Da Vinci Health Record Exchange (HRex)
1.1.0-preview - STU R1 United States of America flag

Da Vinci Health Record Exchange (HRex), published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 1.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ehrx/ and changes regularly. See the Directory of published versions

Example ClaimResponse: Unsolicited Prior Authorization example

Page standards status: Informative

Generated Narrative: ClaimResponse

Resource ClaimResponse "UnsolicitedReferralAuthorizationResponseExample"

Profile: HRex Prior authorization

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: http://example.org/new-payer/fhir/Patient/pat1

created: 2005-05-02 11:02:00+0500

insurer: Organization/full "New Health Plan"

requestor: http://example.org/someProvider/fhir/Organization/good-health-clinic

outcome: complete

preAuthRef: A1B2C3D4


Authorized Date: 2005-05-02 --> 2005-06-02

Pre Authorized Issue Date: 2005-05-02

Authorized Provider: Practitioner/full " BONE"

Item Trace Number: http://example.org/new-payer/fhir/NamingSystem/auth-numbers/A1B2C3D4

itemSequence: 1

productOrService: Consultation (1365#3)

location: 11 (CMS Place of Service Codes (POS)#11)


*Submitted Amount (Adjudication Value Codes#submitted)