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HealthLake 的 FHIR $submit操作 - AWS HealthLake
運作方式API 端點請求結構範例請求回應格式錯誤回應驗證規則效能規格所需的許可重要實作備註相關的 操作

本文為英文版的機器翻譯版本，如內容有任何歧義或不一致之處，概以英文版為準。

HealthLake 的 FHIR $submit操作

$submit 此操作可讓您以電子方式提交預先授權請求給付款人以進行核准。此操作實作 Da Vinci 預先授權支援 (PAS) 實作指南，為預先授權提交提供標準化的 FHIR 工作流程。

運作方式

  • 提交：您傳送 FHIR 套件，其中包含您的預先授權請求和支援的臨床資料

  • 驗證：HealthLake 會根據 PAS 要求驗證提交

  • 持久性：所有資源都存放在 HealthLake 資料存放區中

  • 回應：您立即收到「佇列」狀態的回應

  • 程序：由付款人非同步處理授權決策

API 端點

POST /datastore/{datastoreId}/r4/Claim/$submit  
Content-Type: application/fhir+json

請求結構

套件需求

您的請求必須是具有下列項目的 FHIR 套件資源：

  • Bundle.type：必須為 "collection"

  • Bundle.entry：必須包含一個具有 的宣告資源 use = "preauthorization"

  • 參考資源： 宣告參考的所有資源必須包含在套件中

必要的資源

資源 基數 設定檔 Description
宣告 1 PAS 宣告 預先授權請求
病患 1 PAS 病患 病患人口統計資訊
Organization （保險業者） 1 PAS Insurer 保險公司
Organization （提供者） 1 PAS 請求者 提交請求的醫療保健供應商
涵蓋範圍 1 個或多個 PAS 涵蓋範圍 保險涵蓋範圍詳細資訊

選用資源

資源 基數 設定檔 Description
從業人員 0 或以上 PAS 從業人員 醫療保健從業人員
PractitionerRole 0 或以上 PAS PractitionerRole 從業人員角色
ServiceRequest 0 或以上 PAS ServiceRequest 請求的醫療保健
DeviceRequest 0 或以上 PAS DeviceRequest 請求的醫療設備
MedicationRequest 0 或以上 PAS MedicationRequest 請求的藥品
DocumentReference 0 或以上 PAS DocumentReference 支援臨床文件

範例請求

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"  
    }  
  }]  
}

回應格式

成功回應 (200 OK)

您將會收到 PAS 回應套件，其中包含：

  • 使用 outcome: "queued"和 的 ClaimResponse status: "active"

  • 請求中的所有原始資源

  • 確認接收的時間戳記

{  
  "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"  
    }  
  }]  
}

錯誤回應

400 錯誤的請求

當請求格式無效或格式不正確時傳回。

{  
  "resourceType": "OperationOutcome",  
  "issue": [{  
    "severity": "error",  
    "code": "invalid",  
    "diagnostics": "The provided payload was invalid and could not be parsed correctly."  
  }]  
}

412 先決條件失敗

已提交相同的預先授權請求時傳回 （偵測到重複提交）。

{  
  "resourceType": "OperationOutcome",  
  "issue": [{  
    "severity": "error",  
    "code": "processing",  
    "diagnostics": "PreAuth Claim already exists"  
  }]  
}
冪等性

$submit 操作是等冪的。多次提交相同的請求不會建立重複的預先授權請求。反之，您會收到 412 錯誤，指示您使用 $inquire來檢查原始提交的狀態。

422 無法處理的實體

FHIR 驗證失敗時傳回。

{  
  "resourceType": "OperationOutcome",  
  "issue": [{  
    "severity": "error",  
    "code": "required",  
    "diagnostics": "Bundle contains more than one preauthorization claim"  
  }]  
}

驗證規則

HealthLake 會對您的提交執行全面的驗證：

套件驗證

  • 必須符合 PAS 請求套件描述檔

  • Bundle.type 必須 "collection"

  • 可以包含多個宣告資源

  • 不過， 必須包含一個具有預先授權使用的宣告資源

    • 此宣告資源必須是套件中的第一個項目

  • 套件中必須包含所有參考的資源

宣告驗證

  • 必須符合 PAS 宣告描述檔

  • Claim.use 必須 "preauthorization"

  • 必要欄位：patient、insurer、provider、created、 priority

  • 業務識別符必須存在且有效

資源驗證

  • 所有資源必須符合其各自的 PAS 設定檔

  • 必要的支援資源必須存在 （病患、涵蓋範圍、組織）

  • 交互參考在套件中必須是有效且可解析的

效能規格

指標 規格
套件大小限制 最多 5 MB
資源計數限制 每個套件 500 個資源

所需的許可

若要使用 $submit操作，使用者可以在 FHIR 上使用 AWS Sigv4 或 SMART：

  • 確保您的 IAM 角色具有：healthlake:SubmitPreAuthClaim- 呼叫 操作

FHIR 範圍上的 SMART

所需範圍下限：

  • SMART v1： user/Claim.write & <all_resourceTypes_in_Bundle>.write

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

重要實作備註

資源持久性

  • 所有套件項目都會保留為資料存放區中的個別 FHIR 資源

  • 客戶提供IDs 會在提供時保留

  • 維護版本歷史記錄以供稽核之用

  • 重複偵測可防止資源衝突

處理行為

  • 每個有效的提交只會產生一個 ClaimResponse "queued"結果

  • 無效提交會傳回 400 或 422 狀態碼，其中包含詳細的錯誤資訊

  • 系統錯誤會傳回適當的 5xx 狀態碼

  • 所有成功的提交都會傳回 200 狀態與待定的 ClaimResponse

套件需求

  • Bundle.entry.fullUrl 值必須是 REST URLs或"urn:uuid:[guid]"格式

  • 所有 GUIDs提交之間必須是唯一的 （相同資源執行個體除外）

  • 參考的資源必須存在於套件中或可解析

  • Claim/$inquire - 查詢提交的預先授權請求的狀態

  • Patient/$everything - 針對預先授權內容擷取完整的患者資料