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