Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 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 2.0.1 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

: Homecare Authorization Bundle Example - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "HomecareAuthorizationBundleExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"
    ]
  },
  "identifier" : {
    "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
    "value" : "B56789"
  },
  "type" : "collection",
  "timestamp" : "2005-05-02T14:30:00+05:00",
  "entry" : [
    {
      "fullUrl" : "http://example.org/fhir/Claim/HomecareAuthorizationExample",
      "resource" : {
        "resourceType" : "Claim",
        "id" : "HomecareAuthorizationExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
          ]
        },
        "text" : {
          "status" : "extensions",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_HomecareAuthorizationExample\"> </a><p><b>Generated Narrative: Claim </b><a name=\"HomecareAuthorizationExample\"> </a><a name=\"hcHomecareAuthorizationExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourceClaim &quot;HomecareAuthorizationExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claim.html\">PAS Claim</a></p></div><blockquote><p><b>HomeHealthCareInformation</b></p><blockquote><p><b>url</b></p><code>prognosis</code></blockquote><p><b>value</b>: 1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (923#1)</span></p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></blockquote><p><b>value</b>: 2005-05-02</p></blockquote><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>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: See on this page: Patient/SubscriberExample</p><p><b>created</b>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: See on this page: Organization/InsurerExample</p><p><b>provider</b>: See on this page: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td>See on this page: Coverage/InsuranceExample</td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: Health Services Review <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1525#HS)</span></p><p><b>CertificationType</b>: Initial <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1322#I)</span></p><p><b>sequence</b>: 1</p><p><b>category</b>: Home Health Care <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#42)</span></p><p><b>productOrService</b>: G0154 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-hcpcs-Level-II.html\">Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes</a>#G0154)</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: Health Services Review <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1525#HS)</span></p><p><b>CertificationType</b>: Initial <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1322#I)</span></p><p><b>sequence</b>: 2</p><p><b>category</b>: Home Health Care <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#42)</span></p><p><b>productOrService</b>: B4184 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-hcpcs-Level-II.html\">Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes</a>#B4184)</span></p></blockquote></div>"
        },
        "extension" : [
          {
            "extension" : [
              {
                "url" : "prognosis",
                "valueCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/923",
                      "code" : "1"
                    }
                  ]
                }
              },
              {
                "url" : "date",
                "valueDate" : "2005-05-02"
              }
            ],
            "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation"
          }
        ],
        "identifier" : [
          {
            "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
            "value" : "111099",
            "assigner" : {
              "identifier" : {
                "system" : "http://example.org/USER_ASSIGNED",
                "value" : "9012345678"
              }
            }
          }
        ],
        "status" : "active",
        "type" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
              "code" : "professional"
            }
          ]
        },
        "use" : "preauthorization",
        "patient" : {
          🔗 "reference" : "Patient/SubscriberExample"
        },
        "created" : "2019-07-20T11:01:00+05:00",
        "insurer" : {
          🔗 "reference" : "Organization/InsurerExample"
        },
        "provider" : {
          🔗 "reference" : "Organization/UMOExample"
        },
        "priority" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
              "code" : "normal"
            }
          ]
        },
        "insurance" : [
          {
            "sequence" : 1,
            "focal" : true,
            "coverage" : {
              🔗 "reference" : "Coverage/InsuranceExample"
            }
          }
        ],
        "item" : [
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
                "valueCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/1525",
                      "code" : "HS",
                      "display" : "Health Services Review"
                    }
                  ]
                }
              },
              {
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
                "valueCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/1322",
                      "code" : "I",
                      "display" : "Initial"
                    }
                  ]
                }
              }
            ],
            "sequence" : 1,
            "category" : {
              "coding" : [
                {
                  "system" : "https://codesystem.x12.org/005010/1365",
                  "code" : "42",
                  "display" : "Home Health Care"
                }
              ]
            },
            "productOrService" : {
              "coding" : [
                {
                  "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                  "code" : "G0154"
                }
              ]
            }
          },
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
                "valueCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/1525",
                      "code" : "HS",
                      "display" : "Health Services Review"
                    }
                  ]
                }
              },
              {
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
                "valueCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/1322",
                      "code" : "I",
                      "display" : "Initial"
                    }
                  ]
                }
              }
            ],
            "sequence" : 2,
            "category" : {
              "coding" : [
                {
                  "system" : "https://codesystem.x12.org/005010/1365",
                  "code" : "42",
                  "display" : "Home Health Care"
                }
              ]
            },
            "productOrService" : {
              "coding" : [
                {
                  "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                  "code" : "B4184"
                }
              ]
            }
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/fhir/Organization/UMOExample",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "UMOExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_UMOExample\"> </a><p><b>Generated Narrative: Organization </b><a name=\"UMOExample\"> </a><a name=\"hcUMOExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourceOrganization &quot;UMOExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-requestor.html\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">NPI</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>"
        },
        "identifier" : [
          {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "8189991234"
          }
        ],
        "active" : true,
        "type" : [
          {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/98",
                "code" : "X3"
              }
            ]
          }
        ],
        "name" : "DR. JOE SMITH CORPORATION",
        "address" : [
          {
            "line" : [
              "111 1ST STREET"
            ],
            "city" : "SAN DIEGO",
            "state" : "CA",
            "postalCode" : "92101",
            "country" : "US"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/fhir/Organization/InsurerExample",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "InsurerExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_InsurerExample\"> </a><p><b>Generated Narrative: Organization </b><a name=\"InsurerExample\"> </a><a name=\"hcInsurerExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourceOrganization &quot;InsurerExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-insurer.html\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">NPI</a>/789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
        },
        "identifier" : [
          {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "789312"
          }
        ],
        "active" : true,
        "type" : [
          {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/98",
                "code" : "PR"
              }
            ]
          }
        ],
        "name" : "MARYLAND CAPITAL INSURANCE COMPANY"
      }
    },
    {
      "fullUrl" : "http://example.org/fhir/Coverage/InsuranceExample",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "InsuranceExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_InsuranceExample\"> </a><p><b>Generated Narrative: Coverage </b><a name=\"InsuranceExample\"> </a><a name=\"hcInsuranceExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourceCoverage &quot;InsuranceExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-coverage.html\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: See on this page: Patient/SubscriberExample</p><p><b>payor</b>: See on this page: Organization/InsurerExample</p></div>"
        },
        "status" : "active",
        "beneficiary" : {
          🔗 "reference" : "Patient/SubscriberExample"
        },
        "payor" : [
          {
            🔗 "reference" : "Organization/InsurerExample"
          }
        ]
      }
    },
    {
      "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "SubscriberExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
          ]
        },
        "text" : {
          "status" : "extensions",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_SubscriberExample\"> </a><p><b>Generated Narrative: Patient </b><a name=\"SubscriberExample\"> </a><a name=\"hcSubscriberExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourcePatient &quot;SubscriberExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-subscriber.html\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (584#RU)</span></p><p><b>identifier</b>: <code>http://example.org/MIN</code>/12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>"
        },
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
            "valueCodeableConcept" : {
              "coding" : [
                {
                  "system" : "https://codesystem.x12.org/005010/584",
                  "code" : "RU"
                }
              ]
            }
          }
        ],
        "identifier" : [
          {
            "system" : "http://example.org/MIN",
            "value" : "12345678901"
          }
        ],
        "name" : [
          {
            "family" : "SMITH",
            "given" : [
              "JOE"
            ]
          }
        ],
        "gender" : "male"
      }
    }
  ]
}