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
Generated Narrative: Bundle RejectionResponseBundleExample
Bundle RejectionResponseBundleExample of type collection
Entry 1 - fullUrl = http://example.org/fhir/ClaimResponse/RejectionResponseExample
Resource ClaimResponse:
Generated Narrative: ClaimResponse RejectionResponseExample
identifier:
http://example.org/PATIENT_EVENT_TRACE_NUMBER
/111099status: Active
type: Professional
use: Preauthorization
patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
created: 2005-05-02 11:02:00+0500
insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY
requestor: Organization DR. JOE SMITH CORPORATION
outcome: error
ProcessNotes
Number Text 1 Updates are not allowed. A new auth request must be submitted. error
ErrorElement: 2000E
ErrorFollowupAction: N
code: 33
Entry 2 - fullUrl = http://example.org/fhir/Organization/UMOExample
Resource Organization:
Generated Narrative: Organization UMOExample
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:
Generated Narrative: Organization InsurerExample
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:
Generated Narrative: Patient SubscriberExample
JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
RU