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: Referral Authorization Response Bundle Example

Language: en

Profile: PAS Response Bundle

Bundle ReferralAuthorizationResponseBundleExample of type collection

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

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: PractitionerRole: telecom = ph: 4029993456

> 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: complete

> > item

> > ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02

> > ItemPreAuthIssueDate: 2005-05-02

> > ItemPreAuthPeriod: 2005-05-02 --> 2005-06-02

> > > ItemAuthorizedProvider

> > > - provider: Practitioner SUSAN WATSON

> > > ItemAuthorizedDetail

> > > - productOrServiceCode: Consultation
> > > - unitPrice: $100.00 (USD)
> > > - quantity: 1

> > itemSequence: 1

> > ### Adjudications

> > - | Extension | Category
> > * |  | Submitted Amount

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/Practitioner/ReferralPractitionerExample

Resource Practitioner:

> Language: en

> Profile: PAS Practitioner

> identifier: United States National Provider Identifier/1234567893

> name: SUSAN WATSON