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

: PAS Inquiry Operation Response Example

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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/Parameters/PASClaimInquiryOperationResponseExample> a fhir:Parameters ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "PASClaimInquiryOperationResponseExample"] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:Parameters.parameter [
     fhir:index -1 ;
     fhir:Parameters.parameter.name [ fhir:value "responseBundle" ] ;
     fhir:Parameters.parameter.resource [
       a fhir:Bundle ;
       fhir:Resource.id [ fhir:value "PASClaimInquiryResponseBundleExample" ] ;
       fhir:Resource.meta [
         fhir:Meta.profile [
           fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle" ;
           fhir:index -1 ;
           fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle>
         ]
       ] ;
       fhir:Resource.language [ fhir:value "en" ] ;
       fhir:Bundle.identifier [
         fhir:Identifier.system [ fhir:value "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER" ] ;
         fhir:Identifier.value [ fhir:value "5269367" ]
       ] ;
       fhir:Bundle.type [ fhir:value "collection" ] ;
       fhir:Bundle.timestamp [ fhir:value "2005-05-02T11:01:00+05:00"^^xsd:dateTime ] ;
       fhir:Bundle.entry [
         fhir:index -1 ;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample" ] ;
         fhir:Bundle.entry.resource <http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample>
       ], [
         fhir:index -1 ;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Organization/UMOExample" ] ;
         fhir:Bundle.entry.resource <http://example.org/fhir/Organization/UMOExample>
       ], [
         fhir:index -1 ;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Organization/InsurerExample" ] ;
         fhir:Bundle.entry.resource <http://example.org/fhir/Organization/InsurerExample>
       ], [
         fhir:index -1 ;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Coverage/InsuranceExample" ] ;
         fhir:Bundle.entry.resource <http://example.org/fhir/Coverage/InsuranceExample>
       ], [
         fhir:index -1 ;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Patient/SubscriberExample" ] ;
         fhir:Bundle.entry.resource <http://example.org/fhir/Patient/SubscriberExample>
       ], [
         fhir:index -1 ;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Claim/ReferralAuthorizationExample" ] ;
         fhir:Bundle.entry.resource <http://example.org/fhir/Claim/ReferralAuthorizationExample>
       ]
     ]
  ] .

<http://example.org/fhir/ClaimResponse/PASClaimInquiryResponseExample> a fhir:ClaimResponse ;
  fhir:Resource.id [ fhir:value "PASClaimInquiryResponseExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  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 "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ;
  fhir:ClaimResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/InsurerExample> ;
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ] ;
  fhir:ClaimResponse.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: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: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: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.insurance [
     fhir:index -1 ;
     fhir:ClaimResponse.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:ClaimResponse.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/InsuranceExample> ;
       fhir:Reference.reference [ fhir:value "Coverage/InsuranceExample" ]
     ]
  ] .

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

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

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

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

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

<http://example.org/fhir/Organization/UMOExample> a fhir:Organization ;
  fhir:Resource.id [ fhir:value "UMOExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:Organization.identifier [
     fhir:index -1 ;
     fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ] ;
     fhir:Identifier.value [ fhir:value "8189991234" ]
  ] ;
  fhir:Organization.active [ fhir:value "true"^^xsd:boolean] ;
  fhir:Organization.type [
     fhir:index -1 ;
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/98" ] ;
       fhir:Coding.code [ fhir:value "X3" ]
     ]
  ] ;
  fhir:Organization.name [ fhir:value "DR. JOE SMITH CORPORATION"] ;
  fhir:Organization.address [
     fhir:index -1 ;
     fhir:Address.line [
       fhir:value "111 1ST STREET" ;
       fhir:index -1
     ] ;
     fhir:Address.city [ fhir:value "SAN DIEGO" ] ;
     fhir:Address.state [ fhir:value "CA" ] ;
     fhir:Address.postalCode [ fhir:value "92101" ] ;
     fhir:Address.country [ fhir:value "US" ]
  ] .

<http://example.org/fhir/Organization/InsurerExample> a fhir:Organization ;
  fhir:Resource.id [ fhir:value "InsurerExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:Organization.identifier [
     fhir:index -1 ;
     fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ] ;
     fhir:Identifier.value [ fhir:value "1234567893" ]
  ] ;
  fhir:Organization.active [ fhir:value "true"^^xsd:boolean] ;
  fhir:Organization.type [
     fhir:index -1 ;
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/98" ] ;
       fhir:Coding.code [ fhir:value "PR" ]
     ]
  ] ;
  fhir:Organization.name [ fhir:value "MARYLAND CAPITAL INSURANCE COMPANY"] .

<http://example.org/fhir/Coverage/InsuranceExample> a fhir:Coverage ;
  fhir:Resource.id [ fhir:value "InsuranceExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:Coverage.identifier [
     fhir:index -1 ;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ] ;
         fhir:Coding.code [ fhir:value "MB" ]
       ]
     ]
  ] ;
  fhir:Coverage.status [ fhir:value "active"] ;
  fhir:Coverage.subscriberId [ fhir:value "1122334455"] ;
  fhir:Coverage.beneficiary [
     fhir:link <http://hl7.org/fhir/Patient/SubscriberExample> ;
     fhir:Reference.reference [ fhir:value "Patient/SubscriberExample" ]
  ] ;
  fhir:Coverage.relationship [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ] ;
       fhir:Coding.code [ fhir:value "self" ]
     ], [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1069" ] ;
       fhir:Coding.code [ fhir:value "18" ]
     ]
  ] ;
  fhir:Coverage.payor [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/Organization/InsurerExample> ;
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ] .

<http://example.org/fhir/Patient/SubscriberExample> a fhir:Patient ;
  fhir:Resource.id [ fhir:value "SubscriberExample"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.extension [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus" ] ;
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/584" ] ;
         fhir:Coding.code [ fhir:value "RU" ]
       ]
     ]
  ] ;
  fhir:Patient.identifier [
     fhir:index -1 ;
     fhir:Identifier.system [ fhir:value "http://example.org/MIN" ] ;
     fhir:Identifier.value [ fhir:value "12345678901" ]
  ] ;
  fhir:Patient.name [
     fhir:index -1 ;
     fhir:HumanName.family [ fhir:value "SMITH" ] ;
     fhir:HumanName.given [
       fhir:value "JOE" ;
       fhir:index -1
     ]
  ] ;
  fhir:Patient.gender [ fhir:value "male"] .

<http://example.org/fhir/Claim/ReferralAuthorizationExample> a fhir:Claim ;
  fhir:Resource.id [ fhir:value "ReferralAuthorizationExample"] ;
  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.extension [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode" ] ;
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1338" ] ;
         fhir:Coding.code [ fhir:value "U" ] ;
         fhir:Coding.display [ fhir:value "Urgent" ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "applicationSenderCode" ] ;
       fhir:Extension.valueString [ fhir:value "PROVIDERAPP" ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "applicationReceiverCode" ] ;
       fhir:Extension.valueString [ fhir:value "PAYERAPP" ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "interchangeSenderID" ] ;
       fhir:Extension.valueString [ fhir:value "PROVIDERID" ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "interchangeReceiverID" ] ;
       fhir:Extension.valueString [ fhir:value "PAYERID" ]
     ] ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers" ]
  ] ;
  fhir:Claim.identifier [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://www.usps.com/" ] ;
           fhir:Coding.code [ fhir:value "MA" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment" ] ;
       fhir:Extension.valueString [ fhir:value "223412" ]
     ] ;
     fhir:Identifier.system [ fhir:value "urn:trnorg:9012345678" ] ;
     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 "2005-05-02T11:01:00+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.careTeam [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" ] ;
       fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]
     ] ;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.careTeam.provider [
       fhir:link <http://hl7.org/fhir/PractitionerRole/ReferralPractitionerRoleExample> ;
       fhir:Reference.reference [ fhir:value "PractitionerRole/ReferralPractitionerRoleExample" ]
     ]
  ] ;
  fhir:Claim.supportingInfo [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "reportTypeCode" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/755" ] ;
             fhir:Coding.code [ fhir:value "PY" ] ;
             fhir:Coding.display [ fhir:value "Physician's Report" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "transmissionMethod" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/756" ] ;
             fhir:Coding.code [ fhir:value "EL" ] ;
             fhir:Coding.display [ fhir:value "Electronically Only" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "controlNumber" ] ;
         fhir:Extension.valueString [ fhir:value "111222" ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "description" ] ;
         fhir:Extension.valueString [ fhir:value "A procedure note included to provide details of what has been tried before the referral." ]
       ] ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation" ]
     ] ;
     fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes" ] ;
         fhir:Coding.code [ fhir:value "additionalInformation" ]
       ]
     ] ;
     fhir:Claim.supportingInfo.valueReference [
       fhir:link <http://hl7.org/fhir/DocumentReference/DocumentReferenceExample> ;
       fhir:Reference.reference [ fhir:value "DocumentReference/DocumentReferenceExample" ]
     ]
  ] ;
  fhir:Claim.diagnosis [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate" ] ;
       fhir:Extension.valueDate [ fhir:value "2021-05-10"^^xsd:date ]
     ] ;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ] ;
         fhir:Coding.code [ fhir:value "G89.4" ]
       ]
     ]
  ] ;
  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 "SC" ] ;
           fhir:Coding.display [ fhir:value "Specialty Care 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:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber" ] ;
       fhir:Extension.valueIdentifier [
         fhir:Identifier.system [ fhir:value "http://example.org/ITEM_TRACE_NUMBER" ] ;
         fhir:Identifier.value [ fhir:value "1122334" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber" ] ;
       fhir:Extension.valueString [ fhir:value "1122445" ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber" ] ;
       fhir:Extension.valueString [ fhir:value "9988311" ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService" ] ;
       fhir:Extension.valueReference [
         fhir:link <http://hl7.org/fhir/ServiceRequest/ReferralRequestExample> ;
         fhir:Reference.reference [ fhir:value "ServiceRequest/ReferralRequestExample" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator" ] ;
       fhir:Extension.valueBoolean [ fhir:value "false"^^xsd:boolean ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1345" ] ;
           fhir:Coding.code [ fhir:value "2" ] ;
           fhir:Coding.display [ fhir:value "Newly Admitted" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/1337" ] ;
           fhir:Coding.code [ fhir:value "2" ] ;
           fhir:Coding.display [ fhir:value "Intermediate Care Facility (ICF)" ]
         ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit" ] ;
       fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
     ] ;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index -1
     ] ;
     fhir:Claim.item.diagnosisSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index -1
     ] ;
     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 "3" ] ;
         fhir:Coding.display [ fhir:value "Consultation" ]
       ]
     ] ;
     fhir:Claim.item.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:Coding.display [ fhir:value "Consultation" ]
       ]
     ] ;
     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/Organization/UMOExample> a fhir:Organization .

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

<http://hl7.org/fhir/DocumentReference/DocumentReferenceExample> a fhir:DocumentReference .

<http://hl7.org/fhir/ServiceRequest/ReferralRequestExample> a fhir:ServiceRequest .

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

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