Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1
Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1
This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0: 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
{
"resourceType" : "Bundle",
"id" : "PASSubscriptionNotification",
"type" : "history",
"timestamp" : "2020-05-29T11:44:33.188-05:00",
"entry" : [
{
"fullUrl" : "http://example.org/Parameters/SubscriptionNotificationParameters",
"resource" : {
"resourceType" : "Parameters",
"id" : "SubscriptionNotificationParameters",
"parameter" : [
{
"name" : "subscription",
"valueReference" : {
🔗 "reference" : "StructureDefinition/profile-subscription"
}
},
{
"name" : "topic",
"valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic|2.1.0"
},
{
"name" : "type",
"valueCode" : "event-notification"
},
{
"name" : "notification-event",
"part" : [
{
"name" : "event-number",
"valueString" : "2"
},
{
"name" : "timestamp",
"valueInstant" : "2020-05-29T11:44:33.188-05:00"
},
{
"name" : "focus",
"valueReference" : {
"reference" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
}
}
]
}
]
},
"request" : {
"method" : "GET",
"url" : "https://example.org/Subscription/PAS/$status"
},
"response" : {
"status" : "200"
}
},
{
"fullUrl" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample",
"resource" : {
"resourceType" : "Bundle",
"id" : "ReferralAuthorizationResponseBundleExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"
]
},
"type" : "collection",
"timestamp" : "2005-05-02T11:02:00+05:00",
"entry" : [
{
"fullUrl" : "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "PractitionerRequestorResponseExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
]
},
"identifier" : [
{
"system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value" : "111099",
"assigner" : {
"identifier" : {
"system" : "http://example.org/USER_ASSIGNED",
"value" : "9012345678"
}
}
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}
]
},
"use" : "preauthorization",
"patient" : {
🔗 "reference" : "Patient/SubscriberExample"
},
"created" : "2005-05-02T11:02:00+05:00",
"insurer" : {
🔗 "reference" : "Organization/InsurerExample"
},
"requestor" : {
🔗 "reference" : "PractitionerRole/ReferralPractitionerRoleExample"
},
"request" : {
🔗 "reference" : "Claim/ReferralAuthorizationExample"
},
"outcome" : "complete",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
"valuePeriod" : {
"start" : "2005-05-02",
"end" : "2005-06-02"
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate" : "2005-05-02"
},
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
"valuePeriod" : {
"start" : "2005-05-02",
"end" : "2005-06-02"
}
},
{
"extension" : [
{
"url" : "provider",
"valueReference" : {
🔗 "reference" : "Practitioner/ReferralPractitionerExample"
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension" : [
{
"url" : "productOrServiceCode",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://codesystem.x12.org/005010/1365",
"code" : "3",
"display" : "Consultation"
}
]
}
},
{
"url" : "unitPrice",
"valueMoney" : {
"value" : 100,
"currency" : "USD"
}
},
{
"url" : "quantity",
"valueQuantity" : {
"value" : 1
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
}
],
"itemSequence" : 1,
"adjudication" : [
{
"extension" : [
{
"extension" : [
{
"url" : "number",
"valueString" : "AUTH0001"
},
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://codesystem.x12.org/005010/306",
"code" : "A1",
"display" : "Certified in total"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "submitted"
}
]
}
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/fhir/Organization/UMOExample",
"resource" : {
"resourceType" : "Organization",
"id" : "UMOExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
]
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "8189991234"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "https://codesystem.x12.org/005010/98",
"code" : "X3"
}
]
}
],
"name" : "DR. JOE SMITH CORPORATION",
"address" : [
{
"line" : [
"111 1ST STREET"
],
"city" : "SAN DIEGO",
"state" : "CA",
"postalCode" : "92101",
"country" : "US"
}
]
}
},
{
"fullUrl" : "http://example.org/fhir/Organization/InsurerExample",
"resource" : {
"resourceType" : "Organization",
"id" : "InsurerExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"
]
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1234567893"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "https://codesystem.x12.org/005010/98",
"code" : "PR"
}
]
}
],
"name" : "MARYLAND CAPITAL INSURANCE COMPANY"
}
},
{
"fullUrl" : "http://example.org/fhir/Patient/SubscriberExample",
"resource" : {
"resourceType" : "Patient",
"id" : "SubscriberExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
]
},
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://codesystem.x12.org/005010/584",
"code" : "RU"
}
]
}
}
],
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/MIN",
"value" : "12345678901"
}
],
"name" : [
{
"family" : "SMITH",
"given" : [
"JOE"
]
}
],
"gender" : "male"
}
},
{
"fullUrl" : "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
"resource" : {
"resourceType" : "Practitioner",
"id" : "ReferralPractitionerExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"
]
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1234567893"
}
],
"name" : [
{
"family" : "WATSON",
"given" : [
"SUSAN"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "4029993456"
}
]
}
}
]
},
"request" : {
"method" : "GET",
"url" : "https://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
},
"response" : {
"status" : "200"
}
}
]
}
IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pas#2.1.0 based on FHIR 4.0.1. Generated 2024-12-20
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