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

Example Bundle: PAS Inquiry Request Bundle Example

Bundle PASClaimInquiryBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/Claim/PASClaimInquiryExample

Resource Claim:

Generated Narrative: Claim

ResourceClaim "PASClaimInquiryExample"

Profile: PAS Claim Inquiry

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

status: ACTIVE

type: Professional (Claim Type Codes#professional)

use: PREAUTHORIZATION

patient: See on this page: Patient/SubscriberExample

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

insurer: See on this page: Organization/InsurerExample

provider: See on this page: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

Insurances

-SequenceFocalCoverage
*1trueSee on this page: Coverage/InsuranceExample

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

sequence: 1

productOrService: G0154 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#G0154)

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

CertificationIssueDate: 2019-07-01

CertificationEffectiveDate: 2019-07-01

CertificationExpirationDate: 2019-07-31

ReviewActionCode: Certified in total (306#A1)

ProductOrServiceCodeEnd: B4190 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#B4190)

sequence: 2

productOrService: B4184 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#B4184)

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

Resource Organization:

Generated Narrative: Organization

ResourceOrganization "UMOExample"

Profile: PAS Requestor Organization

identifier: NPI/8189991234

active: true

type: X3 (98#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:

Generated Narrative: Organization

ResourceOrganization "InsurerExample"

Profile: PAS Insurer Organization

identifier: NPI/789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

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

Resource Coverage:

Generated Narrative: Coverage

ResourceCoverage "InsuranceExample"

Profile: PAS Coverage

status: ACTIVE

beneficiary: See on this page: Patient/SubscriberExample

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

Resource Patient:

Anonymous Patient Male, DoB: ( http://example.org/MIN#12345678901)