Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-snapshot - STU 2.2 - Public Review United States of America flag

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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Prior Authorization Implementation Guide Home Page
... 2 Technical Background
... 3 Use Cases and Overview
... 4 Credits
... 5 PAS ePA Coordinator Information
... 6 Conformance
... 7 Conformance Expectations
... 8 Formal Specification
... 9 Request for Additional Information
... 10 HIPAA Regulations
... 11 Privacy & Security
... 12 PAS Metrics
... 13 Artifacts Overview
... 14 PAS Terminology
... 15 Downloads
... 16 Change Log
... 17 Artifacts Summary
.... 17.1 PAS Client
.... 17.2 PAS Payer
.... 17.3 Narrative Conformance Statements
.... 17.4 EHR PAS Capabilities
.... 17.5 Intermediary PAS Capabilities
.... 17.6 Search for a Prior Authorization Response by example
.... 17.7 Submit a Prior Authorization Request for adjudication
.... 17.8 PAS Subscription Topic
.... 17.9 PAS Metric Data
.... 17.10 PAS Claim Base
.... 17.11 PAS Claim Response Base
.... 17.12 PAS Organization Base Profile
.... 17.13 PAS Beneficiary Patient
.... 17.14 PAS Claim
.... 17.15 PAS Claim Inquiry
.... 17.16 PAS Claim Inquiry Response
.... 17.17 PAS Claim Response
.... 17.18 PAS Claim Update
.... 17.19 PAS CommunicationRequest
.... 17.20 PAS Coverage
.... 17.21 PAS Device Request
.... 17.22 PAS Document Reference
.... 17.23 PAS Encounter
.... 17.24 PAS Inquiry Request Bundle
.... 17.25 PAS Inquiry Response Bundle
.... 17.26 PAS Insurer Organization
.... 17.27 PAS Location Profile
.... 17.28 PAS Medication Request
.... 17.29 PAS Nutrition Order
.... 17.30 PAS Practitioner
.... 17.31 PAS PractitionerRole
.... 17.32 PAS Request Bundle
.... 17.33 PAS Requestor Organization
.... 17.34 PAS Response Bundle
.... 17.35 PAS Service Request
.... 17.36 PAS Subscriber Patient
.... 17.37 PAS Subscription
.... 17.38 PAS Task
.... 17.39 PAS Identifier
.... 17.40 PAS Quantity
.... 17.41 PAS Timing
.... 17.42 AdministrationReferenceNumber
.... 17.43 AdmissionDates
.... 17.44 AuthorizationNumber
.... 17.45 AuthorizedProviderType
.... 17.46 CalendarPattern
.... 17.47 CareTeamClaimScope
.... 17.48 CertificationEffectiveDate
.... 17.49 CertificationExpirationDate
.... 17.50 CertificationIssueDate
.... 17.51 CertificationType
.... 17.52 ClaimResponseItemCategory
.... 17.53 ClaimResponseReviewer
.... 17.54 CommunicatedDiagnosis
.... 17.55 ConditionCode
.... 17.56 ContentModifier
.... 17.57 DeliveryPattern
.... 17.58 DiagnosisRecordedDate
.... 17.59 DischargeDate
.... 17.60 DocumentInformation
.... 17.61 EPSDTIndicator
.... 17.62 ErrorElement
.... 17.63 ErrorFollowupAction
.... 17.64 ErrorPath
.... 17.65 HomeHealthCareInformation
.... 17.66 IdentifierJurisdiction
.... 17.67 IdentifierSubDepartment
.... 17.68 InfoCancelledFlag
.... 17.69 InfoChanged
.... 17.70 ItemAuthorizedDetail
.... 17.71 ItemAuthorizedProvider
.... 17.72 ItemPreAuthIssueDate
.... 17.73 ItemPreAuthPeriod
.... 17.74 ItemRequestedServiceDate
.... 17.75 ItemTraceNumber
.... 17.76 LevelOfServiceCode
.... 17.77 MilitaryStatus
.... 17.78 NursingHomeLevelOfCare
.... 17.79 NursingHomeResidentialStatus
.... 17.80 PatientStatus
.... 17.81 ProductOrServiceCodeEnd
.... 17.82 RequestedService
.... 17.83 RevenueCode
.... 17.84 RevenueUnitRateLimit
.... 17.85 ReviewAction
.... 17.86 ReviewActionCode
.... 17.87 ServiceItemRequestType
.... 17.88 ServiceLineNumber
.... 17.89 TransmissionIdentifiers
.... 17.90 AHA NUBC Revenue Value Set
.... 17.91 Claim Response Outcome
.... 17.92 Claim Types
.... 17.93 Metric Data Source
.... 17.94 PAS Communication Medium Value Set
.... 17.95 PAS Conformance Statement Categories
.... 17.96 PAS Information Change Mode Value Set
.... 17.97 PAS LOINC Attachment Codes Value Set
.... 17.98 PAS PWK01 Attachment Report Type Code Value Set
.... 17.99 PAS Supporting Info Type Value Set
.... 17.100 PAS Task Codes
.... 17.101 X12 278 CRC Condition Category
.... 17.102 X12 278 CRC Condition Code
.... 17.103 X12 278 Diagnosis Code Value Set
.... 17.104 X12 278 Diagnosis Information Type
.... 17.105 X12 278 Diagnosis Type Value Set
.... 17.106 X12 278 Follow Up Action Value Set
.... 17.107 X12 278 Health Care Service Location Type Value Set
.... 17.108 X12 278 Nutrition Enteral Formula Type
.... 17.109 X12 278 Nutrition Oral Diet Type
.... 17.110 X12 278 Reject Reason Value Set
.... 17.111 X12 278 Requested Service Modifier Type
.... 17.112 X12 278 Requested Service Type
.... 17.113 X12 278 Review Decision Reason Codes
.... 17.114 PAS Temporary Codes
.... 17.115 Additional Information Task Example
.... 17.116 Authorization Response with Practitioner Requestor and Additional Content Example
.... 17.117 Authorization Response with Practitioner Requestor Example
.... 17.118 Communication Request Example
.... 17.119 Device Request Example
.... 17.120 Encounter Example
.... 17.121 Error Response Bundle Example
.... 17.122 Error Response Example
.... 17.123 Homecare Authorization Bundle Example
.... 17.124 Homecare Authorization Example
.... 17.125 Homecare Authorization Update Bundle Example
.... 17.126 Homecare Authorization Update Example
.... 17.127 Invalid Request Response
.... 17.128 Medical Services Authorization Bundle Example
.... 17.129 Medical Services Authorization Example
.... 17.130 Medication Request Example
.... 17.131 Nutrition Order Example
.... 17.132 PAS Claim Inquiry Example
.... 17.133 PAS Claim Inquiry ResponseExample
.... 17.134 PAS Document Reference Example
.... 17.135 PAS Inquiry Operation Response Example
.... 17.136 PAS Inquiry Request Bundle Example
.... 17.137 PAS Inquiry Response Bundle Example
.... 17.138 PAS Subscription example for a specific provider
.... 17.139 PAS Subscription Notification example
.... 17.140 PAS Subscription Notification Parameters
.... 17.141 Pending Authorization Response with Practitioner Requestor Example
.... 17.142 Referral Authorization Bundle Example
.... 17.143 Referral Authorization Example
.... 17.144 Referral Authorization Response Bundle Example
.... 17.145 Referral Pending Authorization Response Bundle Example
.... 17.146 Rejection Response Bundle Example
.... 17.147 Rejection Response Example
.... 17.148 Submit Claim Beneficiary Example
.... 17.149 Submit Claim Insurance Example
.... 17.150 Submit Claim Insurer Example
.... 17.151 Submit Claim Referral Location Example
.... 17.152 Submit Claim Referral Practitioner Example
.... 17.153 Submit Claim Referral Practitioner Role Example
.... 17.154 Submit Claim Referral Request Example
.... 17.155 Submit Claim Requestor Example
.... 17.156 Submit Claim Subscriber Example
.... 17.157 Submit Claim Surgical Location Example
.... 17.158 Submit Claim Surgical Practitioner Example
.... 17.159 Submit Claim Surgical Practitioner Role Example
.... 17.160 Surgical Admission Request Bundle Example
.... 17.161 Surgical Request Authorization Example