Da Vinci Prior Authorization Support (PAS) FHIR IG
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This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

: Homecare Authorization Bundle Example - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "HomecareAuthorizationBundleExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle>     ] )
  ] ; # 
  fhir:identifier [
fhir:system [ fhir:v "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"^^xsd:anyURI ] ;
fhir:value [ fhir:v "B56789" ]
  ] ; # 
  fhir:type [ fhir:v "collection"] ; # 
  fhir:timestamp [ fhir:v "2005-05-02T14:30:00+05:00"^^xsd:dateTime] ; # 
  fhir:entry ( [
fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/HomecareAuthorizationExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Claim/HomecareAuthorizationExample> )
  ] [
fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/UMOExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Organization/UMOExample> )
  ] [
fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/InsurerExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Organization/InsurerExample> )
  ] [
fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/InsuranceExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Coverage/InsuranceExample> )
  ] [
fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/SubscriberExample"^^xsd:anyURI ] ;
    ( fhir:resource <http://example.org/fhir/Patient/SubscriberExample> )
  ] ) . # 

<http://example.org/fhir/Claim/HomecareAuthorizationExample> a fhir:Claim ;
  fhir:id [ fhir:v "HomecareAuthorizationExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_HomecareAuthorizationExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim HomecareAuthorizationExample</b></p><a name=\"HomecareAuthorizationExample\"> </a><a name=\"hcHomecareAuthorizationExample\"> </a><a name=\"HomecareAuthorizationExample-en-US\"> </a><blockquote><p><b>HomeHealthCareInformation</b></p><ul><li>prognosis: <span title=\"Codes:{https://codesystem.x12.org/005010/923 1}\">1</span></li><li>date: 2005-05-02</li></ul></blockquote><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</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 ( http://example.org/MIN#12345678901)</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>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}\">11</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>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}\">11</span></p></blockquote></div>"
  ] ; # 
  fhir:extension ( [
    ( fhir:extension [
fhir:url [ fhir:v "prognosis"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/923"^^xsd:anyURI ] ;
fhir:code [ fhir:v "1" ]         ] )       ]     ] [
fhir:url [ fhir:v "date"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2005-05-02"^^xsd:date ]     ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation"^^xsd:anyURI ]
  ] ) ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
fhir:value [ fhir:v "111099" ] ;
fhir:assigner [
fhir:identifier [
fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
fhir:value [ fhir:v "9012345678" ]       ]     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "professional" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/SubscriberExample" ]
  ] ; # 
  fhir:created [ fhir:v "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ; # 
  fhir:provider [
fhir:reference [ fhir:v "Organization/UMOExample" ]
  ] ; # 
  fhir:priority [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
fhir:code [ fhir:v "normal" ]     ] )
  ] ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/InsuranceExample" ]     ]
  ] ) ; # 
  fhir:item ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
fhir:code [ fhir:v "HS" ] ;
fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
fhir:code [ fhir:v "I" ] ;
fhir:display [ fhir:v "Initial" ]         ] )       ]     ] ) ;
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
fhir:code [ fhir:v "42" ] ;
fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
fhir:code [ fhir:v "G0154" ]       ] )     ] ;
fhir:location [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
fhir:code [ fhir:v "11" ]       ] )     ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
fhir:code [ fhir:v "HS" ] ;
fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
fhir:code [ fhir:v "I" ] ;
fhir:display [ fhir:v "Initial" ]         ] )       ]     ] ) ;
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
fhir:code [ fhir:v "42" ] ;
fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
fhir:code [ fhir:v "B4184" ]       ] )     ] ;
fhir:location [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
fhir:code [ fhir:v "11" ]       ] )     ]
  ] ) . # 

<http://example.org/fhir/Organization/UMOExample> a fhir:Organization ;
  fhir:id [ fhir:v "UMOExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_UMOExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization UMOExample</b></p><a name=\"UMOExample\"> </a><a name=\"hcUMOExample\"> </a><a name=\"UMOExample-en-US\"> </a><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 X3}\">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ;
fhir:value [ fhir:v "8189991234" ]
  ] ) ; # 
  fhir:active [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:type ( [
    ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ] ;
fhir:code [ fhir:v "X3" ]     ] )
  ] ) ; # 
  fhir:name [ fhir:v "DR. JOE SMITH CORPORATION"] ; # 
  fhir:address ( [
    ( fhir:line [ fhir:v "111 1ST STREET" ] ) ;
fhir:city [ fhir:v "SAN DIEGO" ] ;
fhir:state [ fhir:v "CA" ] ;
fhir:postalCode [ fhir:v "92101" ] ;
fhir:country [ fhir:v "US" ]
  ] ) . # 

<http://example.org/fhir/Organization/InsurerExample> a fhir:Organization ;
  fhir:id [ fhir:v "InsurerExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_InsurerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization InsurerExample</b></p><a name=\"InsurerExample\"> </a><a name=\"hcInsurerExample\"> </a><a name=\"InsurerExample-en-US\"> </a><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 PR}\">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1234567893" ]
  ] ) ; # 
  fhir:active [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:type ( [
    ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PR" ]     ] )
  ] ) ; # 
  fhir:name [ fhir:v "MARYLAND CAPITAL INSURANCE COMPANY"] . # 

<http://example.org/fhir/Coverage/InsuranceExample> a fhir:Coverage ;
  fhir:id [ fhir:v "InsuranceExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_InsuranceExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage InsuranceExample</b></p><a name=\"InsuranceExample\"> </a><a name=\"hcInsuranceExample\"> </a><a name=\"InsuranceExample-en-US\"> </a><p><b>status</b>: Active</p><p><b>subscriberId</b>: 1122334455</p><p><b>beneficiary</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}, {https://codesystem.x12.org/005010/1069 18}\">Self</span></p><p><b>payor</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:subscriberId [ fhir:v "1122334455"] ; # 
  fhir:beneficiary [
fhir:reference [ fhir:v "Patient/SubscriberExample" ]
  ] ; # 
  fhir:relationship [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ;
fhir:code [ fhir:v "self" ]     ] [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/1069"^^xsd:anyURI ] ;
fhir:code [ fhir:v "18" ]     ] )
  ] ; # 
  fhir:payor ( [
fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ) . # 

<http://example.org/fhir/Patient/SubscriberExample> a fhir:Patient ;
  fhir:id [ fhir:v "SubscriberExample"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_SubscriberExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient SubscriberExample</b></p><a name=\"SubscriberExample\"> </a><a name=\"hcSubscriberExample\"> </a><a name=\"SubscriberExample-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"A patient's military status.\"><a href=\"StructureDefinition-extension-militaryStatus.html\"/></td><td colspan=\"3\"><span title=\"Codes:{https://codesystem.x12.org/005010/584 RU}\">RU</span></td></tr></table></div>"
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "https://codesystem.x12.org/005010/584"^^xsd:anyURI ] ;
fhir:code [ fhir:v "RU" ]       ] )     ]
  ] ) ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://example.org/MIN"^^xsd:anyURI ] ;
fhir:value [ fhir:v "12345678901" ]
  ] ) ; # 
  fhir:name ( [
fhir:family [ fhir:v "SMITH" ] ;
    ( fhir:given [ fhir:v "JOE" ] )
  ] ) ; # 
  fhir:gender [ fhir:v "male"] . #