# Homecare Authorization Update Bundle Example - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Example Bundle: Homecare Authorization Update Bundle Example



## Resource Content

```json
{
  "resourceType" : "Bundle",
  "id" : "HomecareAuthorizationUpdateBundleExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"
    ]
  },
  "language" : "en",
  "identifier" : {
    "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
    "value" : "A12345"
  },
  "type" : "collection",
  "timestamp" : "2005-05-02T11:01:00+05:00",
  "entry" : [
    {
      "fullUrl" : "http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample",
      "resource" : {
        "resourceType" : "Claim",
        "id" : "HomecareAuthorizationUpdateExample",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update"
          ]
        },
        "text" : {
          "status" : "extensions",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_HomecareAuthorizationUpdateExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim HomecareAuthorizationUpdateExample</b></p><a name=\"HomecareAuthorizationUpdateExample\"> </a><a name=\"hcHomecareAuthorizationUpdateExample\"> </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-update.html\">PAS Claim Update</a></p></div><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099-UPDATE</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>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-HomecareAuthorizationExample.html\">Claim: extension = ; identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2019-07-20 11:01:00+0500; priority = Normal</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship prior}\">Prior Claim</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 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 3}\">Cancel</span></p><p><b>InfoCancelledFlag</b>: true</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><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>InfoChanged</b>: added</p><p><b>sequence</b>: 3</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 B4185}\">B4185</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>"
        },
        "identifier" : [
          {
            "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
            "value" : "111099-UPDATE",
            "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"
            }
          ]
        },
        "related" : [
          {
            "claim" : {
              "reference" : "Claim/HomecareAuthorizationExample"
            },
            "relationship" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship",
                  "code" : "prior"
                }
              ]
            }
          }
        ],
        "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" : "3",
                      "display" : "Cancel"
                    }
                  ]
                }
              }
            ],
            "modifierExtension" : [
              {
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled",
                "valueBoolean" : true
              }
            ],
            "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"
                }
              ]
            }
          },
          {
            "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"
                    }
                  ]
                }
              },
              {
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged",
                "valueCode" : "added"
              }
            ],
            "sequence" : 3,
            "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" : "B4185"
                }
              ]
            },
            "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"
      }
    },
    {
      "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"
                }
              ]
            }
          }
        ]
      }
    }
  ]
}

```
