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

## : Homecare Authorization Bundle Example - JSON Representation

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    {
      "resourceType" : "Bundle",
      "id" : "HomecareAuthorizationBundleExample",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"
        ]
      },
      "identifier" : {
        "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
        "value" : "B56789"
      },
      "type" : "collection",
      "timestamp" : "2005-05-02T14:30:00+05:00",
      "entry" : [
        {
          "fullUrl" : "http://example.org/fhir/Claim/HomecareAuthorizationExample",
          "resource" : {
            "resourceType" : "Claim",
            "id" : "HomecareAuthorizationExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
              ]
            },
            "text" : {
              "status" : "extensions",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_HomecareAuthorizationExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim HomecareAuthorizationExample</b></p><a name=\"HomecareAuthorizationExample\"> </a><a name=\"hcHomecareAuthorizationExample\"> </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><blockquote><p><b>HomeHealthCareInformation</b></p><ul><li>prognosis: <span title=\"Codes:{https://codesystem.x12.org/005010/923 1}\">1</span></li><li>date: 2005-05-02</li></ul></blockquote><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>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets G0154}\">G0154</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</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>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4184}\">B4184</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote></div>"
            },
            "extension" : [
              {
                "extension" : [
                  {
                    "url" : "prognosis",
                    "valueCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/923",
                          "code" : "1"
                        }
                      ]
                    }
                  },
                  {
                    "url" : "date",
                    "valueDate" : "2005-05-02"
                  }
                ],
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation"
              }
            ],
            "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" : "2019-07-20T11:01:00+05:00",
            "insurer" : {
              🔗 "reference" : "Organization/InsurerExample"
            },
            "provider" : {
              🔗 "reference" : "Organization/UMOExample"
            },
            "priority" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
                  "code" : "normal"
                }
              ]
            },
            "insurance" : [
              {
                "sequence" : 1,
                "focal" : true,
                "coverage" : {
                  🔗 "reference" : "Coverage/InsuranceExample"
                }
              }
            ],
            "item" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
                    "valueCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/1525",
                          "code" : "HS",
                          "display" : "Health Services Review"
                        }
                      ]
                    }
                  },
                  {
                    "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
                    "valueCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/1322",
                          "code" : "I",
                          "display" : "Initial"
                        }
                      ]
                    }
                  }
                ],
                "sequence" : 1,
                "category" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/1365",
                      "code" : "42",
                      "display" : "Home Health Care"
                    }
                  ]
                },
                "productOrService" : {
                  "coding" : [
                    {
                      "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                      "code" : "G0154"
                    }
                  ]
                },
                "locationCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
                      "code" : "11"
                    }
                  ]
                }
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
                    "valueCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/1525",
                          "code" : "HS",
                          "display" : "Health Services Review"
                        }
                      ]
                    }
                  },
                  {
                    "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
                    "valueCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "https://codesystem.x12.org/005010/1322",
                          "code" : "I",
                          "display" : "Initial"
                        }
                      ]
                    }
                  }
                ],
                "sequence" : 2,
                "category" : {
                  "coding" : [
                    {
                      "system" : "https://codesystem.x12.org/005010/1365",
                      "code" : "42",
                      "display" : "Home Health Care"
                    }
                  ]
                },
                "productOrService" : {
                  "coding" : [
                    {
                      "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                      "code" : "B4184"
                    }
                  ]
                },
                "locationCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
                      "code" : "11"
                    }
                  ]
                }
              }
            ]
          }
        },
        {
          "fullUrl" : "http://example.org/fhir/Organization/UMOExample",
          "resource" : {
            "resourceType" : "Organization",
            "id" : "UMOExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "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"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "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/Coverage/InsuranceExample",
          "resource" : {
            "resourceType" : "Coverage",
            "id" : "InsuranceExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "active",
            "subscriberId" : "1122334455",
            "beneficiary" : {
              🔗 "reference" : "Patient/SubscriberExample"
            },
            "relationship" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                  "code" : "self"
                },
                {
                  "system" : "https://codesystem.x12.org/005010/1069",
                  "code" : "18"
                }
              ]
            },
            "payor" : [
              {
                🔗 "reference" : "Organization/InsurerExample"
              }
            ]
          }
        },
        {
          "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample",
          "resource" : {
            "resourceType" : "Patient",
            "id" : "SubscriberExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "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"
          }
        }
      ]
    }