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 Claim: Medical Services Authorization Example

Page standards status: Informative

Language: en

Profile: PAS Claim

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 11:01:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

### Insurances

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

> item

> ServiceItemRequestType: Initial Medical Services Reservation

> CertificationType: Initial

> AuthorizationNumber: 1122344

> AdministrationReferenceNumber: 33441122

> sequence: 1

> category: Medical Care

> productOrService: Established Office Visit

> serviced: 2005-05-10

> location: Office