Da Vinci Health Record Exchange (HRex)
1.1.0 - STU 1.1 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 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

: Unsolicited Prior Authorization example - TTL Representation

Page standards status: Informative

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "UnsolicitedReferralAuthorizationResponseExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse UnsolicitedReferralAuthorizationResponseExample</b></p><a name=\"UnsolicitedReferralAuthorizationResponseExample\"> </a><a name=\"hcUnsolicitedReferralAuthorizationResponseExample\"> </a><a name=\"UnsolicitedReferralAuthorizationResponseExample-en-US\"> </a><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v700@7.0.0&amp;canonical=http://example.org/new-payer/fhir/Patient/pat1\">??</a></p><p><b>created</b>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-full.html\">Organization New Health Plan</a></p><p><b>requestor</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v700@7.0.0&amp;canonical=http://example.org/someProvider/fhir/Organization/good-health-clinic\">??</a></p><p><b>outcome</b>: Processing Complete</p><p><b>preAuthRef</b>: A1B2C3D4</p><blockquote><p><b>addItem</b></p><p><b>Authorized Date</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>Pre Authorized Issue Date</b>: 2005-05-02</p><p><b>Authorized Provider</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v700@7.0.0&amp;canonical=http://example.org/ehr/fhir/Practitioner/pract1\">??</a></p><p><b>Item Trace Number</b>: <code>http://example.org/new-payer/fhir/NamingSystem/auth-numbers</code>/A1B2C3D4</p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">11</span></p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
fhir:value [ fhir:v "111099" ] ;
fhir:assigner [
fhir:identifier [
fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
fhir:value [ fhir:v "9012345678" ]       ]     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "professional" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
fhir:link <http://example.org/new-payer/fhir/Patient/pat1> ;
fhir:reference [ fhir:v "http://example.org/new-payer/fhir/Patient/pat1" ]
  ] ; # 
  fhir:created [ fhir:v "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/full" ]
  ] ; # 
  fhir:requestor [
fhir:link <http://example.org/someProvider/fhir/Organization/good-health-clinic> ;
fhir:reference [ fhir:v "http://example.org/someProvider/fhir/Organization/good-health-clinic" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:preAuthRef [ fhir:v "A1B2C3D4"] ; # 
  fhir:addItem ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate"^^xsd:anyURI ] ;
fhir:value [
a fhir:Period ;
fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ;
fhir:end [ fhir:v "2005-06-02"^^xsd:date ]       ]     ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2005-05-02"^^xsd:date ]     ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:link <http://example.org/ehr/fhir/Practitioner/pract1> ;
fhir:reference [ fhir:v "http://example.org/ehr/fhir/Practitioner/pract1" ]       ]     ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ] ;
fhir:value [
a fhir:Identifier ;
fhir:system [ fhir:v "http://example.org/new-payer/fhir/NamingSystem/auth-numbers"^^xsd:anyURI ] ;
fhir:value [ fhir:v "A1B2C3D4" ]       ]     ] ) ;
    ( fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "http://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
fhir:code [ fhir:v "3" ] ;
fhir:display [ fhir:v "Consultation" ]       ] )     ] ;
fhir:location [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
fhir:code [ fhir:v "11" ]       ] )     ] ;
    ( fhir:adjudication [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "submitted" ]         ] )       ]     ] )
  ] ) . #