FHIR Release 3 (STU) R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.0.2: STU 3). (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R3 R2

12.20 12.19 Resource ProcessRequest - Content

Financial Management Work Group Maturity Level : 2   Trial Use Compartments : Practitioner

This resource provides the target, request and response, and action details for an action to be performed by the target on or about existing resources.

12.20.1 12.19.1 Scope and Usage

NOTE: This resource is slated to be refactored and reduced in scope as some of its functionality is taken over by the Task resource as part of the FHIR Workflow refactoring. Readers of this resource are encouraged to review the Task resource and consider using it instead and/or to provide feedback if they feel it will be inadequate to satisfy the use-cases associated with this resource and to express opinions about which purposes they feel ProcessRequest and ProcessResponse should be retained for.

The ProcessRequest resource allows for the specification of an action to be performed on an existing resource or resources and then provides the additional supporting information to support that action. The actions currently defined are: cancel, poll, reprocess, and status.

Cancel indicates the resource which is to be reversed and provides both supporting information for the reversal and whether the receiving system is permitted to retain a copy of the reversed resource.

The Cancel is the formal request to cease processing an incomplete prior request or to reverse and/or nullify a complete prior request or information submission. When nullify=true then all copies of the original submission are to be purged, although audit logs may be retained. When Nullify=false a copy of the original request may be retained. A ProcessResponse may be craeated created or returned to indicate whether the requestion requested action was accepted and successful.

Poll provides supporting information for the poll request. The response to this a Poll is a previously undelivered response Resource or a ProcessResponse which may contain errors.

This is a formal request for payors or systems which require such and/or requisition-level information or transports which don't support a 'Get Operation', for the retrieval of pended, or held, resources.

A simple Poll request, one which doesn't specify: request, include, exclude or period; would return any pended resource. Specific types of business behaviors may be supported by providing values for the filtering elements, for example:

  • Get any pended resource - no filters specified
  • Get deferred response to a Claim - specify the Claim in the 'request'
  • Get all supporting information - specify 'Communication' as an 'include'
  • Get an Explanation of Benefit - specify 'ExplanationOfBenefit' as an 'include'
  • Get a payment reconciliation - specify a 'period' which contains the expected reconciliation creation date, and specify 'PaymentReconciliation' as an 'include'

Reprocess indicates the resource which is to be reprocessed, for example a claim to be readjudicated re-adjudicated or a specimen or diagnostic image to be re-examined, and provides both supporting information for the reprocessing and the line items which are to be reprocessed.

This is necessary for the limited supporters who require the ability to formally request the reprocessing of specified service sub-trees from an already processed resource such as a previously adjudicated Claim.

Status indicates the resource for which the processing status is requested and provides supporting information for the status request.

This is a formal request for payors systems which require such and/or requisition-level information or transports which don't support a 'Get Operation', for the processing status of a previously submitted processing request.

This resource is referenced by paymentreconciliation

12.20.2 12.19.2 Resource Content

Structure

Name Flags Card. Type Description & Constraints doco
. . ProcessRequest TU DomainResource Request to perform some action on or in regards to an existing resource
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier
. . . status ?! Σ 0..1 code active | cancelled | draft | entered-in-error
Financial Resource Status Codes ( Required )
. . . action 0..1 code cancel | poll | reprocess | status
ActionList ( Required )
. . . target 0..1 Reference ( Organization ) Party which is the target of the request
. . . created 0..1 dateTime Creation date
. . . provider 0..1 Reference ( Practitioner ) Responsible practitioner organization 0..1 Reference | PractitionerRole ( | Organization ) Responsible organization practitioner
. . . request 0..1 Reference ( Any ) Reference to the Request resource
. . . response 0..1 Reference ( Any ) Reference to the Response resource
. . . nullify 0..1 boolean Remove history
. . . reference 0..1 string Reference number/string
. . . item 0..* BackboneElement Items to re-adjudicate
. . . . sequenceLinkId 1..1 integer Service instance
. . . include 0..* string Resource type(s) to include
. . . exclude 0..* string Resource type(s) to exclude
. . . period 0..1 Period Selection period

doco Documentation for this format

UML Diagram ( Legend )

ProcessRequest ( DomainResource ) The ProcessRequest business identifier identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] « A code specifying the state of the resource instance. (Strength=Required) Financial Resource Status ! » The type of processing action being requested, for example Reversal, Readjudication, StatusRequest,PendedRequest action : code [0..1] « List of allowable action which this resource can request. (Strength=Required) ActionList ! » The organization which is the target of the request target : Reference [0..1] « Organization » The date when this resource was created created : dateTime [0..1] The practitioner who is responsible for the action specified in this request provider : Reference [0..1] « Practitioner | PractitionerRole | The organization which is responsible for the action speccified in this request organization : Reference [0..1] Organization » Reference of resource which is the target or subject of this action request : Reference [0..1] « Any » Reference of a prior response to resource which is the target or subject of this action response : Reference [0..1] « Any » If true remove all history excluding audit nullify : boolean [0..1] A reference to supply which authenticates the process reference : string [0..1] Names of resource types to include include : string [0..*] Names of resource types to exclude exclude : string [0..*] A period of time during which the fulfilling resources would have been created period : Period [0..1] Items A service line number sequenceLinkId : integer [1..1] List of top level items to be re-adjudicated, if none specified then the entire submission is re-adjudicated item [0..*]

XML Template 

<

<ProcessRequest xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <
 <

 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <action value="[code]"/><!-- 0..1 cancel | poll | reprocess | status -->

 <target><!-- 0..1 Reference(Organization) Party which is the target of the request --></target>
 <
 <</provider>
 <</organization>

 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <provider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></provider>

 <request><!-- 0..1 Reference(Any) Reference to the Request resource --></request>
 <response><!-- 0..1 Reference(Any) Reference to the Response resource --></response>
 <
 <

 <nullify value="[boolean]"/><!-- 0..1 Remove history -->
 <reference value="[string]"/><!-- 0..1 Reference number/string -->

 <item>  <!-- 0..* Items to re-adjudicate -->
  <

  <sequenceLinkId value="[integer]"/><!-- 1..1 Service instance -->

 </item>
 <
 <

 <include value="[string]"/><!-- 0..* Resource type(s) to include -->
 <exclude value="[string]"/><!-- 0..* Resource type(s) to exclude -->

 <period><!-- 0..1 Period Selection period --></period>
</ProcessRequest>

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ProcessRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ProcessRequest.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:ProcessRequest.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:ProcessRequest.action [ code ]; # 0..1 cancel | poll | reprocess | status
  fhir:ProcessRequest.target [ Reference(Organization) ]; # 0..1 Party which is the target of the request
  fhir:ProcessRequest.created [ dateTime ]; # 0..1 Creation date
  fhir:
  fhir:

  fhir:ProcessRequest.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner

  fhir:ProcessRequest.request [ Reference(Any) ]; # 0..1 Reference to the Request resource
  fhir:ProcessRequest.response [ Reference(Any) ]; # 0..1 Reference to the Response resource
  fhir:ProcessRequest.nullify [ boolean ]; # 0..1 Remove history
  fhir:ProcessRequest.reference [ string ]; # 0..1 Reference number/string
  fhir:ProcessRequest.item [ # 0..* Items to re-adjudicate
    fhir:ProcessRequest.item.sequenceLinkId [ integer ]; # 1..1 Service instance
  ], ...;
  fhir:ProcessRequest.include [ string ], ... ; # 0..* Resource type(s) to include
  fhir:ProcessRequest.exclude [ string ], ... ; # 0..* Resource type(s) to exclude
  fhir:ProcessRequest.period [ Period ]; # 0..1 Selection period
]

Changes since DSTU2 R3

ProcessRequest.status
ProcessRequest Added Element
ProcessRequest.action ProcessRequest.provider
  • Min Cardinality Type changed from 1 Reference(Practitioner) to 0 ProcessRequest.ruleset deleted Reference(Practitioner|PractitionerRole|Organization)
ProcessRequest.originalRuleset ProcessRequest.organization
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Structure

Name Flags Card. Type Description & Constraints doco
. . ProcessRequest TU DomainResource Request to perform some action on or in regards to an existing resource
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier
. . . status ?! Σ 0..1 code active | cancelled | draft | entered-in-error
Financial Resource Status Codes ( Required )
. . . action 0..1 code cancel | poll | reprocess | status
ActionList ( Required )
. . . target 0..1 Reference ( Organization ) Party which is the target of the request
. . . created 0..1 dateTime Creation date
. . . provider 0..1 Reference ( Practitioner ) Responsible practitioner organization 0..1 Reference | PractitionerRole ( | Organization ) Responsible organization practitioner
. . . request 0..1 Reference ( Any ) Reference to the Request resource
. . . response 0..1 Reference ( Any ) Reference to the Response resource
. . . nullify 0..1 boolean Remove history
. . . reference 0..1 string Reference number/string
. . . item 0..* BackboneElement Items to re-adjudicate
. . . . sequenceLinkId 1..1 integer Service instance
. . . include 0..* string Resource type(s) to include
. . . exclude 0..* string Resource type(s) to exclude
. . . period 0..1 Period Selection period

doco Documentation for this format

UML Diagram ( Legend )

ProcessRequest ( DomainResource ) The ProcessRequest business identifier identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] « A code specifying the state of the resource instance. (Strength=Required) Financial Resource Status ! » The type of processing action being requested, for example Reversal, Readjudication, StatusRequest,PendedRequest action : code [0..1] « List of allowable action which this resource can request. (Strength=Required) ActionList ! » The organization which is the target of the request target : Reference [0..1] « Organization » The date when this resource was created created : dateTime [0..1] The practitioner who is responsible for the action specified in this request provider : Reference [0..1] « Practitioner | PractitionerRole | The organization which is responsible for the action speccified in this request organization : Reference [0..1] Organization » Reference of resource which is the target or subject of this action request : Reference [0..1] « Any » Reference of a prior response to resource which is the target or subject of this action response : Reference [0..1] « Any » If true remove all history excluding audit nullify : boolean [0..1] A reference to supply which authenticates the process reference : string [0..1] Names of resource types to include include : string [0..*] Names of resource types to exclude exclude : string [0..*] A period of time during which the fulfilling resources would have been created period : Period [0..1] Items A service line number sequenceLinkId : integer [1..1] List of top level items to be re-adjudicated, if none specified then the entire submission is re-adjudicated item [0..*]

XML Template 

<

<ProcessRequest xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <
 <

 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <action value="[code]"/><!-- 0..1 cancel | poll | reprocess | status -->

 <target><!-- 0..1 Reference(Organization) Party which is the target of the request --></target>
 <
 <</provider>
 <</organization>

 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <provider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></provider>

 <request><!-- 0..1 Reference(Any) Reference to the Request resource --></request>
 <response><!-- 0..1 Reference(Any) Reference to the Response resource --></response>
 <
 <

 <nullify value="[boolean]"/><!-- 0..1 Remove history -->
 <reference value="[string]"/><!-- 0..1 Reference number/string -->

 <item>  <!-- 0..* Items to re-adjudicate -->
  <

  <sequenceLinkId value="[integer]"/><!-- 1..1 Service instance -->

 </item>
 <
 <

 <include value="[string]"/><!-- 0..* Resource type(s) to include -->
 <exclude value="[string]"/><!-- 0..* Resource type(s) to exclude -->

 <period><!-- 0..1 Period Selection period --></period>
</ProcessRequest>

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ProcessRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ProcessRequest.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:ProcessRequest.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:ProcessRequest.action [ code ]; # 0..1 cancel | poll | reprocess | status
  fhir:ProcessRequest.target [ Reference(Organization) ]; # 0..1 Party which is the target of the request
  fhir:ProcessRequest.created [ dateTime ]; # 0..1 Creation date
  fhir:
  fhir:

  fhir:ProcessRequest.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner

  fhir:ProcessRequest.request [ Reference(Any) ]; # 0..1 Reference to the Request resource
  fhir:ProcessRequest.response [ Reference(Any) ]; # 0..1 Reference to the Response resource
  fhir:ProcessRequest.nullify [ boolean ]; # 0..1 Remove history
  fhir:ProcessRequest.reference [ string ]; # 0..1 Reference number/string
  fhir:ProcessRequest.item [ # 0..* Items to re-adjudicate
    fhir:ProcessRequest.item.sequenceLinkId [ integer ]; # 1..1 Service instance
  ], ...;
  fhir:ProcessRequest.include [ string ], ... ; # 0..* Resource type(s) to include
  fhir:ProcessRequest.exclude [ string ], ... ; # 0..* Resource type(s) to exclude
  fhir:ProcessRequest.period [ Period ]; # 0..1 Selection period
]

Changes since DSTU2

ProcessRequest.status
ProcessRequest Added Element
ProcessRequest.action ProcessRequest.provider
  • Min Cardinality Type changed from 1 Reference(Practitioner) to 0 ProcessRequest.ruleset deleted Reference(Practitioner|PractitionerRole|Organization)
ProcessRequest.originalRuleset ProcessRequest.organization
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

 

Alternate definitions: Master Definition ( XML , + JSON ), , XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

12.20.2.1 12.19.2.1 Terminology Bindings

Path Definition Type Reference
ProcessRequest.status A code specifying the state of the resource instance. Required Financial Resource Status Codes
ProcessRequest.action List of allowable action which this resource can request. Required ActionList

12.20.3 12.19.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
action token The action requested by this resource ProcessRequest.action
identifier token The business identifier of the ProcessRequest ProcessRequest.identifier
organization provider reference The organization provider who generated regenerated this request ProcessRequest.organization ProcessRequest.provider
( Practitioner , Organization , PractitionerRole )
provider status reference token The provider who regenerated this status of the process request ProcessRequest.provider ( Practitioner ) ProcessRequest.status