This page is part of the Da Vinci Health Record Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions
Page standards status: Informative |
Generated Narrative
Resource "UnsolicitedReferralAuthorizationResponseExample"
identifier: id: 111099
status: active
type: Professional (Claim Type Codes#professional)
use: preauthorization
patient: http://example.org/new-payer/fhir/Patient/pat1
created: 2005-05-02 11:02:00+0500
insurer: Organization/full "New Health Plan"
requestor: http://example.org/someProvider/fhir/Organization/good-health-clinic
outcome: complete
preAuthRef: A1B2C3D4
addItem
Authorized Date: 2005-05-02 --> 2005-06-02
Pre Authorized Issue Date: 2005-05-02
Authorized Provider: Practitioner/full " BONE"
Item Trace Number: id: A1B2C3D4
itemSequence: 1
productOrService: Consultation (1365#3)
location: 11 (CMS Place of Service Codes (POS)#11)
Adjudications
- Extension Category * Submitted Amount (Adjudication Value Codes#submitted)