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

: Homecare Authorization Example

Page standards status: Informative

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Claim/HomecareAuthorizationExample> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "HomecareAuthorizationExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim HomecareAuthorizationExample</b></p><a name=\"HomecareAuthorizationExample\"> </a><a name=\"hcHomecareAuthorizationExample\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claim.html\">PAS Claim</a></p></div><blockquote><p><b>Home Health Care Information</b></p><ul><li>prognosis: <span title=\"Codes:{https://codesystem.x12.org/005010/923 1}\">1</span></li><li>date: 2005-05-02</li></ul></blockquote><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: identifier = Member Number; status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Service Item Request Type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>Certification Type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets G0154}\">Hhcp-svs of rn,ea 15 min</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote><blockquote><p><b>item</b></p><p><b>Service Item Request Type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>Certification Type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4184}\">B4184</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote></div>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "prognosis" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/923" ] ;
           fhir:Coding.code [ fhir:value "1" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "date" ] ;
       fhir:Extension.valueDate [ fhir:value "2005-05-02"^^xsd:date ]
     ] ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation" ]
  ] ;
  fhir:Claim.identifier [
     fhir:index -1 ;
     fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ] ;
     fhir:Identifier.value [ fhir:value "111099" ] ;
     fhir:Identifier.assigner [
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ] ;
         fhir:Identifier.value [ fhir:value "9012345678" ]
       ]
     ]
  ] ;
  fhir:Claim.status [ fhir:value "active"] ;
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "professional" ]
     ]
  ] ;
  fhir:Claim.use [ fhir:value "preauthorization"] ;
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/SubscriberExample> ;
     fhir:Reference.reference [ fhir:value "Patient/SubscriberExample" ]
  ] ;
  fhir:Claim.created [ fhir:value "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ;
  fhir:Claim.insurer [
     fhir:link <http://hl7.org/fhir/Organization/InsurerExample> ;
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ] ;
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/Organization/UMOExample> ;
     fhir:Reference.reference [ fhir:value "Organization/UMOExample" ]
  ] ;
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ] ;
       fhir:Coding.code [ fhir:value "normal" ]
     ]
  ] ;
  fhir:Claim.insurance [
     fhir:index -1 ;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:Claim.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/InsuranceExample> ;
       fhir:Reference.reference [ fhir:value "Coverage/InsuranceExample" ]
     ]
  ] ;
  fhir:Claim.item [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1525" ] ;
           fhir:Coding.code [ fhir:value "HS" ] ;
           fhir:Coding.display [ fhir:value "Health Services Review" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1322" ] ;
           fhir:Coding.code [ fhir:value "I" ] ;
           fhir:Coding.display [ fhir:value "Initial" ]
         ]
       ]
     ] ;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.item.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1365" ] ;
         fhir:Coding.code [ fhir:value "42" ] ;
         fhir:Coding.display [ fhir:value "Home Health Care" ]
       ]
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets" ] ;
         fhir:Coding.code [ fhir:value "G0154" ]
       ]
     ] ;
     fhir:Claim.item.locationCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ] ;
         fhir:Coding.code [ fhir:value "11" ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1525" ] ;
           fhir:Coding.code [ fhir:value "HS" ] ;
           fhir:Coding.display [ fhir:value "Health Services Review" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1322" ] ;
           fhir:Coding.code [ fhir:value "I" ] ;
           fhir:Coding.display [ fhir:value "Initial" ]
         ]
       ]
     ] ;
     fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:Claim.item.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1365" ] ;
         fhir:Coding.code [ fhir:value "42" ] ;
         fhir:Coding.display [ fhir:value "Home Health Care" ]
       ]
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets" ] ;
         fhir:Coding.code [ fhir:value "B4184" ]
       ]
     ] ;
     fhir:Claim.item.locationCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ] ;
         fhir:Coding.code [ fhir:value "11" ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Patient/SubscriberExample> a fhir:Patient .

<http://hl7.org/fhir/Organization/InsurerExample> a fhir:Organization .

<http://hl7.org/fhir/Organization/UMOExample> a fhir:Organization .

<http://hl7.org/fhir/Coverage/InsuranceExample> a fhir:Coverage .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Claim/HomecareAuthorizationExample.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Claim/HomecareAuthorizationExample.ttl> .