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 ClaimResponse: Authorization Response with Practitioner Requestor Example

Page standards status: Informative

Language: en

Profile: PAS Claim Response

identifier: `http://example.org/PATIENT_EVENT_TRACE_NUMBER`/111099

status: Active

type: Professional

use: Preauthorization

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

created: 2005-05-02 11:02:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

requestor: PractitionerRole: telecom = ph: 4029993456

request: Claim: extension = Urgent; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal

outcome: Processing Complete

> item

> ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02

> ItemPreAuthIssueDate: 2005-05-02

> ItemPreAuthPeriod: 2005-05-02 --> 2005-06-02

> > ItemAuthorizedProvider

> > - provider: Practitioner SUSAN WATSON

> > ItemAuthorizedDetail

> > - productOrServiceCode: Consultation
> > - unitPrice: $100.00 (USD)
> > - quantity: 1

> itemSequence: 1

> ### Adjudications

> - | Extension | Category
> * |  | Submitted Amount