Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1 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 2.1.0 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 Claim: Referral Authorization Example

Page standards status: Informative

Generated Narrative: Claim ReferralAuthorizationExample

LevelOfServiceCode: Urgent

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

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( Member Number)

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

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; subscriberId = 1122334455; relationship = Self

item

ServiceItemRequestType: Specialty Care Review

CertificationType: Initial

ItemTraceNumber: http://example.org/ITEM_TRACE_NUMBER/1122334

AuthorizationNumber: 1122445

AdministrationReferenceNumber: 9988311

RequestedService: ServiceRequest Consultation

EPSDTIndicator: false

NursingHomeResidentialStatus: Newly Admitted

NursingHomeLevelOfCare: Intermediate Care Facility (ICF)

RevenueUnitRateLimit: 100

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

category: Consultation

productOrService: Consultation

location: 11