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](https://hl7.org/fhir/us/davinci-pas/)，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 { "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 `$submit`操作，使用者可以在 FHIR 上使用 AWS Sigv4 或 SMART： + 確保您的 IAM 角色具有：`healthlake:SubmitPreAuthClaim`- 呼叫 操作 **FHIR 範圍上的 SMART** **所需範圍下限：** + **SMART v1**： `user/Claim.write & .write` + **SMART v2**： `user/Claim.c & .c or system/*.*` ## 重要實作備註 ### 資源持久性 + 所有套件項目都會保留為資料存放區中的個別 FHIR 資源 + 客戶提供IDs 會在提供時保留 + 維護版本歷史記錄以供稽核之用 + 重複偵測可防止資源衝突 ### 處理行為 + 每個有效的提交只會產生一個 ClaimResponse `"queued"`結果 + 無效提交會傳回 400 或 422 狀態碼，其中包含詳細的錯誤資訊 + 系統錯誤會傳回適當的 5xx 狀態碼 + 所有成功的提交都會傳回 200 狀態與待定的 ClaimResponse ### 套件需求 + `Bundle.entry.fullUrl` 值必須是 REST URLs或`"urn:uuid:[guid]"`格式 + 所有 GUIDs提交之間必須是唯一的 （相同資源執行個體除外） + 參考的資源必須存在於套件中或可解析 ## 相關的 操作 + `Claim/$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