Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - STU 2 United States of America flag

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

Example Claim: Homecare Authorization Update Example

Page standards status: Informative

Generated Narrative: Claim HomecareAuthorizationUpdateExample

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099-UPDATE

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

created: 2019-07-20 11:01:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

Relateds

-ClaimRelationship
*Claim: extension = ; identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2019-07-20 11:01:00+0500; priority = NormalPrior Claim

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; subscriberId = 1122334455; relationship = Self

item

ServiceItemRequestType: Health Services Review

CertificationType: Initial

sequence: 1

category: Home Health Care

productOrService: G0154

location: 11

item

ServiceItemRequestType: Health Services Review

CertificationType: Cancel

InfoCancelledFlag: true

sequence: 2

category: Home Health Care

productOrService: B4184

location: 11

item

ServiceItemRequestType: Health Services Review

CertificationType: Initial

InfoChanged: added

sequence: 3

category: Home Health Care

productOrService: B4185

location: 11