Da Vinci Prior Authorization Support (PAS) FHIR IG
1.2.0-ballot - STU 1.2 US

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.2.0-ballot: STU 1.2 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

Example Bundle: Homecare Authorization Bundle Example

Bundle HomecareAuthorizationBundleExample of type collection

Entry 1 - Full URL = http://example.org/fhir/Claim/HomecareAuthorizationExample

Resource Claim:

Generated Narrative

Resource "HomecareAuthorizationExample"

Profile: PAS Claim

identifier: id: 111099

status: ACTIVE

type: Professional (Claim Type Codes#professional)

use: PREAUTHORIZATION

patient: Patient/SubscriberExample " SMITH"

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

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

provider: Organization/UMOExample "DR. JOE SMITH CORPORATION"

priority: Normal (Process Priority Codes#normal)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

sequence: 1

productOrService: G0154 (Current Procedural Terminology (CPT®)#G0154)

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

sequence: 2

productOrService: B4184 (Current Procedural Terminology (CPT®)#B4184)

Entry 2 - Full URL = http://example.org/fhir/Organization/UMOExample

Resource Organization:

Generated Narrative

Resource "UMOExample"

Profile: PAS Requestor Organization

identifier: id: 8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

Entry 3 - Full URL = http://example.org/fhir/Organization/InsurerExample

Resource Organization:

Generated Narrative

Resource "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: 789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - Full URL = http://example.org/fhir/Coverage/InsuranceExample

Resource Coverage:

Generated Narrative

Resource "InsuranceExample"

Profile: PAS Coverage

status: ACTIVE

beneficiary: Patient/SubscriberExample " SMITH"

payor: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

Entry 5 - Full URL = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

JOE SMITH Male ( id: 12345678901)