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 Claim: Referral Authorization Example

Page standards status: Informative

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