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

: Additional Information Task Example - JSON Representation

Page standards status: Informative

Raw json | Download


{
  "resourceType" : "Task",
  "id" : "AdditionalInformationTaskExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Task </b><a name=\"AdditionalInformationTaskExample\"> </a><a name=\"hcAdditionalInformationTaskExample\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">ResourceTask &quot;AdditionalInformationTaskExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-task.html\">PAS Task</a></p></div><p><b>identifier</b>: <code>http://example.org/ITEM_TRACE_NUMBER</code>/1122334</p><p><b>status</b>: requested</p><p><b>intent</b>: order</p><p><b>code</b>: Attach Request Code <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PASTempCodes.html\">PAS Temporary Codes</a>#attachment-request-code)</span></p><p><b>for</b>: <a href=\"Patient-BeneficiaryExample.html\">Patient/BeneficiaryExample</a> &quot; SMITH&quot;</p><p><b>requester</b>: <span><a href=\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">NPI</a>/789312</span></p><p><b>owner</b>: <span><a href=\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">NPI</a>/789312</span></p><p><b>reasonCode</b>: Prior Authorization Information Request <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PASTempCodes.html\">PAS Temporary Codes</a>#priorAuthorization)</span></p><p><b>reasonReference</b>: <a href=\"Claim-MedicalServicesAuthorizationExample.html\">Claim/MedicalServicesAuthorizationExample</a></p><blockquote><p><b>input</b></p><p><b>type</b>: Payer URL <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PASTempCodes.html\">PAS Temporary Codes</a>#payer-url)</span></p><p><b>value</b>: <a href=\"http://example.org/payerURL\">http://example.org/payerURL</a></p></blockquote><blockquote><p><b>input</b></p><p><b>PALineNumber</b>: 1</p><p><b>type</b>: Attachments Needed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PASTempCodes.html\">PAS Temporary Codes</a>#attachments-needed)</span></p><p><b>value</b>: Clinical reports.non lab claims attachment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#26443-2)</span></p></blockquote></div>"
  },
  "identifier" : [
    {
      "system" : "http://example.org/ITEM_TRACE_NUMBER",
      "value" : "1122334"
    }
  ],
  "status" : "requested",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "attachment-request-code"
      }
    ]
  },
  "for" : {
    🔗 "reference" : "Patient/BeneficiaryExample"
  },
  "requester" : {
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "789312"
    }
  },
  "owner" : {
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "789312"
    }
  },
  "reasonCode" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "priorAuthorization"
      }
    ]
  },
  "reasonReference" : {
    🔗 "reference" : "Claim/MedicalServicesAuthorizationExample"
  },
  "input" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
            "code" : "payer-url"
          }
        ]
      },
      "valueUrl" : "http://example.org/payerURL"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber",
          "valueInteger" : 1
        }
      ],
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
            "code" : "attachments-needed"
          }
        ]
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "26443-2"
          }
        ]
      }
    }
  ]
}