Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Bundle: PAS Inquiry Request Bundle Example

Bundle PASClaimInquiryBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/Claim/PASClaimInquiryExample

Resource Claim:

Generated Narrative: Claim

Resource Claim "PASClaimInquiryExample"

Profile: PAS Claim Inquiry

identifier: id: 111099

status: ACTIVE

type: Professional (Claim Type Codes#professional)

use: PREAUTHORIZATION

patient: See above (Patient/SubscriberExample)

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

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

sequence: 1

productOrService: G0154 (HCPCSReleaseCodeSets#G0154)

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

CertificationIssueDate: 2019-07-01

CertificationEffectiveDate: 2019-07-01

CertificationExpirationDate: 2019-07-31

ReviewActionCode: Certified in total (306#A1)

ProductOrServiceCodeEnd: B4190 (HCPCSReleaseCodeSets#B4190)

sequence: 2

productOrService: B4184 (HCPCSReleaseCodeSets#B4184)

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

Resource Organization:

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

Contacts

-Address
*111 1ST STREET SAN DIEGO CA 92101 US

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

Resource Organization:

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

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

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: ACTIVE

beneficiary: See above (Patient/SubscriberExample)

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

Resource Patient:

JOE SMITH Male, DoB: ( id: 12345678901)