# PAS Subscription Notification example - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Example Bundle: PAS Subscription Notification example



## Resource Content

```json
{
  "resourceType" : "Bundle",
  "id" : "PASSubscriptionNotification",
  "language" : "en",
  "type" : "history",
  "timestamp" : "2020-05-29T11:44:33.188-05:00",
  "entry" : [
    {
      "fullUrl" : "http://example.org/Parameters/SubscriptionNotificationParameters",
      "resource" : {
        "resourceType" : "Parameters",
        "id" : "SubscriptionNotificationParameters",
        "parameter" : [
          {
            "name" : "subscription",
            "valueReference" : {
              "reference" : "StructureDefinition/profile-subscription"
            }
          },
          {
            "name" : "topic",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic|2.1.0"
          },
          {
            "name" : "type",
            "valueCode" : "event-notification"
          },
          {
            "name" : "notification-event",
            "part" : [
              {
                "name" : "event-number",
                "valueString" : "2"
              },
              {
                "name" : "timestamp",
                "valueInstant" : "2020-05-29T11:44:33.188-05:00"
              },
              {
                "name" : "focus",
                "valueReference" : {
                  "reference" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
                }
              }
            ]
          }
        ]
      },
      "request" : {
        "method" : "GET",
        "url" : "https://example.org/Subscription/PAS/$status"
      },
      "response" : {
        "status" : "200"
      }
    },
    {
      "fullUrl" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample",
      "resource" : {
        "resourceType" : "Bundle",
        "id" : "ReferralAuthorizationResponseBundleExample",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"
          ]
        },
        "identifier" : {
          "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
          "value" : "A12345"
        },
        "type" : "collection",
        "timestamp" : "2005-05-02T11:02:00+05:00",
        "entry" : [
          {
            "fullUrl" : "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample",
            "resource" : {
              "resourceType" : "ClaimResponse",
              "id" : "PractitionerRequestorResponseExample",
              "meta" : {
                "profile" : [
                  "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
                ]
              },
              "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" : "2005-05-02T11:02:00+05:00",
              "insurer" : {
                "reference" : "Organization/InsurerExample"
              },
              "requestor" : {
                "reference" : "PractitionerRole/ReferralPractitionerRoleExample"
              },
              "request" : {
                "reference" : "Claim/ReferralAuthorizationExample"
              },
              "outcome" : "complete",
              "item" : [
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
                      "valuePeriod" : {
                        "start" : "2005-05-02",
                        "end" : "2005-06-02"
                      }
                    },
                    {
                      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
                      "valueDate" : "2005-05-02"
                    },
                    {
                      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
                      "valuePeriod" : {
                        "start" : "2005-05-02",
                        "end" : "2005-06-02"
                      }
                    },
                    {
                      "extension" : [
                        {
                          "url" : "provider",
                          "valueReference" : {
                            "reference" : "Practitioner/ReferralPractitionerExample"
                          }
                        }
                      ],
                      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
                    },
                    {
                      "extension" : [
                        {
                          "url" : "productOrServiceCode",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "https://codesystem.x12.org/005010/1365",
                                "code" : "3",
                                "display" : "Consultation"
                              }
                            ]
                          }
                        },
                        {
                          "url" : "unitPrice",
                          "valueMoney" : {
                            "value" : 100,
                            "currency" : "USD"
                          }
                        },
                        {
                          "url" : "quantity",
                          "valueQuantity" : {
                            "value" : 1
                          }
                        }
                      ],
                      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
                    }
                  ],
                  "itemSequence" : 1,
                  "adjudication" : [
                    {
                      "extension" : [
                        {
                          "extension" : [
                            {
                              "url" : "number",
                              "valueString" : "AUTH0001"
                            },
                            {
                              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
                              "valueCodeableConcept" : {
                                "coding" : [
                                  {
                                    "system" : "https://codesystem.x12.org/005010/306",
                                    "code" : "A1",
                                    "display" : "Certified in total"
                                  }
                                ]
                              }
                            }
                          ],
                          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
                        }
                      ],
                      "category" : {
                        "coding" : [
                          {
                            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code" : "submitted"
                          }
                        ]
                      }
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl" : "http://example.org/fhir/Organization/UMOExample",
            "resource" : {
              "resourceType" : "Organization",
              "id" : "UMOExample",
              "meta" : {
                "profile" : [
                  "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
                ]
              },
              "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"
                ]
              },
              "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/Patient/SubscriberExample",
            "resource" : {
              "resourceType" : "Patient",
              "id" : "SubscriberExample",
              "meta" : {
                "profile" : [
                  "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
                ]
              },
              "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/Practitioner/ReferralPractitionerExample",
            "resource" : {
              "resourceType" : "Practitioner",
              "id" : "ReferralPractitionerExample",
              "meta" : {
                "profile" : [
                  "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"
                ]
              },
              "identifier" : [
                {
                  "system" : "http://hl7.org/fhir/sid/us-npi",
                  "value" : "1234567893"
                }
              ],
              "name" : [
                {
                  "family" : "WATSON",
                  "given" : ["SUSAN"]
                }
              ]
            }
          }
        ]
      },
      "request" : {
        "method" : "GET",
        "url" : "https://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
      },
      "response" : {
        "status" : "200"
      }
    }
  ]
}

```
