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

: Authorization Response with Practitioner Requestor and Additional Content 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/ClaimResponse/PractitionerRequestorAdditionalContentResponseExample> a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "PractitionerRequestorAdditionalContentResponseExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse>
     ]
  ] ;
  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: ClaimResponse PractitionerRequestorAdditionalContentResponseExample</b></p><a name=\"PractitionerRequestorAdditionalContentResponseExample\"> </a><a name=\"hcPractitionerRequestorAdditionalContentResponseExample\"> </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-claimresponse.html\">PAS Claim Response</a></p></div><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>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>requestor</b>: <a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole: telecom = ph: 4029993456</a></p><p><b>request</b>: <a href=\"Claim-ReferralAuthorizationExample.html\">Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>Item Requested Service Date</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>Item Preauthorization Issue Date</b>: 2005-05-02</p><p><b>Item Preauthorization Period</b>: 2005-05-02 --&gt; 2005-06-02</p><blockquote><p><b>Item Authorized Provider</b></p><ul><li>provider: <a href=\"Practitioner-ReferralPractitionerExample.html\">Practitioner SUSAN WATSON </a></li><li>http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType: <span title=\"Codes:{https://codesystem.x12.org/005010/98 P3}\">P3</span></li></ul></blockquote><blockquote><p><b>Item Authorized Detail</b></p><ul><li>productOrServiceCode: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></li><li>unitPrice: <span title=\"US Dollar\">$100.00</span> (USD)</li><li>quantity: 1</li></ul></blockquote><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote><blockquote><p><b>addItem</b></p><p><b>Revenue Code</b>: <span title=\"Codes:{https://www.nubc.org/CodeSystem/RevenueCodes 0202}\">0202</span></p><p><b>Claim Response Item Category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>Admission Dates</b>: 2005-05-02 --&gt; 2005-05-02</p><p><b>Discharge Date</b>: 2005-05-10</p><p><b>itemSequence</b>: 2</p><p><b>provider</b>: <a href=\"Practitioner-ReferralPractitionerExample.html\">Practitioner SUSAN WATSON </a></p><p><b>productOrService</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">3</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>United States dollar</td></tr></table><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote></div>"
  ] ;
  fhir:ClaimResponse.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:ClaimResponse.status [ fhir:value "active"] ;
  fhir:ClaimResponse.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:ClaimResponse.use [ fhir:value "preauthorization"] ;
  fhir:ClaimResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/SubscriberExample> ;
     fhir:Reference.reference [ fhir:value "Patient/SubscriberExample" ]
  ] ;
  fhir:ClaimResponse.created [ fhir:value "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ;
  fhir:ClaimResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/InsurerExample> ;
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ] ;
  fhir:ClaimResponse.requestor [
     fhir:link <http://hl7.org/fhir/PractitionerRole/ReferralPractitionerRoleExample> ;
     fhir:Reference.reference [ fhir:value "PractitionerRole/ReferralPractitionerRoleExample" ]
  ] ;
  fhir:ClaimResponse.request [
     fhir:link <http://hl7.org/fhir/Claim/ReferralAuthorizationExample> ;
     fhir:Reference.reference [ fhir:value "Claim/ReferralAuthorizationExample" ]
  ] ;
  fhir:ClaimResponse.outcome [ fhir:value "complete"] ;
  fhir:ClaimResponse.item [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate" ] ;
       fhir:Extension.valuePeriod [
         fhir:Period.start [ fhir:value "2005-05-02"^^xsd:date ] ;
         fhir:Period.end [ fhir:value "2005-06-02"^^xsd:date ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate" ] ;
       fhir:Extension.valueDate [ fhir:value "2005-05-02"^^xsd:date ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod" ] ;
       fhir:Extension.valuePeriod [
         fhir:Period.start [ fhir:value "2005-05-02"^^xsd:date ] ;
         fhir:Period.end [ fhir:value "2005-06-02"^^xsd:date ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "provider" ] ;
         fhir:Extension.valueReference [
           fhir:link <http://hl7.org/fhir/Practitioner/ReferralPractitionerExample> ;
           fhir:Reference.reference [ fhir:value "Practitioner/ReferralPractitionerExample" ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/98" ] ;
             fhir:Coding.code [ fhir:value "P3" ]
           ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider" ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "productOrServiceCode" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1365" ] ;
             fhir:Coding.code [ fhir:value "3" ] ;
             fhir:Coding.display [ fhir:value "Consultation" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "unitPrice" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "quantity" ] ;
         fhir:Extension.valueQuantity [
           fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail" ]
     ] ;
     fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.item.adjudication [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Element.extension [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "number" ] ;
           fhir:Extension.valueString [ fhir:value "AUTH0001" ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index -1 ;
               fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/306" ] ;
               fhir:Coding.code [ fhir:value "A1" ] ;
               fhir:Coding.display [ fhir:value "Certified in total" ]
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction" ]
       ] ;
       fhir:ClaimResponse.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ]
         ]
       ]
     ]
  ] ;
  fhir:ClaimResponse.addItem [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://www.nubc.org/CodeSystem/RevenueCodes" ] ;
           fhir:Coding.code [ fhir:value "0202" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCategory" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1365" ] ;
           fhir:Coding.code [ fhir:value "3" ] ;
           fhir:Coding.display [ fhir:value "Consultation" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates" ] ;
       fhir:Extension.valuePeriod [
         fhir:Period.start [ fhir:value "2005-05-02"^^xsd:date ] ;
         fhir:Period.end [ fhir:value "2005-05-02"^^xsd:date ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate" ] ;
       fhir:Extension.valueDate [ fhir:value "2005-05-10"^^xsd:date ]
     ] ;
     fhir:ClaimResponse.addItem.itemSequence [
       fhir:value "2"^^xsd:positiveInteger ;
       fhir:index -1
     ] ;
     fhir:ClaimResponse.addItem.provider [
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/Practitioner/ReferralPractitionerExample> ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/98" ] ;
             fhir:Coding.code [ fhir:value "P3" ]
           ]
         ]
       ] ;
       fhir:Reference.reference [ fhir:value "Practitioner/ReferralPractitionerExample" ]
     ] ;
     fhir:ClaimResponse.addItem.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1365" ] ;
         fhir:Coding.code [ fhir:value "3" ]
       ]
     ] ;
     fhir:ClaimResponse.addItem.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]
     ] ;
     fhir:ClaimResponse.addItem.unitPrice [
       fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "USD" ]
     ] ;
     fhir:ClaimResponse.addItem.adjudication [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Element.extension [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "number" ] ;
           fhir:Extension.valueString [ fhir:value "AUTH0001" ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index -1 ;
               fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/306" ] ;
               fhir:Coding.code [ fhir:value "A1" ] ;
               fhir:Coding.display [ fhir:value "Certified in total" ]
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction" ]
       ] ;
       fhir:ClaimResponse.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ]
         ]
       ]
     ]
  ] .

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

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

<http://hl7.org/fhir/PractitionerRole/ReferralPractitionerRoleExample> a fhir:PractitionerRole .

<http://hl7.org/fhir/Claim/ReferralAuthorizationExample> a fhir:Claim .

<http://hl7.org/fhir/Practitioner/ReferralPractitionerExample> a fhir:Practitioner .

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

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