description: A logical model describing the information that should be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation
package_name: hl7.fhir.us.davinci-pas
derivation: specialization
name: PASMetricData
type: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/PASMetricData
elements:
  providerId:
    type: Identifier
    short: User invoking hook
    index: 1
    elements:
      system:
        pattern: {type: Uri, value: 'http://hl7.org/fhir/sid/us-npi'}
        index: 2
      value: {index: 3}
    required: [value]
  groupId:
    type: Identifier
    short: Healthcare org of user
    index: 4
    elements:
      system:
        pattern: {type: Uri, value: 'http://hl7.org/fhir/sid/us-npi'}
        index: 5
      value: {index: 6}
    required: [value]
  issue:
    type: BackboneElement
    short: OperationOutcome info
    array: true
    index: 17
    elements:
      code:
        type: code
        short: Error code
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/issue-type'}
        index: 18
      details:
        type: CodeableConcept
        short: More detailed error code
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/operation-outcome'}
        index: 19
    required: [code]
  supportingDoc: {type: url, short: Documentation submitted as part of PAS Bundle, index: 36}
  exceptionSubmission: {type: boolean, short: True if exchange is based on the exception grant, index: 42}
  source:
    type: code
    short: provider | intermediary | payer
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource'}
    index: 0
  itemDetail:
    type: BackboneElement
    short: Service level item detail
    array: true
    index: 23
    elements:
      denialReason: {type: code, short: Denial Reason, index: 35}
      initialSubmissionTime: {type: dateTime, short: Date/time of the initial submission of the item, index: 27}
      assertionId: {type: string, short: Unique ID for order item, index: 26}
      responsesRequired: {type: integer, short: Number of responses, index: 29}
      item: {type: CodeableConcept, short: 'eg. ICD10, HCPCS, NDC', index: 25}
      result: {type: code, short: approved | modified | denied | pended, index: 34}
      finalResponseTime: {type: dateTime, short: Date/time of final result, index: 28}
      trn: {type: integer, short: Service Level TRN, index: 24}
      locationType: {type: code, short: inpatient | outpatient | home, index: 33}
      aaaCodes:
        type: BackboneElement
        short: AAA codes returned
        array: true
        index: 30
        elements:
          loopID: {type: code, short: see X12 loop IDs, index: 31}
          aaaCode: {type: code, short: approved | modified | deined, index: 32}
        required: [aaaCode, loopID]
    required: [item]
  businessLine: {type: CodeableConcept, short: E.g. MedicareAdvantage, index: 43}
  requestedDoc:
    type: BackboneElement
    short: Documentation requested via 278 response
    array: true
    index: 37
    elements:
      docRequest: {type: CodeableConcept, short: Coded requests for additional documentation, array: true, min: 1, index: 38}
      timeRequested: {type: dateTime, short: Date/Time of initial request, index: 39}
      timeSubmitted: {type: dateTime, short: Date/Time of final result, index: 40}
      submissionMethod: {type: code, short: CDex | portal | fax | x12 | other, index: 41}
    required: [timeRequested, docRequest]
  payerId:
    type: Identifier
    short: Payer receiving hook
    index: 7
    elements:
      system: {index: 8}
      value: {index: 9}
    required: [value, system]
  exchange:
    type: BackboneElement
    short: Prior Authorization Exchanges
    array: true
    min: 1
    index: 10
    elements:
      type: {type: code, short: initial | subsequent | cancel | update | query | initialDocToPayer, index: 11}
      with: {type: code, short: provider | intermediary | payer, index: 12}
      method: {type: code, short: x12 | restful | ihe | direct | other, index: 13}
      requestTime: {type: instant, short: Time exchange initiated, index: 14}
      responseTime: {type: instant, short: Time of exchange response, index: 15}
      httpResponse: {type: code, short: e.g. 200, index: 16}
    required: [httpResponse, method, requestTime, type]
  aaaCodes:
    type: BackboneElement
    short: AAA codes returned
    array: true
    index: 20
    elements:
      loopID: {type: code, short: see X12 loop IDs, index: 21}
      aaaCode: {type: code, short: approved | modified | denied, index: 22}
    required: [aaaCode, loopID]
package_version: 2.1.0
class: logical
kind: logical
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/PASMetricData
base: http://hl7.org/fhir/StructureDefinition/Base
version: 2.1.0
required: [groupId, payerId, providerId, source, exchange]