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

Raw xml | Download

    <Bundle xmlns="http://hl7.org/fhir">
      <id value="PASSubscriptionNotification"/>
      <language value="en"/>
      <type value="history"/>
      <timestamp value="2020-05-29T11:44:33.188-05:00"/>
      <entry>
        <fullUrl
                 value="http://example.org/Parameters/SubscriptionNotificationParameters"/>
        <resource>
          <Parameters>
            <id value="SubscriptionNotificationParameters"/>
            <language value="en"/>
            <parameter>
              <name value="subscription"/>
              <valueReference>🔗
                <reference value="StructureDefinition/profile-subscription"/>
              </valueReference>
            </parameter>
            <parameter>
              <name value="topic"/>
              <valueCanonical
                              value="http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic|2.1.0"/>
            </parameter>
            <parameter>
              <name value="type"/>
              <valueCode value="event-notification"/>
            </parameter>
            <parameter>
              <name value="notification-event"/>
              <part>
                <name value="event-number"/>
                <valueString value="2"/>
              </part>
              <part>
                <name value="timestamp"/>
                <valueInstant value="2020-05-29T11:44:33.188-05:00"/>
              </part>
              <part>
                <name value="focus"/>
                <valueReference>
                  <reference
                             value="http://example.org/Bundle/ReferralAuthorizationResponseBundleExample"/>
                </valueReference>
              </part>
            </parameter>
          </Parameters>
        </resource>
        <request>
          <method value="GET"/>
          <url value="https://example.org/Subscription/PAS/$status"/>
        </request>
        <response>
          <status value="200"/>
        </response>
      </entry>
      <entry>
        <fullUrl
                 value="http://example.org/Bundle/ReferralAuthorizationResponseBundleExample"/>
        <resource>
          <Bundle>
            <id value="ReferralAuthorizationResponseBundleExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"/>
            </meta>
            <language value="en"/>
            <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/PractitionerRequestorResponseExample"/>
              <resource>
                <ClaimResponse>
                  <id value="PractitionerRequestorResponseExample"/>
                  <meta>
                    <profile
                             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"/>
                  </meta>
                  <language value="en"/>
                  <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-itemRequestedServiceDate">
                      <valuePeriod>
                        <start value="2005-05-02"/>
                        <end value="2005-06-02"/>
                      </valuePeriod>
                    </extension>
                    <extension
                               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate">
                      <valueDate value="2005-05-02"/>
                    </extension>
                    <extension
                               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod">
                      <valuePeriod>
                        <start value="2005-05-02"/>
                        <end value="2005-06-02"/>
                      </valuePeriod>
                    </extension>
                    <extension
                               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider">
                      <extension url="provider">
                        <valueReference>🔗
                          <reference
                                     value="Practitioner/ReferralPractitionerExample"/>
                        </valueReference>
                      </extension>
                    </extension>
                    <extension
                               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail">
                      <extension url="productOrServiceCode">
                        <valueCodeableConcept>
                          <coding>
                            <system
                                    value="https://codesystem.x12.org/005010/1365"/>
                            <code value="3"/>
                            <display value="Consultation"/>
                          </coding>
                        </valueCodeableConcept>
                      </extension>
                      <extension url="unitPrice">
                        <valueMoney>
                          <value value="100"/>
                          <currency value="USD"/>
                        </valueMoney>
                      </extension>
                      <extension url="quantity">
                        <valueQuantity>
                          <value value="1"/>
                        </valueQuantity>
                      </extension>
                    </extension>
                    <itemSequence value="1"/>
                    <adjudication>
                      <extension
                                 url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction">
                        <extension url="number">
                          <valueString value="AUTH0001"/>
                        </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>
                      <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>
                  <language value="en"/>
                  <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>
                  <language value="en"/>
                  <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>
                  <language value="en"/>
                  <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>
                  <language value="en"/>
                  <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>
        </resource>
        <request>
          <method value="GET"/>
          <url
               value="https://example.org/Bundle/ReferralAuthorizationResponseBundleExample"/>
        </request>
        <response>
          <status value="200"/>
        </response>
      </entry>
    </Bundle>