本文属于机器翻译版本。若本译文内容与英语原文存在差异，则一律以英文原文为准。 # FHIR 的`$submit`手术 HealthLake 该`$submit`操作使您能够以电子方式向付款人提交事先授权请求以供批准。该操作实施了《[达芬奇事先授权支持（PAS）实施指南》](https://hl7.org/fhir/us/davinci-pas/)，为事先授权提交提供了基于FHIR的标准化工作流程。 ## 工作原理 + **提交**：您发送一份 FHIR 捆绑包，其中包含您先前的授权申请和辅助临床数据 + **验证**：根据 PAS 要求 HealthLake 验证提交的内容 + **保留**：所有资源都存储在您的 HealthLake 数据存储中 + **回复**：您会立即收到状态为 “已排队” 的回复 + **流程**：授权决策由付款人异步处理 ## API 端点 ``` POST /datastore/{datastoreId}/r4/Claim/$submit Content-Type: application/fhir+json ``` ## 请求结构 ### 捆绑包要求 您的请求必须是 FHIR 捆绑包资源，其中包含以下内容： + **Bundle.type：必须是** `"collection"` + b@@ **undle.entr** y：必须恰好包含**一个索赔资源** `use = "preauthorization"` + **参考资源**：声明中引用的所有资源都必须包含在捆绑包中 ### 所需的资源 | 资源 | 基数 | 配置文件 | 说明 | | --- | --- | --- | --- | | 索赔 | 1 | PAS 索赔 | 事先授权请求 | | 病人 | 1 | PAS 患者 | 患者人口统计信息 | | 组织（保险公司） | 1 | PAS 保险公司 | 保险公司 | | 组织（提供商） | 1 | PAS 请求者 | 医疗保健提供者提交申请 | | 覆盖范围 | 1 或更多 | PAS 覆盖范围 | 保险范围详情 | ### 可选资源 | 资源 | 基数 | 配置文件 | 说明 | | --- | --- | --- | --- | | 从业者 | 0 或更多 | PAS从业人员 | 医疗保健从业人员 | | PractitionerRole | 0 或更多 | PAS PractitionerRole | 从业者角色 | | ServiceRequest | 0 或更多 | PAS ServiceRequest | 要求的医疗服务 | | DeviceRequest | 0 或更多 | PAS DeviceRequest | 要求的医疗设备 | | MedicationRequest | 0 或更多 | PAS MedicationRequest | 要求的药物 | | DocumentReference | 0 或更多 | PAS DocumentReference | 支持临床文档 | ## 示例请求 ``` POST /datastore/example-datastore/r4/Claim/$submit Content-Type: application/fhir+json Authorization: Bearer { "resourceType" : "Bundle", "id" : "MedicalServicesAuthorizationBundleExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"] }, "identifier" : { "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER", "value" : "5269367" }, "type" : "collection", "timestamp" : "2005-05-02T11:01:00+05:00", "entry" : [{ "fullUrl" : "http://example.org/fhir/Claim/MedicalServicesAuthorizationExample", "resource" : { "resourceType" : "Claim", "id" : "MedicalServicesAuthorizationExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"] }, "identifier" : [{ "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER", "value" : "111099" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional" }] }, "use" : "preauthorization", "patient" : { "reference" : "Patient/SubscriberExample" }, "created" : "2005-05-02T11:01:00+05:00", "insurer" : { "reference" : "Organization/InsurerExample" }, "provider" : { "reference" : "Organization/UMOExample" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }, "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/InsuranceExample" } }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType", "valueCodeableConcept" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/1525", "code" : "IN", "display" : "Initial Medical Services Reservation" }] } }, { "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType", "valueCodeableConcept" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/1322", "code" : "I", "display" : "Initial" }] } }, { "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber", "valueString" : "1122344" }, { "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber", "valueString" : "33441122" }], "sequence" : 1, "category" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/1365", "code" : "1", "display" : "Medical Care" }] }, "productOrService" : { "coding" : [{ "system" : "http://www.cms.gov/Medicare/Coding/HCPCS​ReleaseCodeSets", "code" : "99212", "display" : "Established Office Visit" }] }, "servicedDate" : "2005-05-10", "locationCodeableConcept" : { "coding" : [{ "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set", "code" : "11" }] } }] } }, { "fullUrl" : "http://example.org/fhir/Organization/UMOExample", "resource" : { "resourceType" : "Organization", "id" : "UMOExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"] }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "8189991234" }], "active" : true, "type" : [{ "coding" : [{ "system" : "https://codesystem.x12.org/005010/98", "code" : "X3" }] }], "name" : "DR. JOE SMITH CORPORATION", "address" : [{ "line" : ["111 1ST STREET"], "city" : "SAN DIEGO", "state" : "CA", "postalCode" : "92101", "country" : "US" }] } }, { "fullUrl" : "http://example.org/fhir/Organization/InsurerExample", "resource" : { "resourceType" : "Organization", "id" : "InsurerExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"] }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "1234567893" }], "active" : true, "type" : [{ "coding" : [{ "system" : "https://codesystem.x12.org/005010/98", "code" : "PR" }] }], "name" : "MARYLAND CAPITAL INSURANCE COMPANY" } }, { "fullUrl" : "http://example.org/fhir/Coverage/InsuranceExample", "resource" : { "resourceType" : "Coverage", "id" : "InsuranceExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"] }, "status" : "active", "subscriberId" : "1122334455", "beneficiary" : { "reference" : "Patient/SubscriberExample" }, "relationship" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code" : "self" }, { "system" : "https://codesystem.x12.org/005010/1069", "code" : "18" }] }, "payor" : [{ "reference" : "Organization/InsurerExample" }] } }, { "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample", "resource" : { "resourceType" : "Patient", "id" : "SubscriberExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"] }, "extension" : [{ "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus", "valueCodeableConcept" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/584", "code" : "RU" }] } }], "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "MB" }] }, "system" : "http://example.org/MIN", "value" : "12345678901" }], "name" : [{ "family" : "SMITH", "given" : ["JOE"] }], "gender" : "male" } }] } ``` ## 响应格式 ### 成功响应 (200 OK) 您将收到一个 PAS 响应包，其中包含： + **ClaimResponse**使用`outcome: "queued"`和 `status: "active"` + 您请求中的所有原始资源 + 确认收货的时间戳 ``` { "resourceType" : "Bundle", "identifier": { "system": "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER", "value": "5269367" }, "type" : "collection", "timestamp" : "2005-05-02T11:02:00+05:00", "entry" : [{ "fullUrl" : "http://example.org/fhir/ClaimResponse/PractitionerRequestorPendingResponseExample", "resource" : { "resourceType" : "ClaimResponse", "id" : "PractitionerRequestorPendingResponseExample", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"] }, "identifier" : [{ "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER", "value" : "111099" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional" }] }, "use" : "preauthorization", "patient" : { "reference" : "Patient/SubscriberExample" }, "created" : "2005-05-02T11:02:00+05:00", "insurer" : { "reference" : "Organization/InsurerExample" }, "requestor" : { "reference" : "PractitionerRole/ReferralPractitionerRoleExample" }, "request" : { "reference" : "Claim/MedicalServicesAuthorizationExample" }, "outcome" : "queued" } }, { "fullUrl" : "http://example.org/fhir/Claim/MedicalServicesAuthorizationExample", "resource" : { "resourceType" : "Claim", "id" : "MedicalServicesAuthorizationExample", "meta" : { "profile": [ "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim|2.1.0" ] }, "identifier" : [{ "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER", "value" : "111099" } }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional" }] }, "use" : "preauthorization", "patient" : { "reference" : "Patient/SubscriberExample" }, "created" : "2005-05-02T11:01:00+05:00", "insurer" : { "reference" : "Organization/InsurerExample" }, "provider" : { "reference" : "Organization/UMOExample" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }, "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/InsuranceExample" } }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType", "valueCodeableConcept" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/1525", "code" : "IN", "display" : "Initial Medical Services Reservation" }] } }, { "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType", "valueCodeableConcept" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/1322", "code" : "I", "display" : "Initial" }] } }, { "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber", "valueString" : "1122344" }, { "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber", "valueString" : "33441122" }], "sequence" : 1, "category" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/1365", "code" : "1", "display" : "Medical Care" }] }, "productOrService" : { "coding" : [{ "system" : "http://www.cms.gov/Medicare/Coding/HCPCS​ReleaseCodeSets", "code" : "99212", "display" : "Established Office Visit" }] }, "servicedDate" : "2005-05-10", "locationCodeableConcept" : { "coding" : [{ "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set", "code" : "11" }] } }] } }, { "fullUrl" : "http://example.org/fhir/Organization/UMOExample", "resource" : { "resourceType" : "Organization", "id" : "UMOExample", "meta" : { "profile": [ "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor|2.1.0" ] }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "8189991234" }], "active" : true, "type" : [{ "coding" : [{ "system" : "https://codesystem.x12.org/005010/98", "code" : "X3" }] }], "name" : "DR. JOE SMITH CORPORATION", "address" : [{ "line" : ["111 1ST STREET"], "city" : "SAN DIEGO", "state" : "CA", "postalCode" : "92101", "country" : "US" }] } }, { "fullUrl" : "http://example.org/fhir/Organization/InsurerExample", "resource" : { "resourceType" : "Organization", "id" : "InsurerExample", "meta" : { "profile": [ "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer|2.1.0" ] }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "1234567893" }], "active" : true, "type" : [{ "coding" : [{ "system" : "https://codesystem.x12.org/005010/98", "code" : "PR" }] }], "name" : "MARYLAND CAPITAL INSURANCE COMPANY" } }, { "fullUrl" : "http://example.org/fhir/Coverage/InsuranceExample", "resource" : { "resourceType" : "Coverage", "id" : "InsuranceExample", "meta": { "profile": [ "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage|2.1.0" ] }, "status" : "active", "subscriberId" : "1122334455", "beneficiary" : { "reference" : "Patient/SubscriberExample" }, "relationship" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code" : "self" }, { "system" : "https://codesystem.x12.org/005010/1069", "code" : "18" }] }, "payor" : [{ "reference" : "Organization/InsurerExample" }] } }, { "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample", "resource" : { "resourceType" : "Patient", "id" : "SubscriberExample", "meta": { "profile": [ "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary|2.1.0" ] }, "extension" : [{ "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus", "valueCodeableConcept" : { "coding" : [{ "system" : "https://codesystem.x12.org/005010/584", "code" : "RU" }] } }], "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "MB" }] }, "system" : "http://example.org/MIN", "value" : "12345678901" }], "name" : [{ "family" : "SMITH", "given" : ["JOE"] }], "gender" : "male" } }] } ``` ## 错误响应 ### 400 错误请求 当请求格式无效或格式错误时返回。 ``` { "resourceType": "OperationOutcome", "issue": [{ "severity": "error", "code": "invalid", "diagnostics": "The provided payload was invalid and could not be parsed correctly." }] } ``` ### 412 前提条件失败 当已提交相同的事先授权请求（检测到重复提交）时返回。 ``` { "resourceType": "OperationOutcome", "issue": [{ "severity": "error", "code": "processing", "diagnostics": "PreAuth Claim already exists" }] } ``` **幂等性** 该`$submit`操作是等效的。多次提交同一个请求不会创建重复的事先授权请求。相反，你会收到一个 412 错误，指示你使用`$inquire`来检查原始提交的状态。 ### 422 无法处理的实体 当 FHIR 验证失败时返回。 ``` { "resourceType": "OperationOutcome", "issue": [{ "severity": "error", "code": "required", "diagnostics": "Bundle contains more than one preauthorization claim" }] } ``` ## 验证规则 HealthLake 对您提交的内容进行全面验证： ### 捆绑包验证 + 必须符合 PAS 请求捆绑包配置文件 + `Bundle.type`必须是 `"collection"` + 可以包含多个 Claim 资源 + 但是，必须仅包含一个可使用预授权的 Claim 资源 + 而且这个 Claim 资源必须是捆绑包中的第一个条目 + 所有引用的资源都必须包含在捆绑包中 ### 索赔验证 + 必须符合 PAS 索赔档案 + `Claim.use`必须是 `"preauthorization"` + 必填字段：`patient``insurer`、、`provider`、`created`、`priority` + 企业标识符必须存在且有效 ### 资源验证 + 所有资源都必须符合各自的 PAS 配置文件 + 必须有所需的支持资源（患者、承保范围、组织） + 交叉引用必须有效且可在 Bundle 中解析 ## 性能规格 | 指标 | 规范 | | --- | --- | | 捆绑包大小限制 | 最大 5 MB | | 资源数量限制 | 每个捆绑包 500 个资源 | ## 所需的权限 要使用该`$submit`操作，可以在 FHIR 上使用 AWS Sigv4 或 SMART： + 确保您的 IAM 角色具有：`healthlake:SubmitPreAuthClaim`-调用操作 **在 FHIR 瞄准镜上使用 S** **所需的最低范围：** + **SMART v1：**`user/Claim.write & .write` + **SMART v2：**`user/Claim.c & .c or system/*.*` ## 重要的实施说明 ### 资源持久性 + 所有 Bundle 条目都作为单独的 FHIR 资源保留在您的数据存储中 + 客户提供的信息在提供时 IDs 会被保留 + 维护版本历史记录以供审计 + 重复检测可防止资源冲突 ### 处理行为 + 每份有效的提交结果恰好是一份 ClaimResponse ，其中包含`"queued"`结果 + 无效的提交会返回 400 或 422 状态码以及详细的错误信息 + 系统错误会返回相应的 5xx 状态码 + 所有成功提交的内容都会返回 200 状态，且状态为待处理 ClaimResponse ### 捆绑包要求 + `Bundle.entry.fullUrl`值必须是 REST URLs 或`"urn:uuid:[guid]"`格式 + 所有提交内容都 GUIDs 必须是唯一的（相同的资源实例除外） + 引用的资源必须存在于捆绑包中或者可以解析 ## 相关 操作 + `Claim/$inquire`-查询已提交的事先授权请求的状态 + `Patient/$everything`-检索全面的患者数据以了解事先授权的情况