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

## : PAS Subscription Notification example - JSON Representation

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    {
      "resourceType" : "Bundle",
      "id" : "PASSubscriptionNotification",
      "type" : "history",
      "timestamp" : "2020-05-29T11:44:33.188-05:00",
      "entry" : [
        {
          "fullUrl" : "http://example.org/Parameters/SubscriptionNotificationParameters",
          "resource" : {
            "resourceType" : "Parameters",
            "id" : "SubscriptionNotificationParameters",
            "parameter" : [
              {
                "name" : "subscription",
                "valueReference" : {
                  🔗 "reference" : "StructureDefinition/profile-subscription"
                }
              },
              {
                "name" : "topic",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic|2.1.0"
              },
              {
                "name" : "type",
                "valueCode" : "event-notification"
              },
              {
                "name" : "notification-event",
                "part" : [
                  {
                    "name" : "event-number",
                    "valueString" : "2"
                  },
                  {
                    "name" : "timestamp",
                    "valueInstant" : "2020-05-29T11:44:33.188-05:00"
                  },
                  {
                    "name" : "focus",
                    "valueReference" : {
                      "reference" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
                    }
                  }
                ]
              }
            ]
          },
          "request" : {
            "method" : "GET",
            "url" : "https://example.org/Subscription/PAS/$status"
          },
          "response" : {
            "status" : "200"
          }
        },
        {
          "fullUrl" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample",
          "resource" : {
            "resourceType" : "Bundle",
            "id" : "ReferralAuthorizationResponseBundleExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"
              ]
            },
            "identifier" : {
              "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
              "value" : "A12345"
            },
            "type" : "collection",
            "timestamp" : "2005-05-02T11:02:00+05:00",
            "entry" : [
              {
                "fullUrl" : "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample",
                "resource" : {
                  "resourceType" : "ClaimResponse",
                  "id" : "PractitionerRequestorResponseExample",
                  "meta" : {
                    "profile" : [
                      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
                    ]
                  },
                  "identifier" : [
                    {
                      "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
                      "value" : "111099",
                      "assigner" : {
                        "identifier" : {
                          "system" : "http://example.org/USER_ASSIGNED",
                          "value" : "9012345678"
                        }
                      }
                    }
                  ],
                  "status" : "active",
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
                        "code" : "professional"
                      }
                    ]
                  },
                  "use" : "preauthorization",
                  "patient" : {
                    🔗 "reference" : "Patient/SubscriberExample"
                  },
                  "created" : "2005-05-02T11:02:00+05:00",
                  "insurer" : {
                    🔗 "reference" : "Organization/InsurerExample"
                  },
                  "requestor" : {
                    🔗 "reference" : "PractitionerRole/ReferralPractitionerRoleExample"
                  },
                  "request" : {
                    🔗 "reference" : "Claim/ReferralAuthorizationExample"
                  },
                  "outcome" : "complete",
                  "item" : [
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
                          "valuePeriod" : {
                            "start" : "2005-05-02",
                            "end" : "2005-06-02"
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
                          "valueDate" : "2005-05-02"
                        },
                        {
                          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
                          "valuePeriod" : {
                            "start" : "2005-05-02",
                            "end" : "2005-06-02"
                          }
                        },
                        {
                          "extension" : [
                            {
                              "url" : "provider",
                              "valueReference" : {
                                🔗 "reference" : "Practitioner/ReferralPractitionerExample"
                              }
                            }
                          ],
                          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
                        },
                        {
                          "extension" : [
                            {
                              "url" : "productOrServiceCode",
                              "valueCodeableConcept" : {
                                "coding" : [
                                  {
                                    "system" : "https://codesystem.x12.org/005010/1365",
                                    "code" : "3",
                                    "display" : "Consultation"
                                  }
                                ]
                              }
                            },
                            {
                              "url" : "unitPrice",
                              "valueMoney" : {
                                "value" : 100,
                                "currency" : "USD"
                              }
                            },
                            {
                              "url" : "quantity",
                              "valueQuantity" : {
                                "value" : 1
                              }
                            }
                          ],
                          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
                        }
                      ],
                      "itemSequence" : 1,
                      "adjudication" : [
                        {
                          "extension" : [
                            {
                              "extension" : [
                                {
                                  "url" : "number",
                                  "valueString" : "AUTH0001"
                                },
                                {
                                  "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
                                  "valueCodeableConcept" : {
                                    "coding" : [
                                      {
                                        "system" : "https://codesystem.x12.org/005010/306",
                                        "code" : "A1",
                                        "display" : "Certified in total"
                                      }
                                    ]
                                  }
                                }
                              ],
                              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
                            }
                          ],
                          "category" : {
                            "coding" : [
                              {
                                "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                                "code" : "submitted"
                              }
                            ]
                          }
                        }
                      ]
                    }
                  ]
                }
              },
              {
                "fullUrl" : "http://example.org/fhir/Organization/UMOExample",
                "resource" : {
                  "resourceType" : "Organization",
                  "id" : "UMOExample",
                  "meta" : {
                    "profile" : [
                      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
                    ]
                  },
                  "identifier" : [
                    {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "8189991234"
                    }
                  ],
                  "active" : true,
                  "type" : [
                    {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/98",
                          "code" : "X3"
                        }
                      ]
                    }
                  ],
                  "name" : "DR. JOE SMITH CORPORATION",
                  "address" : [
                    {
                      "line" : [
                        "111 1ST STREET"
                      ],
                      "city" : "SAN DIEGO",
                      "state" : "CA",
                      "postalCode" : "92101",
                      "country" : "US"
                    }
                  ]
                }
              },
              {
                "fullUrl" : "http://example.org/fhir/Organization/InsurerExample",
                "resource" : {
                  "resourceType" : "Organization",
                  "id" : "InsurerExample",
                  "meta" : {
                    "profile" : [
                      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"
                    ]
                  },
                  "identifier" : [
                    {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "1234567893"
                    }
                  ],
                  "active" : true,
                  "type" : [
                    {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/98",
                          "code" : "PR"
                        }
                      ]
                    }
                  ],
                  "name" : "MARYLAND CAPITAL INSURANCE COMPANY"
                }
              },
              {
                "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample",
                "resource" : {
                  "resourceType" : "Patient",
                  "id" : "SubscriberExample",
                  "meta" : {
                    "profile" : [
                      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
                    ]
                  },
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "https://codesystem.x12.org/005010/584",
                            "code" : "RU"
                          }
                        ]
                      }
                    }
                  ],
                  "identifier" : [
                    {
                      "type" : {
                        "coding" : [
                          {
                            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                            "code" : "MB"
                          }
                        ]
                      },
                      "system" : "http://example.org/MIN",
                      "value" : "12345678901"
                    }
                  ],
                  "name" : [
                    {
                      "family" : "SMITH",
                      "given" : [
                        "JOE"
                      ]
                    }
                  ],
                  "gender" : "male"
                }
              },
              {
                "fullUrl" : "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
                "resource" : {
                  "resourceType" : "Practitioner",
                  "id" : "ReferralPractitionerExample",
                  "meta" : {
                    "profile" : [
                      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"
                    ]
                  },
                  "identifier" : [
                    {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "1234567893"
                    }
                  ],
                  "name" : [
                    {
                      "family" : "WATSON",
                      "given" : [
                        "SUSAN"
                      ]
                    }
                  ]
                }
              }
            ]
          },
          "request" : {
            "method" : "GET",
            "url" : "https://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
          },
          "response" : {
            "status" : "200"
          }
        }
      ]
    }