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

## : Authorization Response with Practitioner Requestor Example

Page standards status: Informative

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    {
      "resourceType" : "ClaimResponse",
      "id" : "PractitionerRequestorResponseExample",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
        ]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse PractitionerRequestorResponseExample</b></p><a name=\"PractitionerRequestorResponseExample\"> </a><a name=\"hcPractitionerRequestorResponseExample\"> </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\">Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claimresponse.html\">PAS Claim Response</a></p></div><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>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>requestor</b>: <a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole: telecom = ph: 4029993456</a></p><p><b>request</b>: <a href=\"Claim-ReferralAuthorizationExample.html\">Claim: extension = Urgent; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>ItemRequestedServiceDate</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>ItemPreAuthIssueDate</b>: 2005-05-02</p><p><b>ItemPreAuthPeriod</b>: 2005-05-02 --&gt; 2005-06-02</p><blockquote><p><b>ItemAuthorizedProvider</b></p><ul><li>provider: <a href=\"Practitioner-ReferralPractitionerExample.html\">Practitioner SUSAN WATSON </a></li></ul></blockquote><blockquote><p><b>ItemAuthorizedDetail</b></p><ul><li>productOrServiceCode: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></li><li>unitPrice: <span title=\"US Dollar\">$100.00</span> (USD)</li><li>quantity: 1</li></ul></blockquote><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote></div>"
      },
      "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"
                  }
                ]
              }
            }
          ]
        }
      ]
    }