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

: Submit Claim Requestor Example - JSON Representation

Page standards status: Informative

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{
  "resourceType" : "Organization",
  "id" : "UMOExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><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>"
  },
  "identifier" : [
    {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "8189991234"
    }
  ],
  "active" : true,
  "type" : [
    {
      "coding" : [
        {
          "system" : "https://codesystem.x12.org/005010/98",
          "code" : "X3"
        }
      ]
    }
  ],
  "name" : "DR. JOE SMITH CORPORATION",
  "address" : [
    {
      "line" : [
        "111 1ST STREET"
      ],
      "city" : "SAN DIEGO",
      "state" : "CA",
      "postalCode" : "92101",
      "country" : "US"
    }
  ]
}