Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - STU 2
Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - STU 2
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 2.1.0-preview 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
@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:Bundle ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "PASClaimInquiryResponseBundleExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle> ] ) ] ; # fhir:identifier [ fhir:system [ fhir:v "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"^^xsd:anyURI ] ; fhir:value [ fhir:v "5269367" ] ] ; # fhir:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2005-05-02T11:01:00+05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/UMOExample"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/UMOExample> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/InsurerExample"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/InsurerExample> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/InsuranceExample"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Coverage/InsuranceExample> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/SubscriberExample"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Patient/SubscriberExample> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/ReferralAuthorizationExample"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Claim/ReferralAuthorizationExample> ) ] ) . # <http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample> a fhir:ClaimResponse ; fhir:id [ fhir:v "PASClaimInquiryResponseExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_PASClaimInquiryResponseExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse PASClaimInquiryResponseExample</b></p><a name=\"PASClaimInquiryResponseExample\"> </a><a name=\"hcPASClaimInquiryResponseExample\"> </a><a name=\"PASClaimInquiryResponseExample-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=\"Patient-SubscriberExample.html\">JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>request</b>: <a href=\"Claim-ReferralAuthorizationExample.html\">Claim: extension = Urgent; identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>ItemRequestedServiceDate</b>: 2005-05-02 --> 2005-06-02</p><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote><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><a href=\"Coverage-InsuranceExample.html\">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table></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:reference [ fhir:v "Patient/SubscriberExample" ] ] ; # fhir:created [ fhir:v "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/InsurerExample" ] ] ; # fhir:request [ fhir:reference [ fhir:v "Claim/ReferralAuthorizationExample" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:item ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate"^^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:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ; ( fhir:adjudication [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "number"^^xsd:anyURI ] ; fhir:value [ fhir:v "AUTH0001" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/306"^^xsd:anyURI ] ; fhir:code [ fhir:v "A1" ] ; fhir:display [ fhir:v "Certified in total" ] ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"^^xsd:anyURI ] ] ) ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "submitted" ] ] ) ] ] ) ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/InsuranceExample" ] ] ] ) . # <http://example.org/fhir/Organization/UMOExample> a fhir:Organization ; fhir:id [ fhir:v "UMOExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_UMOExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization UMOExample</b></p><a name=\"UMOExample\"> </a><a name=\"hcUMOExample\"> </a><a name=\"UMOExample-en-US\"> </a><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 X3}\">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>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "8189991234" ] ] ) ; # fhir:active [ fhir:v "true"^^xsd:boolean] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ] ; fhir:code [ fhir:v "X3" ] ] ) ] ) ; # fhir:name [ fhir:v "DR. JOE SMITH CORPORATION"] ; # fhir:address ( [ ( fhir:line [ fhir:v "111 1ST STREET" ] ) ; fhir:city [ fhir:v "SAN DIEGO" ] ; fhir:state [ fhir:v "CA" ] ; fhir:postalCode [ fhir:v "92101" ] ; fhir:country [ fhir:v "US" ] ] ) . # <http://example.org/fhir/Organization/InsurerExample> a fhir:Organization ; fhir:id [ fhir:v "InsurerExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_InsurerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization InsurerExample</b></p><a name=\"InsurerExample\"> </a><a name=\"hcInsurerExample\"> </a><a name=\"InsurerExample-en-US\"> </a><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 PR}\">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "1234567893" ] ] ) ; # fhir:active [ fhir:v "true"^^xsd:boolean] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ] ; fhir:code [ fhir:v "PR" ] ] ) ] ) ; # fhir:name [ fhir:v "MARYLAND CAPITAL INSURANCE COMPANY"] . # <http://example.org/fhir/Coverage/InsuranceExample> a fhir:Coverage ; fhir:id [ fhir:v "InsuranceExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_InsuranceExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage InsuranceExample</b></p><a name=\"InsuranceExample\"> </a><a name=\"hcInsuranceExample\"> </a><a name=\"InsuranceExample-en-US\"> </a><p><b>status</b>: Active</p><p><b>subscriberId</b>: 1122334455</p><p><b>beneficiary</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}, {https://codesystem.x12.org/005010/1069 18}\">Self</span></p><p><b>payor</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>" ] ; # fhir:status [ fhir:v "active"] ; # fhir:subscriberId [ fhir:v "1122334455"] ; # fhir:beneficiary [ fhir:reference [ fhir:v "Patient/SubscriberExample" ] ] ; # fhir:relationship [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ; fhir:code [ fhir:v "self" ] ] [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1069"^^xsd:anyURI ] ; fhir:code [ fhir:v "18" ] ] ) ] ; # fhir:payor ( [ fhir:reference [ fhir:v "Organization/InsurerExample" ] ] ) . # <http://example.org/fhir/Patient/SubscriberExample> a fhir:Patient ; fhir:id [ fhir:v "SubscriberExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_SubscriberExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient SubscriberExample</b></p><a name=\"SubscriberExample\"> </a><a name=\"hcSubscriberExample\"> </a><a name=\"SubscriberExample-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"A patient's military status.\"><a href=\"StructureDefinition-extension-militaryStatus.html\"/></td><td colspan=\"3\"><span title=\"Codes:{https://codesystem.x12.org/005010/584 RU}\">RU</span></td></tr></table></div>" ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/584"^^xsd:anyURI ] ; fhir:code [ fhir:v "RU" ] ] ) ] ] ) ; # fhir:identifier ( [ fhir:system [ fhir:v "http://example.org/MIN"^^xsd:anyURI ] ; fhir:value [ fhir:v "12345678901" ] ] ) ; # fhir:name ( [ fhir:family [ fhir:v "SMITH" ] ; ( fhir:given [ fhir:v "JOE" ] ) ] ) ; # fhir:gender [ fhir:v "male"] . # <http://example.org/fhir/Claim/ReferralAuthorizationExample> a fhir:Claim ; fhir:id [ fhir:v "ReferralAuthorizationExample"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_ReferralAuthorizationExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim ReferralAuthorizationExample</b></p><a name=\"ReferralAuthorizationExample\"> </a><a name=\"hcReferralAuthorizationExample\"> </a><a name=\"ReferralAuthorizationExample-en-US\"> </a><p><b>LevelOfServiceCode</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1338 U}\">Urgent</span></p><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=\"Patient-SubscriberExample.html\">JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole</a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm G89.4}\">Chronic pain syndrome</span></td></tr></table><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><a href=\"Coverage-InsuranceExample.html\">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 SC}\">Specialty Care Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>ItemTraceNumber</b>: <code>http://example.org/ITEM_TRACE_NUMBER</code>/1122334</p><p><b>AuthorizationNumber</b>: 1122445</p><p><b>AdministrationReferenceNumber</b>: 9988311</p><p><b>RequestedService</b>: <a href=\"ServiceRequest-ReferralRequestExample.html\">ServiceRequest Consultation</a></p><p><b>EPSDTIndicator</b>: false</p><p><b>NursingHomeResidentialStatus</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1345 2}\">Newly Admitted</span></p><p><b>NursingHomeLevelOfCare</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1337 2}\">Intermediate Care Facility (ICF)</span></p><p><b>RevenueUnitRateLimit</b>: 100</p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>productOrService</b>: <span title=\"Codes:{https://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></blockquote></div>" ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1338"^^xsd:anyURI ] ; fhir:code [ fhir:v "U" ] ; fhir:display [ fhir:v "Urgent" ] ] ) ] ] ) ; # fhir:identifier ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://www.usps.com/"^^xsd:anyURI ] ; fhir:code [ fhir:v "MA" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment"^^xsd:anyURI ] ; fhir:value [ fhir:v "223412" ] ] ) ; 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:reference [ fhir:v "Patient/SubscriberExample" ] ] ; # fhir:created [ fhir:v "2005-05-02T11:01:00+05:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/InsurerExample" ] ] ; # fhir:provider [ fhir:reference [ fhir:v "Organization/UMOExample" ] ] ; # fhir:priority [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:careTeam ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"^^xsd:anyURI ] ; fhir:value [ fhir:v "true"^^xsd:boolean ] ] ) ; fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:provider [ fhir:reference [ fhir:v "PractitionerRole/ReferralPractitionerRoleExample" ] ] ] ) ; # fhir:diagnosis ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate"^^xsd:anyURI ] ; fhir:value [ fhir:v "2021-05-10"^^xsd:date ] ] ) ; fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ] ; fhir:code [ fhir:v "G89.4" ] ] ) ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/InsuranceExample" ] ] ] ) ; # fhir:item ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ; fhir:code [ fhir:v "SC" ] ; fhir:display [ fhir:v "Specialty Care Review" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ; fhir:code [ fhir:v "I" ] ; fhir:display [ fhir:v "Initial" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ] ; fhir:value [ a fhir:Identifier ; fhir:system [ fhir:v "http://example.org/ITEM_TRACE_NUMBER"^^xsd:anyURI ] ; fhir:value [ fhir:v "1122334" ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber"^^xsd:anyURI ] ; fhir:value [ fhir:v "1122445" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber"^^xsd:anyURI ] ; fhir:value [ fhir:v "9988311" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService"^^xsd:anyURI ] ; fhir:value [ a fhir:Reference ; fhir:reference [ fhir:v "ServiceRequest/ReferralRequestExample" ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator"^^xsd:anyURI ] ; fhir:value [ fhir:v "false"^^xsd:boolean ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1345"^^xsd:anyURI ] ; fhir:code [ fhir:v "2" ] ; fhir:display [ fhir:v "Newly Admitted" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1337"^^xsd:anyURI ] ; fhir:code [ fhir:v "2" ] ; fhir:display [ fhir:v "Intermediate Care Facility (ICF)" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit"^^xsd:anyURI ] ; fhir:value [ fhir:v "100"^^xsd:decimal ] ] ) ; fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; ( fhir:careTeamSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ; ( fhir:diagnosisSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ; fhir:code [ fhir:v "3" ] ; fhir:display [ fhir:v "Consultation" ] ] ) ] ; fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "https://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" ] ] ) ] ] ) . #
IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pas#2.1.0-preview based on FHIR 4.0.1. Generated 2024-11-14
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