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: Error Response Bundle Example

Language: en

Profile: PAS Response Bundle

Bundle ErrorResponseBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/ClaimResponse/ErrorResponseExample

Resource ClaimResponse:

> 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: Organization DR. JOE SMITH CORPORATION

> 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: error

> > error

> > code: 04

> > error

> > > ErrorElement

> > > - error: 2010A-NM103

> > ErrorPath: Bundle.entry[1].Organization.name

> > ErrorFollowupAction: C

> > code: T4

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/Patient/SubscriberExample

Resource Patient:

> Language: en

> Profile: PAS Subscriber Patient

> JOE SMITH Male, DoB Unknown ( Member Number)

> | RU

Entry 5 - 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