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Packagehl7.fhir.uv.aitransparency
Resource TypeProvenance
IdProvenance-AI-PriorAuth-Provenance.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Provenance AI-PriorAuth-Provenance

Profile: AI Provenance

Provenance for ClaimResponse: status = active; type = Professional; use = preauthorization; created = 2026-02-10 09:15:00+0000; outcome = complete; disposition = Prior authorization approved for the requested MRI of the lumbar spine based on the submitted clinical documentation and the plan's medical-necessity criteria.; preAuthRef = PA-2026-0099

Summary

Occurrence2026-02-10 09:15:00+0000
Recorded2026-02-10 09:20:00+0000
ActivityAI drafted prior-authorization determination, verified by a utilization reviewer

Agents

Typewho
Verifierhttp://server.example.org/fhir/Practitioner/utilization-reviewer
AuthorDevice: extension = Large Language Models; identifier = http://example.org/ehr/client-ids#goodhealth; manufacturer = Acme Devices, Inc; type = All kinds of Artificial Intelligence; contact = http://example.org

Source1

{
  "resourceType": "Provenance",
  "id": "AI-PriorAuth-Provenance",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/aitransparency/StructureDefinition/AI-Provenance"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "target": [
    {
      "reference": "ClaimResponse/AI-PriorAuth-Determination"
    }
  ],
  "occurredDateTime": "2026-02-10T09:15:00Z",
  "recorded": "2026-02-10T09:20:00Z",
  "reason": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
          "code": "AIAST"
        }
      ]
    }
  ],
  "activity": {
    "text": "AI drafted prior-authorization determination, verified by a utilization reviewer"
  },
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "verifier",
            "display": "Verifier"
          }
        ]
      },
      "who": {
        "reference": "http://server.example.org/fhir/Practitioner/utilization-reviewer"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "author",
            "display": "Author"
          }
        ]
      },
      "who": {
        "reference": "Device/TheAI"
      }
    }
  ],
  "entity": [
    {
      "role": "source",
      "what": {
        "reference": "http://server.example.org/fhir/Claim/priorauth-mri-request"
      }
    }
  ]
}