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

## Example Bundle: Surgical Admission Request Bundle Example

Language: en

Profile: PAS Request Bundle

Bundle SurgicalRequestBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/Claim/SurgicalAuthorizationRequestExample

Resource Claim:

> Language: en

> Profile: PAS Claim

> LevelOfServiceCode: Elective

> Extension Definition for Claim.encounter for Version 5.0: Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --> 2020-07-09

> > ConditionCode

> > - category: 07
> > - indicator: true
> > - code: 09

> identifier: `http://example.org/PATIENT_EVENT_TRACE_NUMBER`/16139462398

> status: Active

> type: Institutional

> use: Preauthorization

> patient: JOE SMITH Male, DoB Unknown ( Member Number)

> created: 2020-06-24 07:34:00+0500

> insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

> provider: Organization DR. JOE SMITH CORPORATION

> priority: Normal

> ### CareTeams

> - | Extension | Sequence | Provider
> * |  | 1 | PractitionerRole: telecom = ph: 4029993456

> ### SupportingInfos

> - | Sequence | Category | Timing[x]
> * | 1 | Admission Dates | 2020-07-02 --> 2020-07-09

> ### Diagnoses

> - | Extension | Sequence | Diagnosis[x]
> * |  | 1 | Malignant neoplasm of colon, unspecified

> ### Insurances

> - | Sequence | Focal | Coverage
> * | 1 | true | Coverage: status = active; subscriberId = 1122334455; relationship = Self

> > item

> > ServiceItemRequestType: Admission Review

> > CertificationType: Initial

> > ItemTraceNumber: `http://example.org/ITEM_TRACE_NUMBER`/1122334

> > AuthorizationNumber: 1122445

> > AdministrationReferenceNumber: 9988311

> > sequence: 1

> > careTeamSequence: 1

> > diagnosisSequence: 1

> > category: Surgical

> > productOrService: Under Venous Grafting Only for Coronary Artery Bypass

> > location: Inpatient Hospital

Entry 2 - fullUrl = http://example.org/fhir/Organization/UMOExample

Resource Organization:

> Language: en

> Profile: PAS Requestor Organization

> identifier: United States National Provider Identifier/8189991234

> active: true

> type: X3

> name: DR. JOE SMITH CORPORATION

> ### Contacts

> - | Address
> * | 111 1ST STREET SAN DIEGO CA 92101 US

Entry 3 - fullUrl = http://example.org/fhir/Organization/InsurerExample

Resource Organization:

> Language: en

> Profile: PAS Insurer Organization

> identifier: United States National Provider Identifier/1234567893

> active: true

> type: PR

> name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - fullUrl = http://example.org/fhir/Coverage/InsuranceExample

Resource Coverage:

> Language: en

> Profile: PAS Coverage

> status: Active

> subscriberId: 1122334455

> beneficiary: JOE SMITH Male, DoB Unknown ( Member Number)

> relationship: Self

Entry 5 - fullUrl = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

> Language: en

> Profile: PAS Subscriber Patient

> JOE SMITH Male, DoB Unknown ( Member Number)

> | RU

Entry 6 - fullUrl = http://example.org/fhir/Encounter/SurgicalEncounterExample

Resource Encounter:

> Language: en

> Profile: PAS Encounter

> PatientStatus: Still a patient

> status: Planned

> class: ambulatory

> type: 2

> subject: JOE SMITH Male, DoB Unknown ( Member Number)

Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/SurgicalPractitionerRoleExample

Resource PractitionerRole:

> Language: en

> Profile: PAS PractitionerRole

> practitioner: Practitioner SUSAN WATSON

> location: Location REFERRAL CLINIC

Entry 8 - fullUrl = http://example.org/fhir/Practitioner/SurgicalPractitionerExample

Resource Practitioner:

> Language: en

> Profile: PAS Practitioner

> identifier: United States National Provider Identifier/1234567893

> name: SUSAN WATSON

Entry 9 - fullUrl = http://example.org/fhir/Location/SurgicalLocationExample

Resource Location:

> Language: en

> Profile: PAS Location Profile

> name: REFERRAL CLINIC

> address: 111 1ST STREET SAN DIEGO CA 92101 US