Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0 - STU 2.2 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 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

Example Bundle: PAS Inquiry Response Bundle Example

Language: en

Profile: PAS Inquiry Response Bundle

Bundle PASClaimInquiryResponseBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample

Resource ClaimResponse:

Language: en

Profile: PAS Claim Inquiry Response

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

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

created: 2019-07-20 11:01:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

request: Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal

outcome: complete

item

Item Requested Service Date: 2005-05-02 --> 2005-06-02

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = Member Number; status = active; subscriberId = 1122334455; relationship = Self

Entry 2 - fullUrl = http://example.org/fhir/Organization/UMOExample

Resource Organization:

Language: en

Profile: PAS Requestor Organization

identifier: United States National Provider Identifier/8189991234

active: true

type: X3

name: DR. JOE SMITH CORPORATION

Contacts

-Address
*111 1ST STREET SAN DIEGO CA 92101 US

Entry 3 - fullUrl = http://example.org/fhir/Organization/InsurerExample

Resource Organization:

Language: en

Profile: PAS Insurer Organization

identifier: United States National Provider Identifier/1234567893

active: true

type: PR

name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - fullUrl = http://example.org/fhir/Coverage/InsuranceExample

Resource Coverage:

Language: en

Profile: PAS Coverage

identifier: Member Number/?ngen-9?

status: Active

subscriberId: 1122334455

beneficiary: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

relationship: Self

Entry 5 - fullUrl = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

Language: en

Profile: PAS Subscriber Patient

JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

Military StatusRU

Entry 6 - fullUrl = http://example.org/fhir/Claim/ReferralAuthorizationExample

Resource Claim:

Language: en

Profile: PAS Claim

Level of Service Code: Urgent

Transmission Identifiers

  • applicationSenderCode: PROVIDERAPP
  • applicationReceiverCode: PAYERAPP
  • interchangeSenderID: PROVIDERID
  • interchangeReceiverID: PAYERID

identifier: urn:trnorg:9012345678/111099

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

created: 2005-05-02 11:01:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole: telecom = ph: 4029993456

SupportingInfos

-ExtensionSequenceCategoryValue[x]
*1Additional InformationDocumentReference: status = current; type = Physician procedure note; category = Clinical Note

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = Member Number; status = active; subscriberId = 1122334455; relationship = Self

item

Service Item Request Type: Specialty Care Review

Certification Type: Initial

Item Trace Number: http://example.org/ITEM_TRACE_NUMBER/1122334

Authorization Number: 1122445

Administration Reference Number: 9988311

Requested Service: ServiceRequest Consultation

EPSDT Indicator: false

Nursing Home Residential Status: Newly Admitted

Nursing Home Level of Care: Intermediate Care Facility (ICF)

Revenue Unit Rate Limit: 100

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

category: Consultation

productOrService: Consultation

location: Office