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

## : Surgical Request Authorization Example - TTL Representation

Page standards status: Informative

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:Claim ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "SurgicalAuthorizationRequestExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim SurgicalAuthorizationRequestExample</b></p><a name=\"SurgicalAuthorizationRequestExample\"> </a><a name=\"hcSurgicalAuthorizationRequestExample\"> </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-claim.html\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1338 E}\">Elective</span></p><p><b>Extension Definition for Claim.encounter for Version 5.0</b>: <a href=\"Encounter-SurgicalEncounterExample.html\">Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --&gt; 2020-07-09</a></p><blockquote><p><b>ConditionCode</b></p><ul><li>category: <span title=\"Codes:{https://codesystem.x12.org/005010/1136 07}\">07</span></li><li>indicator: true</li><li>code: <span title=\"Codes:{https://codesystem.x12.org/005010/1321 09}\">09</span></li></ul></blockquote><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/16139462398</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</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>: 2020-06-24 07:34:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><a href=\"PractitionerRole-SurgicalPractitionerRoleExample.html\">PractitionerRole: telecom = ph: 4029993456</a></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Timing[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes admissionDates}\">Admission Dates</span></td><td>2020-07-02 --&gt; 2020-07-09</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm C18.9}\">Malignant neoplasm of colon, unspecified</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 AR}\">Admission Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>ItemTraceNumber</b>: <code>http://example.org/ITEM_TRACE_NUMBER</code>/1122334</p><p><b>AuthorizationNumber</b>: 1122445</p><p><b>AdministrationReferenceNumber</b>: 9988311</p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 2}\">Surgical</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets 33510}\">Under Venous Grafting Only for Coronary Artery Bypass</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 21}\">Inpatient Hospital</span></p></blockquote></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:extension ( [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1338"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "E" ] ;
    fhir:display [ fhir:v "Elective" ]       ] )     ]
      ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:Reference ;
    fhir:reference [ fhir:v "Encounter/SurgicalEncounterExample" ]     ]
      ] [
        ( fhir:extension [
    fhir:url [ fhir:v "category"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1136"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "07" ]         ] )       ]     ] [
    fhir:url [ fhir:v "indicator"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:boolean ;
    fhir:v true       ]     ] [
    fhir:url [ fhir:v "code"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1321"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "09" ]         ] )       ]     ] ) ;
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode"^^xsd:anyURI ]
      ] ) ; #
      fhir:identifier ( [
    fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "16139462398" ] ;
    fhir:assigner [
    fhir:identifier [
    fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "3030240928" ]       ]     ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:type [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "institutional" ]     ] )
      ] ; #
      fhir:use [ fhir:v "preauthorization"] ; #
      fhir:patient [
    fhir:reference [ fhir:v "Patient/SubscriberExample" ]
      ] ; #
      fhir:created [ fhir:v "2020-06-24T07:34:00+05:00"^^xsd:dateTime] ; #
      fhir:insurer [
    fhir:reference [ fhir:v "Organization/InsurerExample" ]
      ] ; #
      fhir:provider [
    fhir:reference [ fhir:v "Organization/UMOExample" ]
      ] ; #
      fhir:priority [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "normal" ]     ] )
      ] ; #
      fhir:careTeam ( [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:boolean ;
    fhir:v true       ]     ] ) ;
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:provider [
    fhir:reference [ fhir:v "PractitionerRole/SurgicalPractitionerRoleExample" ]     ]
      ] ) ; #
      fhir:supportingInfo ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "admissionDates" ]       ] )     ] ;
    fhir:timing [
    a fhir:Period ;
    fhir:start [ fhir:v "2020-07-02"^^xsd:date ] ;
    fhir:end [ fhir:v "2020-07-09"^^xsd:date ]     ]
      ] ) ; #
      fhir:diagnosis ( [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:date ;
    fhir:v "2020-06-24"^^xsd:date       ]     ] ) ;
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:diagnosis [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "C18.9" ]       ] )     ]
      ] ) ; #
      fhir:insurance ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:focal [ fhir:v true ] ;
    fhir:coverage [
    fhir:reference [ fhir:v "Coverage/InsuranceExample" ]     ]
      ] ) ; #
      fhir:item ( [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "AR" ] ;
    fhir:display [ fhir:v "Admission Review" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "I" ] ;
    fhir:display [ fhir:v "Initial" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:Identifier ;
    fhir:system [ fhir:v "http://example.org/ITEM_TRACE_NUMBER"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "1122334" ]       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:string ;
    fhir:v "1122445"       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:string ;
    fhir:v "9988311"       ]     ] ) ;
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
        ( fhir:careTeamSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
        ( fhir:diagnosisSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "2" ] ;
    fhir:display [ fhir:v "Surgical" ]       ] )     ] ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "33510" ] ;
    fhir:display [ fhir:v "Under Venous Grafting Only for Coronary Artery Bypass" ]       ] )     ] ;
    fhir:location [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "21" ]       ] )     ]
      ] ) . #