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

## : PAS Claim Inquiry ResponseExample

Page standards status: Informative

Raw ttl | Download

    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:ClaimResponse ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "PASClaimInquiryResponseExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse>     ] )
      ] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse PASClaimInquiryResponseExample</b></p><a name=\"PASClaimInquiryResponseExample\"> </a><a name=\"hcPASClaimInquiryResponseExample\"> </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-claiminquiryresponse.html\">PAS Claim Inquiry 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>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</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>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><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:identifier ( [
    fhir:system [
    fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ;
    fhir:l <http://example.org/PATIENT_EVENT_TRACE_NUMBER>     ] ;
    fhir:value [ fhir:v "111099" ] ;
    fhir:assigner [
    fhir:identifier [
    fhir:system [
    fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ;
    fhir:l <http://example.org/USER_ASSIGNED>         ] ;
    fhir:value [ fhir:v "9012345678" ]       ]     ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:type [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
    fhir:code [ fhir:v "professional" ]     ] )
      ] ; #
      fhir:use [ fhir:v "preauthorization"] ; #
      fhir:patient [
    fhir:l fhir:Patient/SubscriberExample ;
    fhir:reference [ fhir:v "Patient/SubscriberExample" ]
      ] ; #
      fhir:created [ fhir:v "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ; #
      fhir:insurer [
    fhir:l fhir:Organization/InsurerExample ;
    fhir:reference [ fhir:v "Organization/InsurerExample" ]
      ] ; #
      fhir:request [
    fhir:l fhir:Claim/ReferralAuthorizationExample ;
    fhir:reference [ fhir:v "Claim/ReferralAuthorizationExample" ]
      ] ; #
      fhir:outcome [ fhir:v "complete"] ; #
      fhir:item ( [
        ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate>       ] ;
    fhir:value [
    a fhir:Period ;
    fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ;
    fhir:end [ fhir:v "2005-06-02"^^xsd:date ]       ]     ] ) ;
    fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
        ( fhir:adjudication [
          ( fhir:extension [
            ( fhir:extension [
    fhir:url [
    fhir:v "number"^^xsd:anyURI ;
    fhir:l fhir:number           ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "AUTH0001"           ]         ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode>           ] ;
    fhir:value [
    a fhir:CodeableConcept ;
                ( fhir:coding [
    fhir:system [
    fhir:v "https://codesystem.x12.org/005010/306"^^xsd:anyURI ;
    fhir:l <https://codesystem.x12.org/005010/306>               ] ;
    fhir:code [ fhir:v "A1" ] ;
    fhir:display [ fhir:v "Certified in total" ]             ] )           ]         ] ) ;
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction>         ]       ] ) ;
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/adjudication>           ] ;
    fhir:code [ fhir:v "submitted" ]         ] )       ]     ] )
      ] ) ; #
      fhir:insurance ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:focal [ fhir:v true ] ;
    fhir:coverage [
    fhir:l fhir:Coverage/InsuranceExample ;
    fhir:reference [ fhir:v "Coverage/InsuranceExample" ]     ]
      ] ) . #