Da Vinci - Prior Authorization Support
0.1.0 - STU Ballot
Da Vinci - Prior Authorization Support
0.1.0 - STU Ballot
This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "Bundle",
"id" : "pa-response-example-referral",
"type" : "collection",
"timestamp" : "2005-05-02T11:02:00+05:00",
"entry" : [
{
"fullUrl" : "http://example.org/fhir/ClaimResponse/1",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 1</p><p><b>identifier</b>: AUTH0001</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/claim-type code 'professional' = 'Professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient/1\">Patient/1</a></p><p><b>created</b>: Jul 20, 2019 12:00:00 AM</p><p><b>insurer</b>: <a href=\"Organization/1\">Organization/1</a></p><p><b>requestor</b>: <a href=\"PractitionerRole/1\">PractitionerRole/1</a></p><p><b>outcome</b>: complete</p></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction",
"valueCode" : "A1"
},
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedEventDate",
"valuePeriod" : {
"start" : "2005-05-02",
"end" : "2005-06-02"
}
}
],
"identifier" : [
{
"system" : "http://example.org/REVIEW_IDENTIFICATION_NUMBER",
"value" : "AUTH0001"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}
]
},
"use" : "preauthorization",
"patient" : {
"reference" : "Patient/1"
},
"created" : "2019-07-20",
"insurer" : {
"reference" : "Organization/1"
},
"requestor" : {
"reference" : "PractitionerRole/1"
},
"outcome" : "complete"
}
},
{
"fullUrl" : "http://example.org/fhir/Organization/1",
"resource" : {
"resourceType" : "Organization",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 1</p><p><b>identifier</b>: ETIN = 789312</p><p><b>type</b>: Utilization Management Organization <span style=\"background: LightGoldenRodYellow\">(Details : {http://example.org/ENTITY_IDENTIFIER_CODE code 'X3' = 'X3', given as 'Utilization Management Organization'})</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://example.org/IDENTIFICATION_CODE_QUALIFIER",
"code" : "46",
"display" : "ETIN"
}
]
},
"system" : "http://example.org/ETIN",
"value" : "789312"
}
],
"type" : [
{
"coding" : [
{
"system" : "http://example.org/ENTITY_IDENTIFIER_CODE",
"code" : "X3",
"display" : "Utilization Management Organization"
}
]
}
],
"name" : "MARYLAND CAPITAL INSURANCE COMPANY"
}
},
{
"fullUrl" : "http://example.org/fhir/PractitionerRole/1",
"resource" : {
"resourceType" : "PractitionerRole",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 1</p><p><b>practitioner</b>: <a href=\"Practitioner/1\">Practitioner/1</a></p><p><b>code</b>: Provider <span style=\"background: LightGoldenRodYellow\">(Details : {http://example.org/ENTITY_IDENTIFIER_CODE code '1P' = '1P', given as 'Provider'})</span></p></div>"
},
"practitioner" : {
"reference" : "Practitioner/1"
},
"code" : [
{
"coding" : [
{
"system" : "http://example.org/ENTITY_IDENTIFIER_CODE",
"code" : "1P",
"display" : "Provider"
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/fhir/Practitioner/1",
"resource" : {
"resourceType" : "Practitioner",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 1</p><p><b>identifier</b>: ETIN = 8189991234</p><p><b>name</b>: JAMES GARDENER </p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://example.org/IDENTIFICATION_CODE_QUALIFIER",
"code" : "46",
"display" : "ETIN"
}
]
},
"system" : "http://example.org/ETIN",
"value" : "8189991234"
}
],
"name" : [
{
"family" : "GARDENER",
"given" : [
"JAMES"
]
}
]
}
},
{
"fullUrl" : "http://example.org/fhir/Coverage/1",
"resource" : {
"resourceType" : "Coverage",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 1</p><p><b>status</b>: active</p><p><b>beneficiary</b>: <a href=\"Patient/1\">Patient/1</a></p><p><b>payor</b>: <a href=\"Organization/1\">Organization/1</a></p></div>"
},
"status" : "active",
"beneficiary" : {
"reference" : "Patient/1"
},
"payor" : [
{
"reference" : "Organization/1"
}
]
}
},
{
"fullUrl" : "http://example.org/fhir/Patient/1",
"resource" : {
"resourceType" : "Patient",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 1</p><p><b>identifier</b>: Member Identification Number = 12345678901</p><p><b>name</b>: JOE SMITH </p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://example.org/IDENTIFICATION_CODE_QUALIFIER",
"code" : "MI",
"display" : "Member Identification Number"
}
]
},
"system" : "http://example.org/MIN",
"value" : "12345678901"
}
],
"name" : [
{
"family" : "SMITH",
"given" : [
"JOE"
]
}
]
}
}
]
}
IG © 2019+ HL7 International - Financial Management Work Group. Package hl7.fhir.us.davinci-pas#0.1.0 based on FHIR 4.0.0. Generated 2019-08-05
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