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: Referral Authorization Example

Page standards status: Informative

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