Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.1 - STU 2.2 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 2.2.1 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

Example Bundle: Rejection Response Bundle Example

Language: en

Profile: PAS Response Bundle

Bundle RejectionResponseBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/ClaimResponse/RejectionResponseExample

Resource ClaimResponse:

Language: en

Profile: PAS Claim Response

Claim Response Reviewer

  • wasHumanReviewedFlag: true

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

status: Active

type: Professional

use: Preauthorization

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

insurer: MARYLAND CAPITAL INSURANCE COMPANY (PR) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893)

requestor: DR. JOE SMITH CORPORATION (X3) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#8189991234)

request: Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal

outcome: Processing Complete

item

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount

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/Patient/SubscriberExample

Resource Patient:

Language: en

Profile: PAS Subscriber Patient

JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

Military StatusRU

Entry 5 - 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:9012345678/111099

status: Active

type: Professional

use: Preauthorization

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

insurer: MARYLAND CAPITAL INSURANCE COMPANY (PR) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893)

provider: DR. JOE SMITH CORPORATION (X3) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#8189991234)

priority: Normal

CareTeams

-ExtensionSequenceProvider
*1SUSAN WATSON (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#1234567893)

SupportingInfos

-ExtensionSequenceCategoryValue[x]
*1Additional InformationDocumentReference: status = current; type = Physician procedure note; category = Clinical Note

Diagnoses

-ExtensionSequence
*1

Insurances

-SequenceFocalCoverage
*1trueCoverage: 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/1122334

Authorization 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