FHIR 的$submit手术 HealthLake - AWS HealthLake
工作原理API 端点请求结构示例请求响应格式错误响应验证规则性能规格所需的权限重要的实施说明相关 操作

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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》，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 <your-token>  
  
{  
  "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：patientinsurer、、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 & <all_resourceTypes_in_Bundle>.write

  • SMART v2：user/Claim.c & <all_resourceTypes_in_Bundle>.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

  • 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