Preauthorisation enhancement

Extends an approved preauthorisation: a longer stay or an added package. The same endpoint and the same case number, under workflow 13, with the header x-hcx-use_case: Enhancement and a new correlation id.

Sent on /v1/preauth/submit, answered on /v1/preauth/on_submit, workflow 13, and 131 to answer an enhancement query.

The bundle

#	Resource	Profile
1	`Claim`	Claim
2	`Patient`	Patient
3	`Organization (prov)`	Organization
4	`Organization (pay)`	Organization
5	`Coverage`	Coverage
6	`Practitioner`	Practitioner
7	`Procedure`	Procedure
8	`Procedure`	Procedure
9	`QuestionnaireResponse`	`QuestionnaireResponse`, which NRCeS does not publish; base FHIR QuestionnaireResponse

Elements

1. Claim

NRCeS profile: Claim.

Element	Example
`identifier[]`	system `https://nhcx.abdm.gov.in`, value `NM-26-0SE00002G`
`identifier[].type.coding[]`	`CLN` Claim number in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code`
`status`	`active`
`type.coding[]`	`737481003` Inpatient care management (procedure) in `http://snomed.info/sct`
`use`	`preauthorization`
`patient`	reference `https://nhcx.abdm.gov.in/patient`
`billablePeriod`	start `2026-09-10T00:00:00+05:30`, end `2026-09-10T00:00:00+05:30`
`created`	`2026-09-10T23:50:33+05:30`
`insurer`	reference `https://nhcx.abdm.gov.in/payer`
`provider`	reference `https://nhcx.abdm.gov.in/provider`
`priority.coding[]`	`normal` Normal in `http://terminology.hl7.org/CodeSystem/processpriority`
`careTeam[]`	sequence `1`
`careTeam[].provider`	reference `https://nhcx.abdm.gov.in/practitioner`
`careTeam[].role.coding[]`	`primary` Primary provider in `http://terminology.hl7.org/CodeSystem/claimcareteamrole`
`careTeam[].qualification.coding[]`	`394802001` General medicine in `http://snomed.info/sct`
`supportingInfo[]`	id `SupportingInformation/1`, sequence `1`
	id `SupportingInformation/2`, sequence `2`
	id `SupportingInformation/3`, sequence `3`
	and 9 more
`supportingInfo[].category.coding[]`	`INV` Document Type - Investigation in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category`
	`ONS` Period, start or end dates of aspects of the Condition. (e.g. admission, discha… in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category`
	`OTH` Other in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category`
	and 1 more
`supportingInfo[].code.coding[]`	`POI` Proof of Identity (Aadhaar / Passport / Voter ID) in `https://nhcx.abdm.gov.in/document-code`
	`CER` Medical Certificate / Doctor Referral in `https://nhcx.abdm.gov.in/document-code`
	`RAD` Radiology / X-Ray / CT / MRI Scan Reports in `https://nhcx.abdm.gov.in/document-code`
	and 9 more
`supportingInfo[].valueAttachment`	contentType `application/pdf`, title `Proof of Identity (Aadhaar / Passport / Voter ID)`
	contentType `application/pdf`, title `Medical Certificate / Doctor Referral`
	contentType `application/pdf`, title `Radiology / X-Ray / CT / MRI Scan Reports`
	and 6 more
`supportingInfo[].valueReference`	reference `https://nhcx.abdm.gov.in/questionnaireresponse/1`, display `Total Knee Replacement (Unilateral), Standard Treatment Guidelines`
`diagnosis[]`	sequence `1`
`diagnosis[].diagnosisCodeableConcept.coding[]`	`E11.9` Type 2 diabetes mellitus without complications in `http://hl7.org/fhir/sid/icd-10`
`diagnosis[].type[].coding[]`	`admitting` Admitting Diagnosis in `http://terminology.hl7.org/CodeSystem/ex-diagnosistype`
`diagnosis[].onAdmission.coding[]`	`yes` Yes in `http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission`
`procedure[]`	id `Procedure/1`, sequence `1`, date `2026-09-10T00:00:00+05:30`
	id `Procedure/2`, sequence `2`, date `2026-09-10T00:00:00+05:30`
`procedure[].type[].coding[]`	`surgical` Surgical in `https://nhcx.abdm.gov.in/procedure-type`
`procedure[].procedureReference`	reference `https://nhcx.abdm.gov.in/procedure/1`, display `Total Knee Replacement (Unilateral)`
	reference `https://nhcx.abdm.gov.in/procedure/2`, display `Acute Appendectomy (Laparoscopic)`
`insurance[]`	sequence `1`, focal `true`
`insurance[].coverage`	reference `https://nhcx.abdm.gov.in/coverage`
`item[]`	id `Item/1`, sequence `1`, factor `1`, careTeamSequence `1`, diagnosisSequence `1`, procedureSequence `1`, informationSequence `1`, `2`, `3`, `4`, `5`, `6`, `7`, `8`, `9`, `10`, `11`, `12`
	id `Item/2`, sequence `2`, factor `0.5`, careTeamSequence `1`, diagnosisSequence `1`, procedureSequence `2`, informationSequence `1`, `2`, `3`, `4`, `5`, `6`, `7`, `8`, `9`, `10`, `11`, `12`
`item[].productOrService.coding[]`	`PROC-KNEE-01` Total Knee Replacement (Unilateral) in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-procedure-code`
	`PROC-APP-02` Acute Appendectomy (Laparoscopic) in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-procedure-code`
`item[].servicedPeriod`	start `2026-09-10`, end `2026-09-10`
`item[].quantity`	value `1`
`item[].unitPrice`	value `150000`, currency `INR`
	value `45000`, currency `INR`
`item[].net`	value `150000`, currency `INR`
	value `45000`, currency `INR`
`item[].category.coding[]`	`Surgical` Surgical in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-benefit-category`
`total`	value `195000`, currency `INR`

2. Patient

NRCeS profile: Patient.

Element	Example
`identifier[]`	value `MRAV1985001`
	value `91-1234-1234-1234`
`identifier[].type.coding[]`	`PMJAY` Pradhan Mantri Jan Aarogya Yojana (PMJAY) ID in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code`
	`ABHA` Ayushman Bharat Health Account (ABHA) ID in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code`
	`MB` Member Number in `http://terminology.hl7.org/CodeSystem/v2-0203`
`name[]`	text `<patient name>`
`telecom[]`	system `phone`, value `9876543210`
`gender`	`male`
`birthDate`	`1985-06-15`

3. Organization (prov)

NRCeS profile: Organization.

Element	Example
`identifier[]`	system `https://nhcx.abdm.gov.in`, value `IN1910000151`
`identifier[].type.coding[]`	`NPI` National provider identifier in `http://terminology.hl7.org/CodeSystem/v2-0203`
`type[].coding[]`	`prov` Healthcare Provider in `http://terminology.hl7.org/CodeSystem/organization-type`
`name`	`KyroCare Multispeciality Hospital`

4. Organization (pay)

NRCeS profile: Organization.

Element	Example
`identifier[]`	system `https://nhcx.abdm.gov.in`, value `1000004805`
`identifier[].type.coding[]`	`NIIP` National Insurance Payor Identifier (Payor) in `http://terminology.hl7.org/CodeSystem/v2-0203`
`type[].coding[]`	`pay` Payer in `http://terminology.hl7.org/CodeSystem/organization-type`
`name`	`Sandbox Payer`

5. Coverage

NRCeS profile: Coverage.

Element	Example
`identifier[]`	value `POL7UMU001`
`identifier[].type.coding[]`	`NH` National Health Plan Identifier in `http://terminology.hl7.org/CodeSystem/v2-0203`
`status`	`active`
`type.coding[]`	`HIP` health insurance plan policy in `http://terminology.hl7.org/CodeSystem/v3-ActCode`
`subscriber`	reference `https://nhcx.abdm.gov.in/patient`
`subscriberId`	`MRAV1985001`
`beneficiary`	reference `https://nhcx.abdm.gov.in/patient`
`relationship.coding[]`	`self` in `http://terminology.hl7.org/CodeSystem/subscriber-relationship`
`payor[]`	reference `https://nhcx.abdm.gov.in/payer`

6. Practitioner

NRCeS profile: Practitioner.

Element	Example
`identifier[]`	system `https://nhcx.abdm.gov.in`, value `71-8422-5818-7201`
	system `https://hpr.abdm.gov.in`, value `71-8422-5818-7201`
`identifier[].type.coding[]`	`HPID` Healthcare Professional ID (HPID) in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code`
	`HPIN` Health Practitioner ID issued by NDHM in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code`
`name[]`	text `Dr. Ananya Rao`
`qualification[].code.coding[]`	`MD` Doctor of Medicine in `http://terminology.hl7.org/CodeSystem/v2-0360`

7. Procedure

NRCeS profile: Procedure.

Element	Example
`status`	`preparation`
`code`	text `Total Knee Replacement (Unilateral)`
`code.coding[]`	`71388002` Procedure (procedure) in `http://snomed.info/sct`
`subject`	reference `https://nhcx.abdm.gov.in/patient`
`performedDateTime`	`2026-09-10T00:00:00+05:30`

8. Procedure

NRCeS profile: Procedure.

Element	Example
`status`	`preparation`
`code`	text `Acute Appendectomy (Laparoscopic)`
`code.coding[]`	`71388002` Procedure (procedure) in `http://snomed.info/sct`
`subject`	reference `https://nhcx.abdm.gov.in/patient`
`performedDateTime`	`2026-09-10T00:00:00+05:30`

9. QuestionnaireResponse

Element	Example
`questionnaire`	`<participant-defined>`
`status`	`completed`
`subject`	reference `https://nhcx.abdm.gov.in/patient`
`authored`	`2026-09-10T23:50:33+05:30`
`item[]`	linkId `PROC-KNEE-01/stg/1`, text `Duration of symptoms and the conservative treatment tried (months of physiother…`
	linkId `PROC-KNEE-01/stg/2`, text `Kellgren-Lawrence grade of osteoarthritis on the standing X-ray`
	linkId `PROC-KNEE-01/stg/3`, text `Range of motion and deformity of the knee (flexion contracture, varus/valgus)`
	and 2 more
`item[].answer[]`	valueString `Recorded.`

Rules

1. The protocol says enhancement, not the payload

Claim.use stays preauthorization and the case number is unchanged. The workflow code and x-hcx-use_case declare the enhancement.

2. Cumulative

Carry the approved items and the ones now sought. Claim.total is the sum of all of them.

3. No link in the payload

Claim.related is absent. The case number and your stored correlation ids are the thread.

4. One at a time

Refused when there is no approval, when a request on the case is still open, or after the claim has been raised.

5. Order

Response items can come back out of order; read by itemSequence. Order a case's messages by receipt, not by Bundle.timestamp.

PMJAY

The generic bundle above is what every payer takes, IRDAI-regulated insurers and TPAs included. PMJAY takes it with the changes and requirements below.

What changes in the bundle

Resources

PMJAY adds 1 QuestionnaireResponse.

Elements PMJAY adds

Element	Example
`Claim.item[].modifier[].coding[]`	`STRAT006a` Routine Ward
`Claim.item[].programCode[].coding[]`	`AB-PMJAY` Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in `https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-program-code`
`QuestionnaireResponse.item[].answer[].valueAttachment`	contentType `application/pdf`, title `Medical Superintendent Declaration Form (During Admission)`

What PMJAY specifies

On the response, the benefit total is the increment and the wallet's eligible total is cumulative.
The acknowledgement carries no preAuthRef. Carry the parent case id onto the enhancement yourself.
A query on an enhancement arrives on 241 and is answered by a fresh submit on 131.

What PMJAY requires

Only packages flagged EnhancementAllowed Y may be added.
One Conservative package per case. Refused with PAYR-1245.
One request at a time on a case. Refused with PAYR-1322.

Use cases, APIs and data elements

D6 Raise an enhancement (pmjay)

Adds to an approved pre-authorisation, as many times as needed until discharge, one at a time, and only for packages whose plan flag allows it. The bundle carries the approved items and the ones now sought. A query on it arrives as a ClaimResponse on 241, on the case's own thread, and is answered by a fresh submit on 131.


API	`/v1/preauth/submit` `apis/03-preauth/v1-preauth-enhancement.bru`
Callback	`/v1/preauth/on_submit` `apis/03-preauth/v1-preauth-on-submit.bru`
Workflow	13, and 131 to answer an enhancement query raised on 241
Carries JWE	yes
Focal resource	`Claim`
Simulator console	`/builder?family=preauth&usecase=enhance`

Request headers

Header	Example value
`x-hcx-sender_code`	`1000004446@hcx`
`x-hcx-recipient_code`	`1518@hcx`
`x-hcx-api_call_id`	`{{$guid}}`
`x-hcx-request_id`	`{{$guid}}`
`x-hcx-correlation_id`	`{{$guid}}`
`x-hcx-workflow_id`	`13`
`x-hcx-timestamp`	`{{$isoTimestamp}}`
`x-hcx-status`	`request.initiated`
`x-hcx-ben-abha-id`	`91711234567890`
`x-hcx-use_case`	`Enhancement`

Workflow codes

Code	Name	Authored by	`x-hcx-status`	Means
`13`	Enhancement Request Initiated	provider	`request.initiated`	Enhancement (additional amount) request
`131`	Enhancement Query Response Submitted	provider	`response.partial`, `response.error`, `response.complete`	Response to enhancement query
`241`	Enhancement Request Queried	payer	`request.initiated`	Enhancement request queried by payer

Data elements

Element	Label	Group	Type	Card.	FHIR path	Example
`claimNumber`	Case Number	Case	`string`	`1..1`	`Claim.identifier[0].value`	`VB26AA2600001`
`preAuthRef`	Initial Approval Reference	Case	`string`	`1..1`	`Claim.insurance[0].preAuthRef[0]`	`APPR-2026-HP-00891`
`workflowId`	Workflow Code	Header	`string`	`1..1`	`Header.x-hcx-workflow_id`	`13`

NRCeS profiles: Claim.

The bundle​

Elements​

1. Claim​

2. Patient​

3. Organization (prov)​

4. Organization (pay)​

5. Coverage​

6. Practitioner​

7. Procedure​

8. Procedure​

9. QuestionnaireResponse​

Rules​

1. The protocol says enhancement, not the payload​

2. Cumulative​

3. No link in the payload​

4. One at a time​

5. Order​

PMJAY​

What changes in the bundle​

Resources​

Elements PMJAY adds​

What PMJAY specifies​

What PMJAY requires​

Use cases, APIs and data elements​

D6 Raise an enhancement (pmjay)​