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
Bundle ReferralAuthorizationBundleExample of type collection
Entry 1 - fullUrl = http://example.org/fhir/Claim/ReferralAuthorizationExample
Resource Claim:
Resource Claim "ReferralAuthorizationExample"
Profile: PAS Claim
LevelOfServiceCode: Urgent (1338#U)
identifier: id: 111099
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: PREAUTHORIZATION
patient: See above (Patient/SubscriberExample)
created: 2005-05-02 11:01:00+0500
insurer: See above (Organization/InsurerExample)
provider: See above (Organization/UMOExample)
priority: Normal (Process Priority Codes#normal)
CareTeams
Extension Sequence Provider 1 See above (PractitionerRole/ReferralPractitionerRoleExample) Diagnoses
Extension Sequence Diagnosis[x] 1 G89.4 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4) Insurances
Sequence Focal Coverage 1 true See above (Coverage/InsuranceExample) Items
Extension Sequence CareTeamSequence DiagnosisSequence Category ProductOrService Location[x] , , , , , , , , , 1 1 1 Consultation (1365#3) Consultation (1365#3) 11 (CMS Place of Service Codes (POS)#11)
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:
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)
Entry 6 - fullUrl = http://example.org/fhir/ServiceRequest/ReferralRequestExample
Resource ServiceRequest:
Generated Narrative: ServiceRequest
Resource ServiceRequest "ReferralRequestExample"
Profile: PAS Service Request
status: ACTIVE
intent: ORDER
code: Consultation (1365#3)
quantity: 1 visit (Details: UCUM code 1 = '1')
Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/ReferralPractitionerRoleExample
Resource PractitionerRole:
Generated Narrative: PractitionerRole
Resource PractitionerRole "ReferralPractitionerRoleExample"
Profile: PAS PractitionerRole
practitioner: See above (Practitioner/ReferralPractitionerExample)
Entry 8 - fullUrl = http://example.org/fhir/Practitioner/ReferralPractitionerExample
Resource Practitioner:
Generated Narrative: Practitioner
Resource Practitioner "ReferralPractitionerExample"
Profile: PAS Practitioner
identifier: id: #987654321
name: SUSAN WATSON
telecom: ph: 4029993456
Entry 9 - fullUrl = http://example.org/fhir/Location/ReferralLocationExample
Resource Location:
Resource Location "ReferralLocationExample"
Profile: PAS Location Profile
name: REFERRAL CLINIC
address: 111 1ST STREET SAN DIEGO CA 92101 US