Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-snapshot - STU 2.2 - Public Review
Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-snapshot - STU 2.2 - Public Review
Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-snapshot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions
<Parameters xmlns="http://hl7.org/fhir">
<id value="PASClaimInquiryOperationResponseExample"/>
<language value="en"/>
<parameter>
<name value="responseBundle"/>
<resource>
<Bundle>
<id value="PASClaimInquiryResponseBundleExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle"/>
</meta>
<language value="en"/>
<identifier>
<system
value="http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"/>
<value value="5269367"/>
</identifier>
<type value="collection"/>
<timestamp value="2005-05-02T11:01:00+05:00"/>
<entry>
<fullUrl
value="http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample"/>
<resource>
<ClaimResponse>
<id value="PASClaimInquiryResponseExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse"/>
</meta>
<language value="en"/>
<identifier>
<system
value="http://example.org/PATIENT_EVENT_TRACE_NUMBER"/>
<value value="111099"/>
<assigner>
<identifier>
<system value="http://example.org/USER_ASSIGNED"/>
<value value="9012345678"/>
</identifier>
</assigner>
</identifier>
<status value="active"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
</coding>
</type>
<use value="preauthorization"/>
<patient>🔗
<reference value="Patient/SubscriberExample"/>
</patient>
<created value="2019-07-20T11:01:00+05:00"/>
<insurer>🔗
<reference value="Organization/InsurerExample"/>
</insurer>
<request>🔗
<reference value="Claim/ReferralAuthorizationExample"/>
</request>
<outcome value="complete"/>
<item>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate">
<valuePeriod>
<start value="2005-05-02"/>
<end value="2005-06-02"/>
</valuePeriod>
</extension>
<itemSequence value="1"/>
<adjudication>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction">
<extension url="number">
<valueString value="AUTH0001"/>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode">
<valueCodeableConcept>
<coding>
<system
value="https://codesystem.x12.org/005010/306"/>
<code value="A1"/>
<display value="Certified in total"/>
</coding>
</valueCodeableConcept>
</extension>
</extension>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="submitted"/>
</coding>
</category>
</adjudication>
</item>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/InsuranceExample"/>
</coverage>
</insurance>
</ClaimResponse>
</resource>
</entry>
<entry>
<fullUrl value="http://example.org/fhir/Organization/UMOExample"/>
<resource>
<Organization>
<id value="UMOExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"/>
</meta>
<language value="en"/>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="8189991234"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system value="https://codesystem.x12.org/005010/98"/>
<code value="X3"/>
</coding>
</type>
<name value="DR. JOE SMITH CORPORATION"/>
<address>
<line value="111 1ST STREET"/>
<city value="SAN DIEGO"/>
<state value="CA"/>
<postalCode value="92101"/>
<country value="US"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Organization/InsurerExample"/>
<resource>
<Organization>
<id value="InsurerExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"/>
</meta>
<language value="en"/>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system value="https://codesystem.x12.org/005010/98"/>
<code value="PR"/>
</coding>
</type>
<name value="MARYLAND CAPITAL INSURANCE COMPANY"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="http://example.org/fhir/Coverage/InsuranceExample"/>
<resource>
<Coverage>
<id value="InsuranceExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"/>
</meta>
<language value="en"/>
<status value="active"/>
<subscriberId value="1122334455"/>
<beneficiary>🔗
<reference value="Patient/SubscriberExample"/>
</beneficiary>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
</coding>
<coding>
<system value="https://codesystem.x12.org/005010/1069"/>
<code value="18"/>
</coding>
</relationship>
<payor>🔗
<reference value="Organization/InsurerExample"/>
</payor>
</Coverage>
</resource>
</entry>
<entry>
<fullUrl value="http://example.org/fhir/Patient/SubscriberExample"/>
<resource>
<Patient>
<id value="SubscriberExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"/>
</meta>
<language value="en"/>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus">
<valueCodeableConcept>
<coding>
<system value="https://codesystem.x12.org/005010/584"/>
<code value="RU"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<system value="http://example.org/MIN"/>
<value value="12345678901"/>
</identifier>
<name>
<family value="SMITH"/>
<given value="JOE"/>
</name>
<gender value="male"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/fhir/Claim/ReferralAuthorizationExample"/>
<resource>
<Claim>
<id value="ReferralAuthorizationExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"/>
</meta>
<language value="en"/>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode">
<valueCodeableConcept>
<coding>
<system value="https://codesystem.x12.org/005010/1338"/>
<code value="U"/>
<display value="Urgent"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers">
<extension url="applicationSenderCode">
<valueString value="PROVIDERAPP"/>
</extension>
<extension url="applicationReceiverCode">
<valueString value="PAYERAPP"/>
</extension>
<extension url="interchangeSenderID">
<valueString value="PROVIDERID"/>
</extension>
<extension url="interchangeReceiverID">
<valueString value="PAYERID"/>
</extension>
</extension>
<identifier>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction">
<valueCodeableConcept>
<coding>
<system value="https://www.usps.com/"/>
<code value="MA"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment">
<valueString value="223412"/>
</extension>
<system value="urn:trnorg:9012345678"/>
<value value="111099"/>
<assigner>
<identifier>
<system value="http://example.org/USER_ASSIGNED"/>
<value value="9012345678"/>
</identifier>
</assigner>
</identifier>
<status value="active"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
</coding>
</type>
<use value="preauthorization"/>
<patient>🔗
<reference value="Patient/SubscriberExample"/>
</patient>
<created value="2005-05-02T11:01:00+05:00"/>
<insurer>🔗
<reference value="Organization/InsurerExample"/>
</insurer>
<provider>🔗
<reference value="Organization/UMOExample"/>
</provider>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
</coding>
</priority>
<careTeam>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope">
<valueBoolean value="true"/>
</extension>
<sequence value="1"/>
<provider>🔗
<reference
value="PractitionerRole/ReferralPractitionerRoleExample"/>
</provider>
</careTeam>
<supportingInfo>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation">
<extension url="reportTypeCode">
<valueCodeableConcept>
<coding>
<system
value="https://codesystem.x12.org/005010/755"/>
<code value="PY"/>
<display value="Physician's Report"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="transmissionMethod">
<valueCodeableConcept>
<coding>
<system
value="https://codesystem.x12.org/005010/756"/>
<code value="EL"/>
<display value="Electronically Only"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="controlNumber">
<valueString value="111222"/>
</extension>
<extension url="description">
<valueString
value="A procedure note included to provide details of what has been tried before the referral."/>
</extension>
</extension>
<sequence value="1"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
<code value="additionalInformation"/>
</coding>
</category>
<valueReference>🔗
<reference
value="DocumentReference/DocumentReferenceExample"/>
</valueReference>
</supportingInfo>
<diagnosis>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate">
<valueDate value="2021-05-10"/>
</extension>
<sequence value="1"/>
<diagnosisCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="G89.4"/>
</coding>
</diagnosisCodeableConcept>
</diagnosis>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/InsuranceExample"/>
</coverage>
</insurance>
<item>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType">
<valueCodeableConcept>
<coding>
<system value="https://codesystem.x12.org/005010/1525"/>
<code value="SC"/>
<display value="Specialty Care Review"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType">
<valueCodeableConcept>
<coding>
<system value="https://codesystem.x12.org/005010/1322"/>
<code value="I"/>
<display value="Initial"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber">
<valueIdentifier>
<system value="http://example.org/ITEM_TRACE_NUMBER"/>
<value value="1122334"/>
</valueIdentifier>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber">
<valueString value="1122445"/>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber">
<valueString value="9988311"/>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService">
<valueReference>🔗
<reference value="ServiceRequest/ReferralRequestExample"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator">
<valueBoolean value="false"/>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus">
<valueCodeableConcept>
<coding>
<system value="https://codesystem.x12.org/005010/1345"/>
<code value="2"/>
<display value="Newly Admitted"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare">
<valueCodeableConcept>
<coding>
<system value="https://codesystem.x12.org/005010/1337"/>
<code value="2"/>
<display value="Intermediate Care Facility (ICF)"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit">
<valueDecimal value="100"/>
</extension>
<sequence value="1"/>
<careTeamSequence value="1"/>
<diagnosisSequence value="1"/>
<category>
<coding>
<system value="https://codesystem.x12.org/005010/1365"/>
<code value="3"/>
<display value="Consultation"/>
</coding>
</category>
<productOrService>
<coding>
<system value="https://codesystem.x12.org/005010/1365"/>
<code value="3"/>
<display value="Consultation"/>
</coding>
</productOrService>
<locationCodeableConcept>
<coding>
<system
value="https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"/>
<code value="11"/>
</coding>
</locationCodeableConcept>
</item>
</Claim>
</resource>
</entry>
</Bundle>
</resource>
</parameter>
</Parameters>
IG © 2020+ HL7 International / Financial Management.
Package hl7.fhir.us.davinci-pas#2.2.0-snapshot based on FHIR 4.0.1.
Generated
2026-01-30
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