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

## : Homecare Authorization Update Example

Page standards status: Informative

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    {
      "resourceType" : "Claim",
      "id" : "HomecareAuthorizationUpdateExample",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update"
        ]
      },
      "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: Claim HomecareAuthorizationUpdateExample</b></p><a name=\"HomecareAuthorizationUpdateExample\"> </a><a name=\"hcHomecareAuthorizationUpdateExample\"> </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-claim-update.html\">PAS Claim Update</a></p></div><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099-UPDATE</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>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-HomecareAuthorizationExample.html\">Claim: extension = ; identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2019-07-20 11:01:00+0500; priority = Normal</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship prior}\">Prior Claim</span></td></tr></table><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><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets G0154}\">G0154</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 3}\">Cancel</span></p><p><b>InfoCancelledFlag</b>: true</p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4184}\">B4184</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>InfoChanged</b>: added</p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4185}\">B4185</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote></div>"
      },
      "identifier" : [
        {
          "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
          "value" : "111099-UPDATE",
          "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" : "2019-07-20T11:01:00+05:00",
      "insurer" : {
        🔗 "reference" : "Organization/InsurerExample"
      },
      "provider" : {
        🔗 "reference" : "Organization/UMOExample"
      },
      "priority" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
            "code" : "normal"
          }
        ]
      },
      "related" : [
        {
          "claim" : {
            🔗 "reference" : "Claim/HomecareAuthorizationExample"
          },
          "relationship" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship",
                "code" : "prior"
              }
            ]
          }
        }
      ],
      "insurance" : [
        {
          "sequence" : 1,
          "focal" : true,
          "coverage" : {
            🔗 "reference" : "Coverage/InsuranceExample"
          }
        }
      ],
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "https://codesystem.x12.org/005010/1525",
                    "code" : "HS",
                    "display" : "Health Services Review"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "https://codesystem.x12.org/005010/1322",
                    "code" : "I",
                    "display" : "Initial"
                  }
                ]
              }
            }
          ],
          "sequence" : 1,
          "category" : {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/1365",
                "code" : "42",
                "display" : "Home Health Care"
              }
            ]
          },
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                "code" : "G0154"
              }
            ]
          },
          "locationCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
                "code" : "11"
              }
            ]
          }
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "https://codesystem.x12.org/005010/1525",
                    "code" : "HS",
                    "display" : "Health Services Review"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "https://codesystem.x12.org/005010/1322",
                    "code" : "3",
                    "display" : "Cancel"
                  }
                ]
              }
            }
          ],
          "modifierExtension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled",
              "valueBoolean" : true
            }
          ],
          "sequence" : 2,
          "category" : {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/1365",
                "code" : "42",
                "display" : "Home Health Care"
              }
            ]
          },
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                "code" : "B4184"
              }
            ]
          },
          "locationCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
                "code" : "11"
              }
            ]
          }
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "https://codesystem.x12.org/005010/1525",
                    "code" : "HS",
                    "display" : "Health Services Review"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "https://codesystem.x12.org/005010/1322",
                    "code" : "I",
                    "display" : "Initial"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged",
              "valueCode" : "added"
            }
          ],
          "sequence" : 3,
          "category" : {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/1365",
                "code" : "42",
                "display" : "Home Health Care"
              }
            ]
          },
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                "code" : "B4185"
              }
            ]
          },
          "locationCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
                "code" : "11"
              }
            ]
          }
        }
      ]
    }