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 Claim: Referral Authorization Example

Generated Narrative

Resource "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample " SMITH"

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

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

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1Practitioner/ReferralPractitionerExample " WATSON"

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)