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

## : Referral Pending Authorization Response Bundle Example - XML Representation

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    <Bundle xmlns="http://hl7.org/fhir">
      <id value="ReferralPendingAuthorizationResponseBundleExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"/>
      </meta>
      <identifier>
        <system value="http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"/>
        <value value="A12345"/>
      </identifier>
      <type value="collection"/>
      <timestamp value="2005-05-02T11:02:00+05:00"/>
      <entry>
        <fullUrl
                 value="http://example.org/fhir/ClaimResponse/PractitionerRequestorPendingResponseExample"/>
        <resource>
          <ClaimResponse>
            <id value="PractitionerRequestorPendingResponseExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"/>
            </meta>
            <text>
              <status value="extensions"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="ClaimResponse_PractitionerRequestorPendingResponseExample"> </a><p class="res-header-id"><b>Generated Narrative: ClaimResponse PractitionerRequestorPendingResponseExample</b></p><a name="PractitionerRequestorPendingResponseExample"> </a><a name="hcPractitionerRequestorPendingResponseExample"> </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 ( Member Number)</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>AdministrationReferenceNumber</b>: PEND0001</p><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></div>
            </text>
            <identifier>
              <system value="http://example.org/PATIENT_EVENT_TRACE_NUMBER"/>
              <value value="111099"/>
              <assigner>
                <identifier>
                  <system value="http://example.org/USER_ASSIGNED"/>
                  <value value="9012345678"/>
                </identifier>
              </assigner>
            </identifier>
            <status value="active"/>
            <type>
              <coding>
                <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
                <code value="professional"/>
              </coding>
            </type>
            <use value="preauthorization"/>
            <patient>🔗
              <reference value="Patient/SubscriberExample"/>
            </patient>
            <created value="2005-05-02T11:02:00+05:00"/>
            <insurer>🔗
              <reference value="Organization/InsurerExample"/>
            </insurer>
            <requestor>🔗
              <reference
                         value="PractitionerRole/ReferralPractitionerRoleExample"/>
            </requestor>
            <request>🔗
              <reference value="Claim/ReferralAuthorizationExample"/>
            </request>
            <outcome value="complete"/>
            <item>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber">
                <valueString value="PEND0001"/>
              </extension>
              <itemSequence value="1"/>
              <adjudication>
                <extension
                           url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction">
                  <extension
                             url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode">
                    <valueCodeableConcept>
                      <coding>
                        <system value="https://codesystem.x12.org/005010/306"/>
                        <code value="A4"/>
                        <display value="Pending"/>
                      </coding>
                    </valueCodeableConcept>
                  </extension>
                </extension>
                <category>
                  <coding>
                    <system
                            value="http://terminology.hl7.org/CodeSystem/adjudication"/>
                    <code value="submitted"/>
                  </coding>
                </category>
              </adjudication>
            </item>
          </ClaimResponse>
        </resource>
      </entry>
      <entry>
        <fullUrl value="http://example.org/fhir/Organization/UMOExample"/>
        <resource>
          <Organization>
            <id value="UMOExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_UMOExample"> </a><p class="res-header-id"><b>Generated Narrative: Organization UMOExample</b></p><a name="UMOExample"> </a><a name="hcUMOExample"> </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-requestor.html">PAS Requestor Organization</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/6.2.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{https://codesystem.x12.org/005010/98 X3}">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>
            </text>
            <identifier>
              <system value="http://hl7.org/fhir/sid/us-npi"/>
              <value value="8189991234"/>
            </identifier>
            <active value="true"/>
            <type>
              <coding>
                <system value="https://codesystem.x12.org/005010/98"/>
                <code value="X3"/>
              </coding>
            </type>
            <name value="DR. JOE SMITH CORPORATION"/>
            <address>
              <line value="111 1ST STREET"/>
              <city value="SAN DIEGO"/>
              <state value="CA"/>
              <postalCode value="92101"/>
              <country value="US"/>
            </address>
          </Organization>
        </resource>
      </entry>
      <entry>
        <fullUrl value="http://example.org/fhir/Organization/InsurerExample"/>
        <resource>
          <Organization>
            <id value="InsurerExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_InsurerExample"> </a><p class="res-header-id"><b>Generated Narrative: Organization InsurerExample</b></p><a name="InsurerExample"> </a><a name="hcInsurerExample"> </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-insurer.html">PAS Insurer Organization</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/6.2.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{https://codesystem.x12.org/005010/98 PR}">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>
            </text>
            <identifier>
              <system value="http://hl7.org/fhir/sid/us-npi"/>
              <value value="1234567893"/>
            </identifier>
            <active value="true"/>
            <type>
              <coding>
                <system value="https://codesystem.x12.org/005010/98"/>
                <code value="PR"/>
              </coding>
            </type>
            <name value="MARYLAND CAPITAL INSURANCE COMPANY"/>
          </Organization>
        </resource>
      </entry>
      <entry>
        <fullUrl value="http://example.org/fhir/Patient/SubscriberExample"/>
        <resource>
          <Patient>
            <id value="SubscriberExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_SubscriberExample"> </a><p class="res-header-id"><b>Generated Narrative: Patient SubscriberExample</b></p><a name="SubscriberExample"> </a><a name="hcSubscriberExample"> </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-subscriber.html">PAS Subscriber Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">JOE SMITH  Male, DoB Unknown ( Member Number)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="A patient's military status."><a href="StructureDefinition-extension-militaryStatus.html"/></td><td colspan="3"><span title="Codes:{https://codesystem.x12.org/005010/584 RU}">RU</span></td></tr></table></div>
            </text>
            <extension
                       url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus">
              <valueCodeableConcept>
                <coding>
                  <system value="https://codesystem.x12.org/005010/584"/>
                  <code value="RU"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <identifier>
              <type>
                <coding>
                  <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                  <code value="MB"/>
                </coding>
              </type>
              <system value="http://example.org/MIN"/>
              <value value="12345678901"/>
            </identifier>
            <name>
              <family value="SMITH"/>
              <given value="JOE"/>
            </name>
            <gender value="male"/>
          </Patient>
        </resource>
      </entry>
      <entry>
        <fullUrl
                 value="http://example.org/fhir/Practitioner/ReferralPractitionerExample"/>
        <resource>
          <Practitioner>
            <id value="ReferralPractitionerExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_ReferralPractitionerExample"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner ReferralPractitionerExample</b></p><a name="ReferralPractitionerExample"> </a><a name="hcReferralPractitionerExample"> </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-practitioner.html">PAS Practitioner</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/6.2.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567893</p><p><b>name</b>: SUSAN WATSON </p></div>
            </text>
            <identifier>
              <system value="http://hl7.org/fhir/sid/us-npi"/>
              <value value="1234567893"/>
            </identifier>
            <name>
              <family value="WATSON"/>
              <given value="SUSAN"/>
            </name>
          </Practitioner>
        </resource>
      </entry>
    </Bundle>