Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

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 2.2.0-ballot 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 Claim: Surgical Request Authorization Example

Page standards status: Informative

Profile: PAS Claim

LevelOfServiceCode: Elective

Extension Definition for Claim.encounter for Version 5.0: Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --> 2020-07-09

> ConditionCode

> - category: 07
> - indicator: true
> - code: 09

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

status: Active

type: Institutional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( Member Number)

created: 2020-06-24 07:34:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

### CareTeams

- | Extension | Sequence | Provider
* |  | 1 | PractitionerRole: telecom = ph: 4029993456

### SupportingInfos

- | Sequence | Category | Timing[x]
* | 1 | Admission Dates | 2020-07-02 --> 2020-07-09

### Diagnoses

- | Extension | Sequence | Diagnosis[x]
* |  | 1 | Malignant neoplasm of colon, unspecified

### Insurances

- | Sequence | Focal | Coverage
* | 1 | true | Coverage: status = active; subscriberId = 1122334455; relationship = Self

> item

> ServiceItemRequestType: Admission Review

> CertificationType: Initial

> ItemTraceNumber: `http://example.org/ITEM_TRACE_NUMBER`/1122334

> AuthorizationNumber: 1122445

> AdministrationReferenceNumber: 9988311

> sequence: 1

> careTeamSequence: 1

> diagnosisSequence: 1

> category: Surgical

> productOrService: Under Venous Grafting Only for Coronary Artery Bypass

> location: Inpatient Hospital