https://github.com/inferno-framework/davinci-pas-test-kit/issues/11)
35
35
  for additional details.
36
36
  )
37
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@75', 'hl7.fhir.us.davinci-pas_2.0.1@121',
38
+ 'hl7.fhir.us.davinci-pas_2.0.1@122', 'hl7.fhir.us.davinci-pas_2.0.1@123',
39
+ 'hl7.fhir.us.davinci-pas_2.0.1@125', 'hl7.fhir.us.davinci-pas_2.0.1@126',
40
+ 'hl7.fhir.us.davinci-pas_2.0.1@127', 'hl7.fhir.us.davinci-pas_2.0.1@128'
37
41
 
38
42
  def request_type_tag
39
43
  INQUIRE_TAG
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_submit_test.rb CHANGED
@@ -18,6 +18,12 @@ module DaVinciPASTestKit
18
18
  notification that the claim has been finalized and expect the
19
19
  client under test to send a follow-up inquiry.
20
20
  )
21
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@58', 'hl7.fhir.us.davinci-pas_2.0.1@62',
22
+ 'hl7.fhir.us.davinci-pas_2.0.1@67', 'hl7.fhir.us.davinci-pas_2.0.1@70',
23
+ 'hl7.fhir.us.davinci-pas_2.0.1@119', 'hl7.fhir.us.davinci-pas_2.0.1@120',
24
+ 'hl7.fhir.us.davinci-pas_2.0.1@153', 'hl7.fhir.us.davinci-pas_2.0.1@202',
25
+ 'hl7.fhir.us.davinci-pas_2.0.1@203'
26
+
21
27
  config options: { accepts_multiple_requests: true }
22
28
  input :access_token,
23
29
  title: 'Access Token',
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_request_bundle_validation_test.rb CHANGED
@@ -34,6 +34,12 @@ module DaVinciPASTestKit
34
34
  issue](https://github.com/inferno-framework/davinci-pas-test-kit/issues/11)
35
35
  for additional details.
36
36
  )
37
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@58', 'hl7.fhir.us.davinci-pas_2.0.1@59',
38
+ 'hl7.fhir.us.davinci-pas_2.0.1@60', 'hl7.fhir.us.davinci-pas_2.0.1@74',
39
+ 'hl7.fhir.us.davinci-pas_2.0.1@75', 'hl7.fhir.us.davinci-pas_2.0.1@76',
40
+ 'hl7.fhir.us.davinci-pas_2.0.1@77', 'hl7.fhir.us.davinci-pas_2.0.1@78',
41
+ 'hl7.fhir.us.davinci-pas_2.0.1@81', 'hl7.fhir.us.davinci-pas_2.0.1@85',
42
+ 'hl7.fhir.us.davinci-pas_2.0.1@86'
37
43
 
38
44
  def workflow_tag
39
45
  config.options[:workflow_tag]
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_submit_must_support_test.rb CHANGED
@@ -11,6 +11,9 @@ module DaVinciPASTestKit
11
11
  This test allows the client to send $submit requests in addition to any already sent in previous test groups
12
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  for Inferno to evaluate coverage of must support elements.
13
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  )
14
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@58', 'hl7.fhir.us.davinci-pas_2.0.1@62',
15
+ 'hl7.fhir.us.davinci-pas_2.0.1@70', 'hl7.fhir.us.davinci-pas_2.0.1@202'
16
+
14
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  input :access_token,
15
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  title: 'Access Token',
16
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  description: %(
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_create_test.rb CHANGED
@@ -11,6 +11,9 @@ module DaVinciPASTestKit
11
11
  Inferno will wait for a Subscription Creation request
12
12
  and then perform a handshake to activate the Subscription.
13
13
  )
14
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@137', 'hl7.fhir.us.davinci-pas_2.0.1@140',
15
+ 'hl7.fhir.us.davinci-pas_2.0.1@142'
16
+
14
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  input :access_token,
15
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  title: 'Access Token',
16
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  description: %(
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_pas_conformance_test.rb CHANGED
@@ -12,6 +12,7 @@ module DaVinciPASTestKit
12
12
  Topic](https://hl7.org/fhir/us/davinci-pas/STU2/SubscriptionTopic-PASSubscriptionTopic.html), and
13
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  - Inclusion of filter criteria for the client's organization.
14
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  )
15
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@143'
15
16
 
16
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  run do
17
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  load_tagged_requests(SUBSCRIPTION_CREATE_TAG)
data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/error_tests/pas_submission_error_test.rb CHANGED
@@ -20,6 +20,7 @@ module DaVinciPASTestKit
20
20
 
21
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  The server SHOULD respond within 15 seconds.
22
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  }
23
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@70'
23
24
 
24
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  output :response_time
25
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  makes_request :pa_invalid_request
data/lib/davinci_pas_test_kit/generated/v2.0.1/claim/claim_operation_test.rb CHANGED
@@ -13,6 +13,7 @@ module DaVinciPASTestKit
13
13
 
14
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  )
15
15
 
16
+
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  input :pa_submit_request_payload,
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  title: 'PAS Submit Request Payload',
18
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  description: 'Insert Bundle to be sent for PAS Submit Request',
data/lib/davinci_pas_test_kit/generated/v2.0.1/claiminquiryresponse/server_inquire_response_claiminquiryresponse_must_support_test.rb CHANGED
@@ -44,6 +44,7 @@ module DaVinciPASTestKit
44
44
  * ClaimResponse.requestor
45
45
  * ClaimResponse.status
46
46
  )
47
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@40'
47
48
 
48
49
  id :pas_server_inquire_response_v201_claiminquiryresponse_must_support_test
49
50
 
data/lib/davinci_pas_test_kit/generated/v2.0.1/claimresponse/server_submit_response_claimresponse_must_support_test.rb CHANGED
@@ -46,6 +46,7 @@ module DaVinciPASTestKit
46
46
  * ClaimResponse.requestor
47
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  * ClaimResponse.status
48
48
  )
49
+ verifies_requirements 'hl7.fhir.us.davinci-pas_2.0.1@39'
49
50
 
50
51
  id :pas_server_submit_response_v201_claimresponse_must_support_test
51
52
 
data/lib/davinci_pas_test_kit/pas_bundle_validation.rb CHANGED
@@ -70,7 +70,7 @@ module DaVinciPASTestKit
70
70
  # referenced in the Claim resource are included in the bundle. It ensures that the first
71
71
  # entry in the Bundle is a Claim resource and additional entries are populated
72
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  # with referenced resources, following the traversal of references.
73
- # Duplicate resources are handled as required( appearing only once
73
+ # Duplicate resources are handled as required (appearing only once
74
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  # in the bundle entry).
75
75
  def validate_pa_request_payload_structure(bundle, request_type)
76
76
  bundle_entry_resources = bundle.entry.map(&:resource)
@@ -299,7 +299,7 @@ module DaVinciPASTestKit
299
299
  # Processes the profiles associated with a given instance in a FHIR bundle.
300
300
  # It adds the instance's profiles to the resource target profile map and handles recursive profile extraction.
301
301
  # The profiles collected here are possible profiles the given instance may conform to.
302
- # The conformance validation will ensure that the resource is comformant to at least one of the target profiles.
302
+ # The conformance validation will ensure that the resource is conformant to at least one of the target profiles.
303
303
  # @param instance [Object] The instance whose profiles are to be processed.
304
304
  # @param bundle_entry [Array] The bundle.entry contents.
305
305
  # @param reference_element [Hash] The reference element related to the instance.
@@ -342,7 +342,7 @@ module DaVinciPASTestKit
342
342
  end
343
343
 
344
344
  # Adds a specific profile URL to an instance in the resource target profile map.
345
- # It recursively processes the instance for further profilce extraction.
345
+ # It recursively processes the instance for further profile extraction.
346
346
  # @param instance [Object] The instance to which the profile URL is added.
347
347
  # @param profile_url [String] The profile URL to be added.
348
348
  # @param bundle_entry [Array] The bundle.entry contents.
@@ -455,7 +455,7 @@ module DaVinciPASTestKit
455
455
  # as required by the PAS IG.
456
456
  # @param target_resource [FHIR::Model] The FHIR resource to traverse and validate.
457
457
  # @param base_url [String] The server base url.
458
- # @param resources_to_match [Array<FHIR:Bundel:Entry] The list of FHIR bundle entries to match references against.
458
+ # @param resources_to_match [Array<FHIR:Bundle:Entry] The list of FHIR bundle entries to match references against.
459
459
  def check_presence_of_referenced_resources(target_resource, base_url, resources_to_match)
460
460
  return if target_resource.blank?
461
461
 
data/lib/davinci_pas_test_kit/requirements/davinci-pas-test-kit_out_of_scope_requirements.csv ADDED
@@ -0,0 +1,11 @@
1
+ Req Set,ID,Reason,Details
2
+ hl7.fhir.us.davinci-pas_2.0.1,12,Not Tested,Details of X12 messages will not be tested by Inferno.
3
+ hl7.fhir.us.davinci-pas_2.0.1,13,Not Tested,Details of X12 messages will not be tested by Inferno.
4
+ hl7.fhir.us.davinci-pas_2.0.1,14,Not Tested,Details of X12 messages will not be tested by Inferno.
5
+ hl7.fhir.us.davinci-pas_2.0.1,15,Not Tested,Details of X12 messages will not be tested by Inferno.
6
+ hl7.fhir.us.davinci-pas_2.0.1,96,Not Tested,Details of X12 messages will not be tested by Inferno.
7
+ hl7.fhir.us.davinci-pas_2.0.1,108,Not Verifiable,The specification does not provide clear details on the indicated responses (unclear diagram)
8
+ hl7.fhir.us.davinci-pas_2.0.1,109,Not Verifiable,The specification does not provide clear details on the indicated responses (unclear diagram)
9
+ hl7.fhir.us.davinci-pas_2.0.1,124,Not Tested,The rules for determining matching claims are specified in a proprietary X12 specification.
10
+ hl7.fhir.us.davinci-pas_2.0.1,132,Not Tested,How to request a subset of information is not detailed in the specification and lives in priopietary X12 specifications and mappings.
11
+ hl7.fhir.us.davinci-pas_2.0.1,191,Not Tested,Details of payer business rules will not be tested by Inferno.
data/lib/davinci_pas_test_kit/requirements/davinci-pas-test-kit_requirements.csv ADDED
@@ -0,0 +1,214 @@
1
+ Req Set,ID,URL,Requirement,Conformance,Actor,Sub-Requirement(s),Conditionality
2
+ hl7.fhir.us.davinci-pas_2.0.1,1,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 implementer(s) **SHALL** disregard any requirements in this Implementation Guide to translate the PAS FHIR Bundle into or out of the X12 278.",SHALL,Server,,true
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
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
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
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
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
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
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
10
+ hl7.fhir.us.davinci-pas_2.0.1,9,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#gather-prior-authorization-information,Information gathered to support prior authorization is expected to be stored in the EHR in addition to being used as part of the prior authorization request process.,SHOULD,Client,,false
11
+ hl7.fhir.us.davinci-pas_2.0.1,10,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#gather-prior-authorization-information,"As well, EHRs **SHOULD** annotate their orders with the decisions contained in the PAS Response.",SHOULD,Client,,false
12
+ hl7.fhir.us.davinci-pas_2.0.1,11,https://hl7.org/fhir/us/davinci-pas/STU2/usecases.html#submit-prior-authorization,"Prior to sending clinical data as part of the PAS exchange, the provider (or their designated agent) **SHALL** have the ability, but not an obligation, to review patient information and where appropriate amend or withhold submission to comply with current regulations and relevant provider policies.",SHALL,Client,,false
13
+ hl7.fhir.us.davinci-pas_2.0.1,12,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,A payer may request additional information from the provider to support a prior authorization request by responding to the X12 278 Request with an X12 278 Response … [with o]ne or more codes in the PWK01 element,MAY,Server,,true
14
+ hl7.fhir.us.davinci-pas_2.0.1,13,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,A payer may request additional information from the provider to support a prior authorization request by responding to the X12 278 Request with an X12 278 Response … [with o]ne or more of the approved LOINC codes Attachments – LOINC in the HI segment,MAY,Server,,true
15
+ hl7.fhir.us.davinci-pas_2.0.1,14,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,A payer may request additional information from the provider to support a prior authorization request by responding to the X12 278 Request with an X12 278 Response ... [with a] single 102089-0 LOINC code in the HI segment to request information via a payer’s specific questionnaire.,MAY,Server,,true
16
+ hl7.fhir.us.davinci-pas_2.0.1,15,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"When this [102089-0 LOINC code in the HI segment] option is used [to request additional information], the TRN at the X12 278 header or line level associated with the 102089-0 LOINC code SHALL be the DTR context ID used to retrieve the appropriate questionnaire",SHALL,Server,,true
17
+ hl7.fhir.us.davinci-pas_2.0.1,16,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,All of the additional information request codes SHOULD be used as input to a CDex task.,SHOULD,Server,,true
18
+ hl7.fhir.us.davinci-pas_2.0.1,17,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,The CDex task [created to request additional information] will include all of the information required to enable CDex to assemble the required documentation and send it to the payer’s operation endpoint for attachments.,SHALL,Server,,true
19
+ hl7.fhir.us.davinci-pas_2.0.1,18,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"When the LOINC code 102089-0 is present, the associated TRNs SHALL also be exchange as Task.input. The following diagram defines the PAS, CDex, DTR workflow.",SHALL,Server,,true
20
+ hl7.fhir.us.davinci-pas_2.0.1,19,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"A separate task SHALL be created for each of the above attachment request types (PWK01, LOINC, questionnaire).",SHALL,Server,,true
21
+ hl7.fhir.us.davinci-pas_2.0.1,20,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,The [PAS task profile](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-task.html) SHALL be used to convey PAS X12 278 Response information to CDex.,SHALL,Server,,true
22
+ hl7.fhir.us.davinci-pas_2.0.1,21,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"For guidance when the provider is not able to complete the Task, refer to the [When The Task Cannot Be Completed CDex section](http://hl7.org/fhir/us/davinci-cdex/STU2/task-based-approach.html#when-the-task-cannot-be-completed).",SHOULD,Client,,true
23
+ hl7.fhir.us.davinci-pas_2.0.1,22,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"[When responding to requests for additional information i]f the Task.code is “attachment-request-code”, the provider system returns attachment(s) identified by the LOINC attachment code(s) or the PWK01 cod(s) [sic] in the “attachments-needed” input parameter.",SHALL,Client,,true
24
+ hl7.fhir.us.davinci-pas_2.0.1,23,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"[When responding to requests for additional information i]f the code is “attachment-request-questionnaire”, the provider system uses Documentation Templates and Rules (DTR) to complete the Questionnaire referenced in the “questionnaires-needed” input parameter.",SHALL,Client,,true
25
+ hl7.fhir.us.davinci-pas_2.0.1,24,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,[To provide gathered additional information to the payer] the provider system uses the $submit-attachment operation to return the information to the endpoint provided in “payer-url” input parameter.,SHALL,Client,,true
26
+ hl7.fhir.us.davinci-pas_2.0.1,25,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"[When creating a Task instance to request additional information, t]he Task.requester.identifier and Task.owner.reference represents the Payer ID",SHALL,Server,,true
27
+ hl7.fhir.us.davinci-pas_2.0.1,26,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"[When creating a Task instance to request additional information, t]he Task.for references the Patient information.",SHALL,Server,,true
28
+ hl7.fhir.us.davinci-pas_2.0.1,27,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,"[When creating a Task instance to request additional information, t]he Task.reasonReference references the [original] Prior Authorization request.",SHALL,Server,,true
29
+ hl7.fhir.us.davinci-pas_2.0.1,28,https://hl7.org/fhir/us/davinci-pas/STU2/additionalinfo.html,The Task.input … ‘payerUrl’ slice represents the Payer endpoint URL that is used to submit attachments using the $submit-attachment operation,SHALL,Server,,true
30
+ hl7.fhir.us.davinci-pas_2.0.1,29,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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
45
+ hl7.fhir.us.davinci-pas_2.0.1,44,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Servers] **SHALL** also support the US Core R4 profiles for Condition,SHALL,Server,,false
46
+ hl7.fhir.us.davinci-pas_2.0.1,45,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Clients] **SHALL** also support the US Core R4 profiles for Condition,SHALL,Client,,false
47
+ hl7.fhir.us.davinci-pas_2.0.1,46,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Servers] **SHALL** also support the US Core R4 profiles for … Observation,SHALL,Server,,false
48
+ hl7.fhir.us.davinci-pas_2.0.1,47,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Clients] **SHALL** also support the US Core R4 profiles for … Observation,SHALL,Client,,false
49
+ hl7.fhir.us.davinci-pas_2.0.1,48,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Servers] **SHALL** also support the US Core R4 profiles for … Procedure,SHALL,Server,,false
50
+ hl7.fhir.us.davinci-pas_2.0.1,49,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Clients] **SHALL** also support the US Core R4 profiles for … Procedure,SHALL,Client,,false
51
+ hl7.fhir.us.davinci-pas_2.0.1,50,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Servers] **SHOULD** support any other [US Core] profiles relevant to the types of prior authorizations they process.,SHOULD,Server,,false
52
+ hl7.fhir.us.davinci-pas_2.0.1,51,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,[Clients] **SHOULD** support any other [US Core] profiles relevant to the types of prior authorizations they process.,SHOULD,Client,,false
53
+ hl7.fhir.us.davinci-pas_2.0.1,52,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,Clients ... supporting this implementation guide **SHOULD** also comply with the Da Vinci [Coverage Requirements Discovery (CRD)](http://www.hl7.org/fhir/us/davinci-crd) implementation guide,SHOULD,Client,,false
54
+ hl7.fhir.us.davinci-pas_2.0.1,53,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 [Coverage Requirements Discovery (CRD)](http://www.hl7.org/fhir/us/davinci-crd) implementation guide,SHOULD,Server,,false
55
+ hl7.fhir.us.davinci-pas_2.0.1,54,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#integration-with-other-implementation-guides,Clients 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,Client,,false
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
+
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
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
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
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
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
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
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
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
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
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
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
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
94
+ hl7.fhir.us.davinci-pas_2.0.1,90,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,[Server] system[s] MAY treat the presence of … [a] [non-must support] element [in the [PASBundle](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-pas-request-bundle.html) for prior authorization submission] as an error.,MAY,Server,,true
95
+ hl7.fhir.us.davinci-pas_2.0.1,91,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,Details on how to map the FHIR Bundle to the relevant X12N 278 and 275 messages are expected to be published by ASC X12N. The mapping [by the payer system] for the 278 Request and Response will be whatever is currently mandated by HIPAA and the mapping for the 278 Inquiry and Response will be the compatible version.,SHALL,Server,,false
96
+ hl7.fhir.us.davinci-pas_2.0.1,92,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"[T]he [server] system is responsible for performing full conversion of all mapped elements, including execution of terminology translations when necessary.",SHALL,Server,,false
97
+ hl7.fhir.us.davinci-pas_2.0.1,93,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,[T]he [server] system SHALL make the entire PAS FHIR Bundle [submitted for prior authorization] available to the intended payer.,SHALL,Server,,false
98
+ hl7.fhir.us.davinci-pas_2.0.1,94,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,The method [of making the submitted FHIR prior authorization bundle available] may be based on the X12 275 or another method that trading partners have agreed to use.,MAY,Server,,false
99
+ hl7.fhir.us.davinci-pas_2.0.1,95,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"If the X12 275 is used for this purpose [of making the FHIR prior authorization bundle avilable], the 275 BDS01 Filter ID Code element SHALL be set to “B64”.",SHALL,Server,,true
100
+ hl7.fhir.us.davinci-pas_2.0.1,96,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#prior-authorization-submission,"Since the 275 binary segment doesn’t contain a field for the binary data MIME type, any system reading that field [to access the FHIR prior authorization bundle avilable] will have to parse out the first few characters to determine whether the FHIR resources are encoded using XML or JSON syntax.",SHALL,Server,,true
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
152
+ hl7.fhir.us.davinci-pas_2.0.1,149,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#subscription,Servers supporting subscriptions **SHALL** expose this as part of the Server’s CapabilityStatement,SHALL,Server,,false
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
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
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
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
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
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
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
160
+ hl7.fhir.us.davinci-pas_2.0.1,157,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,There are four types of changes possible [by clients]: … [including c]anceling the entire prior authorization (including all contained items),MAY,Client,,true
161
+ hl7.fhir.us.davinci-pas_2.0.1,158,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,There are four types of changes possible [by clients]: … [including i]tems within the request can be canceled.,MAY,Client,,true
162
+ hl7.fhir.us.davinci-pas_2.0.1,159,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,Systems **SHALL** communicate a cancellation of an item if the corresponding order is canceled and a final authorization determination has not yet been received for that item.,SHALL,Client,,true
163
+ hl7.fhir.us.davinci-pas_2.0.1,160,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"There are four types of changes possible [by clients]: … [including c]ertain elements can be revised within a previously submitted item. Specifically, the Claim.billablePeriod",MAY,Client,,true
164
+ hl7.fhir.us.davinci-pas_2.0.1,161,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"There are four types of changes possible [by clients]: … [including c]ertain elements can be revised within a previously submitted item. Specifically, ... Claim.item.serviced[x]",MAY,Client,,true
165
+ hl7.fhir.us.davinci-pas_2.0.1,162,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"There are four types of changes possible [by clients]: … [including c]ertain elements can be revised within a previously submitted item. Specifically, ... Claim.item.quantity",MAY,Client,,true
166
+ hl7.fhir.us.davinci-pas_2.0.1,163,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"There are four types of changes possible [by clients]: … [including c]ertain elements can be revised within a previously submitted item. Specifically, ... Claim.item.net.",MAY,Client,,true
167
+ hl7.fhir.us.davinci-pas_2.0.1,164,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,Other types of changes [to elements where updates are not allowed] are accomplished by canceling an existing item and adding a new item.,SHALL,Client,,true
168
+ hl7.fhir.us.davinci-pas_2.0.1,165,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,There are four types of changes possible [by clients]: … [including a]dditional items and/or supporting documentation can be added to the prior authorization request.,MAY,Client,,true
169
+ hl7.fhir.us.davinci-pas_2.0.1,166,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,[A submitted claim] update is requested by creating a new Bundle containing a new Claim resource with its own unique Claim.identifier and posting it using the $submit operation.,SHALL,Client,,true
170
+ hl7.fhir.us.davinci-pas_2.0.1,167,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,That [new Claim] resource will point to the previous [replaced] Claim using the Claim.related element.,SHALL,Client,,true
171
+ hl7.fhir.us.davinci-pas_2.0.1,168,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,The relationship type [of the updated Claim] will be ‘replaces’.,SHALL,Client,,true
172
+ hl7.fhir.us.davinci-pas_2.0.1,169,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,The new claim resource instance [for the updated Claim] will comply with the [Revised Prior Authorization](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-claim-update.html) profile.,SHALL,Client,,true
173
+ hl7.fhir.us.davinci-pas_2.0.1,170,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,**All** items and supporting information is included in the Bundle - including items that have not changed at all.,SHALL,Client,,true
174
+ hl7.fhir.us.davinci-pas_2.0.1,171,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"Any items within the Claim that have been canceled (where the cancellation is at the item level, not at the whole prior authorization level) will be flagged with the [cancelled](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-modifierextension-infoCancelled.html) modifierExtension. This indicates that the item is no longer actually part of the prior authorization request and is included only to distinguish it as ‘canceled’.",SHALL,Client,,true
175
+ hl7.fhir.us.davinci-pas_2.0.1,172,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"[When submitting an update,] if an item was canceled previously, it will still have a ‘canceled’ modifier extension, even though the cancellation is not new.",SHALL,Client,,true
176
+ hl7.fhir.us.davinci-pas_2.0.1,173,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,The [Certification Type extension](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-extension-certificationType.html) with the appropriate code is used to indicate that each item previously requested is being canceled (using the code ‘3’ - Cancel).,SHALL,Client,,true
177
+ hl7.fhir.us.davinci-pas_2.0.1,174,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,All items and supportingInfo elements that have been added or changed (including flagging them as cancelled) must be marked with a [changed](https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-extension-infoChanged.html) extension that indicates that the element was changed and what type of change has happened. (Newly marking an item as canceled is considered a ‘change’.),SHALL,Client,,true
178
+ hl7.fhir.us.davinci-pas_2.0.1,175,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,"Only the items that have changed in this submission will be marked with the ‘changed’ extension. Elements that were previously added, modified or canceled will not be marked as changes unless they have been further changed in this version of the prior authorization.",SHALL,Client,,true
179
+ hl7.fhir.us.davinci-pas_2.0.1,176,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,The intermediary will create 278 and/or 275 submissions that instantiate the changes (by looking for those items and supportingInfo elements),SHALL,Server,,true
180
+ hl7.fhir.us.davinci-pas_2.0.1,177,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#updating-authorization-requests,The intermediary will create 278 and/or 275 submissions that... will ignore the unchanged items.,SHALL,Server,,true
181
+ hl7.fhir.us.davinci-pas_2.0.1,178,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,"[In response to an update to a previously-submitted prior authorization request,] payers may include responses for all items in the authorization.",MAY,Server,,true
182
+ hl7.fhir.us.davinci-pas_2.0.1,179,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,"In response to an update to a previously-submitted prior authorization request, payers] might only include responses for those items that were specifically changed.",MAY,Server,,true
183
+ hl7.fhir.us.davinci-pas_2.0.1,180,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,"[I]f a ClaimResponse does not contain items corresponding to all that are part of the revised prior authorization (including those canceled or unmodified), it **SHALL** declare a [security tag](http://hl7.org/fhir/R4/resource-definitions.html#Meta.security) with a value of [SUBSETTED](http://hl7.org/fhir/R4/v3/ObservationValue/cs.html#v3-ObservationValue-SUBSETTED) to make clear that the resource is incomplete.",SHALL,Server,,true
184
+ hl7.fhir.us.davinci-pas_2.0.1,181,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,The [server] intermediary would populate the ClaimResponse Bundle based on the approach the payer had chosen in their 278 response.,SHALL,Server,,true
185
+ hl7.fhir.us.davinci-pas_2.0.1,182,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,"When querying for the current status of a prior authorization, the prior authorization response **SHALL** include all items, even if the identifier queried against corresponds to a prior authorization response whose synchronous response was a differential.",SHALL,Server,,true
186
+ hl7.fhir.us.davinci-pas_2.0.1,183,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,PAS systems **SHALL** ensure that prior authorizations that were initially pended remain available for query for at least 6 months after the anticipated completion of the services whose authorization was requested.,SHALL,Server,,true
187
+ hl7.fhir.us.davinci-pas_2.0.1,184,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,"If the prior authorization response is a denial, it is not permitted to send an ‘update’ to the request. Instead, a new request must be initiated.",SHALL,Client,,false
188
+ hl7.fhir.us.davinci-pas_2.0.1,185,https://hl7.org/fhir/us/davinci-pas/STU2/specification.html#responses-to-changed-prior-authorization-requests,"Note that data submitted by client systems will comply with US Core profiles, meaning that codes for medications, conditions, etc. will be those used for clinical purposes, not billing. The intermediary will be responsible for performing any necessary mappings (e.g. SNOMED diagnosis codes to ICD10).",SHALL,Server,,false
189
+ hl7.fhir.us.davinci-pas_2.0.1,186,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,"[Clients] submitting prior authorization requests using PAS must be aware of (and adhere to) their responsibilities with respect to data sharing imposed by regulations such as HIPAA’s “minimum necessary” rule, patient consent rules, etc.",SHALL,Client,,false
190
+ hl7.fhir.us.davinci-pas_2.0.1,187,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,[Clients] **SHALL** permit provider review of [prior authorization submission] data prior to transmission,SHALL,Client,,false
191
+ hl7.fhir.us.davinci-pas_2.0.1,188,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,[Clients] **SHALL NOT** require such review [by providers before prior authorization submission].,SHALL NOT,Client,,false
192
+ hl7.fhir.us.davinci-pas_2.0.1,189,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,Payers are responsible for ensuring that only information necessary to make the prior authorization decision is solicited [under HIPAA’s “minimum necessary” regulations],SHALL,Server,,false
193
+ hl7.fhir.us.davinci-pas_2.0.1,190,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,[Under HIPAA’s “minimum necessary” regulations] providers are responsible for ensuring that only data that is reasonably relevant to the prior authorization decision is transmitted.,SHALL,Client,,false
194
+ hl7.fhir.us.davinci-pas_2.0.1,191,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,"Some of the data shared as part of the prior authorization process may have associated constraints on the use of that information for other purposes, including subsequent disclosure to other payers, practitioners, policy-holders, etc. While HL7 FHIR supports conveying this information via security labels on transmitted resources, this information is not currently mappable (and thus findable) in the X12 275 and 278 transactions. Payers who do not view the FHIR version of the transmitted information should be aware of the possibility of these limitations and ensure they have policies that enforce appropriate sharing constraints on data.",SHOULD,Server,,true
195
+ hl7.fhir.us.davinci-pas_2.0.1,192,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,PAS Servers **SHOULD** support server-server Oauth,SHOULD,Server,,false
196
+ hl7.fhir.us.davinci-pas_2.0.1,193,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,PAS Servers ... **MAY** support mutually authenticated TLS.,MAY,Server,,false
197
+ hl7.fhir.us.davinci-pas_2.0.1,194,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,Every [server] system implementing the Prior Authorization guide will need to be aware of and follow the guidance in the FHIR Core Specification on [Clinical Safety](http://hl7.org/fhir/safety.html),SHALL,Server,,false
198
+ hl7.fhir.us.davinci-pas_2.0.1,195,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,Every [client] system implementing the Prior Authorization guide will need to be aware of and follow the guidance in the FHIR Core Specification on [Clinical Safety](http://hl7.org/fhir/safety.html),SHALL,Client,,false
199
+ hl7.fhir.us.davinci-pas_2.0.1,196,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,Every [server] system implementing the Prior Authorization guide will need to be aware of and follow the guidance in ... 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
200
+ hl7.fhir.us.davinci-pas_2.0.1,197,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,Every [client] system implementing the Prior Authorization guide will need to be aware of and follow the guidance in ... 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
201
+ hl7.fhir.us.davinci-pas_2.0.1,198,https://hl7.org/fhir/us/davinci-pas/STU2/privacy.html,"Once the system authentication has occurred, the payer will perform any authorization required for the provider to see the current state of the prior authorization.",SHALL,Server,,false
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
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
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
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
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
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
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
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
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
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
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
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