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 Inquiry Request Bundle Example - XML Representation

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    <Bundle xmlns="http://hl7.org/fhir">
      <id value="PASClaimInquiryBundleExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-request-bundle"/>
      </meta>
      <identifier>
        <system value="http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"/>
        <value value="5269367"/>
      </identifier>
      <type value="collection"/>
      <timestamp value="2005-05-02T11:01:00+05:00"/>
      <entry>
        <fullUrl value="http://example.org/fhir/Claim/PASClaimInquiryExample"/>
        <resource>
          <Claim>
            <id value="PASClaimInquiryExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry"/>
            </meta>
            <text>
              <status value="extensions"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_PASClaimInquiryExample"> </a><p class="res-header-id"><b>Generated Narrative: Claim PASClaimInquiryExample</b></p><a name="PASClaimInquiryExample"> </a><a name="hcPASClaimInquiryExample"> </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-inquiry.html">PAS Claim Inquiry</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>: 2019-07-20 11:01:00+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>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 HS}">Health Services Review</span></p><p><b>CertificationType</b>: <span title="Codes:{https://codesystem.x12.org/005010/1322 I}">Initial</span></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets G0154}">G0154</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title="Codes:{https://codesystem.x12.org/005010/1525 HS}">Health Services Review</span></p><p><b>CertificationType</b>: <span title="Codes:{https://codesystem.x12.org/005010/1322 I}">Initial</span></p><p><b>CertificationIssueDate</b>: 2019-07-01</p><p><b>CertificationEffectiveDate</b>: 2019-07-01</p><p><b>CertificationExpirationDate</b>: 2019-07-31</p><p><b>ReviewActionCode</b>: <span title="Codes:{https://codesystem.x12.org/005010/306 A1}">Certified in total</span></p><p><b>ProductOrServiceCodeEnd</b>: <span title="Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4190}">B4190</span></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title="Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4184}">B4184</span></p></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="2019-07-20T11:01:00+05:00"/>
            <insurer>🔗
              <reference value="Organization/InsurerExample"/>
            </insurer>
            <provider>🔗
              <reference value="Organization/UMOExample"/>
            </provider>
            <priority>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/processpriority"/>
                <code value="normal"/>
              </coding>
            </priority>
            <insurance>
              <sequence value="1"/>
              <focal value="true"/>
              <coverage>🔗
                <reference value="Coverage/InsuranceExample"/>
              </coverage>
            </insurance>
            <item>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType">
                <valueCodeableConcept>
                  <coding>
                    <system value="https://codesystem.x12.org/005010/1525"/>
                    <code value="HS"/>
                    <display value="Health Services Review"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType">
                <valueCodeableConcept>
                  <coding>
                    <system value="https://codesystem.x12.org/005010/1322"/>
                    <code value="I"/>
                    <display value="Initial"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <sequence value="1"/>
              <productOrService>
                <coding>
                  <system
                          value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
                  <code value="G0154"/>
                </coding>
              </productOrService>
            </item>
            <item>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType">
                <valueCodeableConcept>
                  <coding>
                    <system value="https://codesystem.x12.org/005010/1525"/>
                    <code value="HS"/>
                    <display value="Health Services Review"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType">
                <valueCodeableConcept>
                  <coding>
                    <system value="https://codesystem.x12.org/005010/1322"/>
                    <code value="I"/>
                    <display value="Initial"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate">
                <valueDate value="2019-07-01"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate">
                <valueDate value="2019-07-01"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate">
                <valueDate value="2019-07-31"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode">
                <valueCodeableConcept>
                  <coding>
                    <system value="https://codesystem.x12.org/005010/306"/>
                    <code value="A1"/>
                    <display value="Certified in total"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd">
                <valueCodeableConcept>
                  <coding>
                    <system
                            value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
                    <code value="B4190"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <sequence value="2"/>
              <productOrService>
                <coding>
                  <system
                          value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
                  <code value="B4184"/>
                </coding>
              </productOrService>
            </item>
          </Claim>
        </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/Coverage/InsuranceExample"/>
        <resource>
          <Coverage>
            <id value="InsuranceExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_InsuranceExample"> </a><p class="res-header-id"><b>Generated Narrative: Coverage InsuranceExample</b></p><a name="InsuranceExample"> </a><a name="hcInsuranceExample"> </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-coverage.html">PAS Coverage</a></p></div><p><b>status</b>: Active</p><p><b>subscriberId</b>: 1122334455</p><p><b>beneficiary</b>: <a href="Patient-SubscriberExample.html">JOE SMITH  Male, DoB Unknown ( Member Number)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}, {https://codesystem.x12.org/005010/1069 18}">Self</span></p><p><b>payor</b>: <a href="Organization-InsurerExample.html">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>
            </text>
            <status value="active"/>
            <subscriberId value="1122334455"/>
            <beneficiary>🔗
              <reference value="Patient/SubscriberExample"/>
            </beneficiary>
            <relationship>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
                <code value="self"/>
              </coding>
              <coding>
                <system value="https://codesystem.x12.org/005010/1069"/>
                <code value="18"/>
              </coding>
            </relationship>
            <payor>🔗
              <reference value="Organization/InsurerExample"/>
            </payor>
          </Coverage>
        </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>
    </Bundle>