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: Referral Authorization Bundle Example

Bundle ReferralAuthorizationBundleExample of type collection

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

Resource Claim:

Generated Narrative: Claim

ResourceClaim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

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: 2005-05-02 11:01:00+0500

insurer: See on this page: Organization/InsurerExample

provider: See on this page: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See on this page: PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

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

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)

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)

Entry 6 - fullUrl = http://example.org/fhir/ServiceRequest/ReferralRequestExample

Resource ServiceRequest:

Generated Narrative: ServiceRequest

ResourceServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: ACTIVE

intent: ORDER

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code1 = '1')

subject: See on this page: Patient/SubscriberExample

Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/ReferralPractitionerRoleExample

Resource PractitionerRole:

Generated Narrative: PractitionerRole

ResourcePractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See on this page: Practitioner/ReferralPractitionerExample

location: See on this page: Location/ReferralLocationExample

Entry 8 - fullUrl = http://example.org/fhir/Practitioner/ReferralPractitionerExample

Resource Practitioner:

Generated Narrative: Practitioner

ResourcePractitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: NPI/987654321

name: SUSAN WATSON

telecom: ph: 4029993456

Entry 9 - fullUrl = http://example.org/fhir/Location/ReferralLocationExample

Resource Location:

Generated Narrative: Location

ResourceLocation "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US