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 ClaimResponse: Authorization Response with Practitioner Requestor and Additional Content Example

Page standards status: Informative

Generated Narrative: ClaimResponse PractitionerRequestorAdditionalContentResponseExample

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 11:02:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

requestor: PractitionerRole

request: 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

outcome: Processing Complete

item

ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02

ItemPreAuthIssueDate: 2005-05-02

ItemPreAuthPeriod: 2005-05-02 --> 2005-06-02

ItemAuthorizedProvider

ItemAuthorizedDetail

  • productOrServiceCode: Consultation
  • unitPrice: $100.00 (USD)
  • quantity: 1

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount

addItem

RevenueCode: 0202

itemSequence: 2

provider: Practitioner SUSAN WATSON

productOrService: 3

quantity: 1

UnitPrices

-ValueCurrency
*100United States dollar

Adjudications

-ExtensionCategory
*Submitted Amount