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 ClaimResponse: Referral Authorization Response Example

Generated Narrative

Resource "ReferralAuthorizationResponseExample"

Profile: PAS Claim Response

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample " SMITH"

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

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

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

outcome: complete

item

ItemAuthorizedDate: 2005-05-02 --> 2005-06-02

ItemPreAuthIssueDate: 2005-05-02

ItemPreAuthPeriod: 2005-05-02 --> 2005-06-02

ItemAuthorizedProvider

value: Practitioner/ReferralPractitionerExample " WATSON"

ItemAuthorizedDetail

value: Consultation (1365#3)

value: $100.00 (USD)

value: 1

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount (Adjudication Value Codes#submitted)