Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.1 - STU 2.2
Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.1 - STU 2.2
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 2.2.1 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
Language: en
Profile: PAS Request Bundle
Bundle ReferralAuthorizationBundleExample of type collection
Entry 1 - fullUrl = http://example.org/fhir/Claim/ReferralAuthorizationExample
Resource Claim:
Language: en
Profile: PAS Claim
Level of Service Code: Urgent
Transmission Identifiers
- applicationSenderCode: PROVIDERAPP
- applicationReceiverCode: PAYERAPP
- interchangeSenderID: PROVIDERID
- interchangeReceiverID: PAYERID
identifier:
urn:trnorg:9012345678/111099status: Active
type: Professional
use: Preauthorization
created: 2005-05-02 11:01:00+0500
priority: Normal
CareTeams
Extension Sequence Provider 1 SUSAN WATSON (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893) SupportingInfos
Extension Sequence Category Value[x] 1 Additional Information DocumentReference: status = current; type = Physician procedure note; category = Clinical Note Diagnoses
Extension Sequence 1 Insurances
Sequence Focal Coverage 1 true Coverage: identifier = Member Number: ?ngen-9?; status = active; subscriberId = 1122334455; relationship = Self item
Service Item Request Type: Specialty Care Review
Certification Type: Initial
Item Trace Number:
http://example.org/ITEM_TRACE_NUMBER/1122334Authorization Number: 1122445
Administration Reference Number: 9988311
Requested Service: ServiceRequest Consultation
EPSDT Indicator: false
Nursing Home Residential Status: Newly Admitted
Nursing Home Level of Care: Intermediate Care Facility (ICF)
Revenue Unit Rate Limit: 100
sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
category: Consultation
productOrService: Consultation
location: Office
Entry 2 - fullUrl = http://example.org/fhir/Organization/UMOExample
Resource Organization:
Language: en
Profile: PAS Requestor Organization
DR. JOE SMITH CORPORATION (X3) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#8189991234)
Active: true Type: X3 Contact Detail
- 111 1ST STREET SAN DIEGO CA 92101 US
Entry 3 - fullUrl = http://example.org/fhir/Organization/InsurerExample
Resource Organization:
Language: en
Profile: PAS Insurer Organization
MARYLAND CAPITAL INSURANCE COMPANY (PR) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893)
Active: true Type: PR
Entry 4 - fullUrl = http://example.org/fhir/Coverage/InsuranceExample
Resource Coverage:
Language: en
Profile: PAS Coverage
identifier: Member Number/?ngen-9?
status: Active
subscriberId: 1122334455
beneficiary: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
relationship: Self
Entry 5 - fullUrl = http://example.org/fhir/Patient/SubscriberExample
Resource Patient:
Language: en
Profile: PAS Subscriber Patient
JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
Military Status RU
Entry 6 - fullUrl = http://example.org/fhir/ServiceRequest/ReferralRequestExample
Resource ServiceRequest:
Language: en
Profile: PAS Service Request
status: Active
intent: Order
code: No display for ServiceRequest.code (concept: Consultation)
quantity: 1 visit (Details: UCUM code1 = '1')
subject: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/ReferralPractitionerRoleExample
Resource PractitionerRole:
Language: en
Profile: PAS PractitionerRole
SUSAN WATSON (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893)
Practitioner: SUSAN WATSON (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893) Location: REFERRAL CLINIC Contact Detail
- ph: 4029993456
Entry 8 - fullUrl = http://example.org/fhir/Practitioner/ReferralPractitionerExample
Resource Practitioner:
Language: en
Profile: PAS Practitioner
SUSAN WATSON (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893)
Entry 9 - fullUrl = http://example.org/fhir/Location/ReferralLocationExample
Resource Location:
Language: en
Profile: PAS Location Profile
REFERRAL CLINIC
Address: 111 1ST STREET SAN DIEGO CA 92101 US
Entry 10 - fullUrl = http://example.org/fhir/DocumentReference/DocumentReferenceExample
Resource DocumentReference:
Language: en
Profile: PAS Document Reference
status: Current
type: Physician procedure note
category: Clinical Note
subject: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
content
Attachments
ContentType Data text/plain VGhpcyBpcyBzYW1wbGUgYmFzZTY0IGVuY29kaW5nLg==
IG © 2020+ HL7 International / Financial Management.
Package hl7.fhir.us.davinci-pas#2.2.1 based on FHIR 4.0.1.
Generated
2026-10-09
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