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: Referral Authorization Bundle Example

Language: en

Profile: PAS Request Bundle

Bundle ReferralAuthorizationBundleExample of type collection

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

Resource Claim:

> Language: en

> Profile: PAS Claim

> LevelOfServiceCode: Urgent

> identifier: `urn:trnorg:9012345678`/111099

> status: Active

> type: Professional

> use: Preauthorization

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

> created: 2005-05-02 11:01:00+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

> - | Extension | Sequence | Category | Value[x]
> * |  | 1 | Additional Information | DocumentReference: status = current; type = Physician procedure note; category = Clinical Note

> ### Diagnoses

> - | Extension | Sequence | Diagnosis[x]
> * |  | 1 | Chronic pain syndrome

> ### Insurances

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

> > item

> > ServiceItemRequestType: Specialty Care Review

> > CertificationType: Initial

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

> > AuthorizationNumber: 1122445

> > AdministrationReferenceNumber: 9988311

> > RequestedService: ServiceRequest Consultation

> > EPSDTIndicator: false

> > NursingHomeResidentialStatus: Newly Admitted

> > NursingHomeLevelOfCare: Intermediate Care Facility (ICF)

> > RevenueUnitRateLimit: 100

> > sequence: 1

> > careTeamSequence: 1

> > diagnosisSequence: 1

> > category: Consultation

> > productOrService: Consultation

> > location: Office

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/ServiceRequest/ReferralRequestExample

Resource ServiceRequest:

> Language: en

> Profile: PAS Service Request

> status: Active

> intent: Order

> code: No display for ServiceRequest.code (concept: Consultation)

> quantity: 1 visit (Details: UCUM code1 = '1')

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

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

Resource PractitionerRole:

> Language: en

> Profile: PAS PractitionerRole

> practitioner: Practitioner SUSAN WATSON

> location: Location REFERRAL CLINIC

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

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/ReferralLocationExample

Resource Location:

> Language: en

> Profile: PAS Location Profile

> name: REFERRAL CLINIC

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

Entry 10 - fullUrl = http://example.org/fhir/DocumentReference/DocumentReferenceExample

Resource DocumentReference:

> Language: en

> Profile: PAS Document Reference

> status: Current

> type: Physician procedure note

> category: Clinical Note

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

> > content

> > ### Attachments

> > - | ContentType | Data
> > * | text/plain | `VGhpcyBpcyBzYW1wbGUgYmFzZTY0IGVuY29kaW5nLg==`