Da Vinci - Coverage Requirements Discovery
1.1.0-ballot - STU 1.1
US
Da Vinci - Coverage Requirements Discovery
1.1.0-ballot - STU 1.1
US
This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v1.1.0-ballot: STU 1.1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions 
Generated Narrative
Resource "priorauth-example"
status: active
type: Oral (Claim Type Codes#oral)
use: preauthorization
patient: Patient/example " SHAW"
created: 2014-08-16
insurer:
outcome: complete
disposition: The enclosed services are authorized for your provision within 30 days of this notice.
preAuthRef: 18SS12345
payeeType: Provider (ClaimPayeeTypeCodes#provider)
addItem
itemSequence: 1
productOrService: 1101 (oralservicecodes#1101)
modifier: None (modifiers#x)
noteNumber: 101
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
adjudication
category: CoPay (Adjudication Value Codes#copay)
adjudication
category: Eligible % (Adjudication Value Codes#eligpercent)
value: 100.00
adjudication
category: Benefit Amount (Adjudication Value Codes#benefit)
addItem
itemSequence: 1
productOrService: Radiograph, series (12) (oralservicecodes#2101)
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
adjudication
category: Eligible % (Adjudication Value Codes#eligpercent)
value: 100.00
adjudication
category: Benefit Amount (Adjudication Value Codes#benefit)
total
category: Submitted Amount (Adjudication Value Codes#submitted)
total
category: Benefit Amount (Adjudication Value Codes#benefit)
| - | Number | Type | Text | Language |
| * | 101 | Please submit a Pre-Authorization request if a more extensive examination or urgent services are required. | English (Region=Canada) (Tags for the Identification of Languages#en-CA) |
| - | Sequence | Focal | Coverage |
| * | 1 | true | Coverage/example |
IG © 2019+ HL7 International - Financial Management Work Group. Package hl7.fhir.us.davinci-crd#1.1.0-ballot based on FHIR 4.0.1. Generated 2022-02-17
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