Da Vinci Prior Authorization Support (PAS) FHIR IG
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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

: Referral Authorization Response Bundle Example - TTL Representation

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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:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ReferralAuthorizationResponseBundleExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle>     ] )
  ] ; # 
  fhir:type [ fhir:v "collection"] ; # 
  fhir:timestamp [ fhir:v "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ; # 
  fhir:entry ( [
fhir:fullUrl [ fhir:v "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample> )
  ] [
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/Patient/SubscriberExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Patient/SubscriberExample> )
  ] [
fhir:fullUrl [ fhir:v "http://example.org/fhir/Practitioner/ReferralPractitionerExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Practitioner/ReferralPractitionerExample> )
  ] ) . # 

<http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample> a fhir:ClaimResponse ;
  fhir:id [ fhir:v "PractitionerRequestorResponseExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_PractitionerRequestorResponseExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse PractitionerRequestorResponseExample</b></p><a name=\"PractitionerRequestorResponseExample\"> </a><a name=\"hcPractitionerRequestorResponseExample\"> </a><a name=\"PractitionerRequestorResponseExample-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>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>requestor</b>: <a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole</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 --&gt; 2005-06-02</p><p><b>ItemPreAuthIssueDate</b>: 2005-05-02</p><p><b>ItemPreAuthPeriod</b>: 2005-05-02 --&gt; 2005-06-02</p><blockquote><p><b>ItemAuthorizedProvider</b></p><ul><li>provider: <a href=\"Practitioner-ReferralPractitionerExample.html\">Practitioner SUSAN WATSON </a></li></ul></blockquote><blockquote><p><b>ItemAuthorizedDetail</b></p><ul><li>productOrServiceCode: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></li><li>unitPrice: <span title=\"US Dollar\">$100.00</span> (USD)</li><li>quantity: 1</li></ul></blockquote><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></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 "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "PractitionerRole/ReferralPractitionerRoleExample" ]
  ] ; # 
  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:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2005-05-02"^^xsd:date ]     ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod"^^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:extension [
fhir:url [ fhir:v "provider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "Practitioner/ReferralPractitionerExample" ]         ]       ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"^^xsd:anyURI ]     ] [
      ( fhir:extension [
fhir:url [ fhir:v "productOrServiceCode"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
          ( 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:url [ fhir:v "unitPrice"^^xsd:anyURI ] ;
fhir:value [
a fhir:Money ;
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]         ]       ] [
fhir:url [ fhir:v "quantity"^^xsd:anyURI ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "1"^^xsd:decimal ]         ]       ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"^^xsd:anyURI ]     ] ) ;
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" ]         ] )       ]     ] )
  ] ) . # 

<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/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/Practitioner/ReferralPractitionerExample> a fhir:Practitioner ;
  fhir:id [ fhir:v "ReferralPractitionerExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_ReferralPractitionerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner ReferralPractitionerExample</b></p><a name=\"ReferralPractitionerExample\"> </a><a name=\"hcReferralPractitionerExample\"> </a><a name=\"ReferralPractitionerExample-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>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1234567893" ]
  ] ) ; # 
  fhir:name ( [
fhir:family [ fhir:v "WATSON" ] ;
    ( fhir:given [ fhir:v "SUSAN" ] )
  ] ) ; # 
  fhir:telecom ( [
fhir:system [ fhir:v "phone" ] ;
fhir:value [ fhir:v "4029993456" ]
  ] ) . #