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: Surgical Admission Request Bundle Example

Language: en

Profile: PAS Request Bundle

Bundle SurgicalRequestBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/Claim/SurgicalAuthorizationRequestExample

Resource Claim:

Language: en

Profile: PAS Claim

Level of Service Code: Elective

R5: Encounters associated with the listed treatments (new): Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --> 2020-07-09

Condition Code

  • category: 07
  • indicator: true
  • code: 09

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/16139462398

status: Active

type: Institutional

use: Preauthorization

created: 2020-06-24 07:34:00+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

-SequenceCategoryTiming[x]
*1Admission Dates2020-07-02 --> 2020-07-09

Diagnoses

-ExtensionSequence
*1

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = Member Number: ?ngen-9?; status = active; subscriberId = 1122334455; relationship = Self

item

Service Item Request Type: Admission Review

Certification Type: Initial

Item Trace Number: http://example.org/ITEM_TRACE_NUMBER/1122334

Authorization Number: 1122445

Administration Reference Number: 9988311

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

category: Surgical

productOrService: Under Venous Grafting Only for Coronary Artery Bypass

location: Inpatient Hospital

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 StatusRU

Entry 6 - fullUrl = http://example.org/fhir/Encounter/SurgicalEncounterExample

Resource Encounter:

Language: en

Profile: PAS Encounter

Patient Status: Still a patient

status: Planned

class: ambulatory

type: 2

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

Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/SurgicalPractitionerRoleExample

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/SurgicalPractitionerExample

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/SurgicalLocationExample

Resource Location:

Language: en

Profile: PAS Location Profile

REFERRAL CLINIC

Address:111 1ST STREET SAN DIEGO CA 92101 US