Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1 United States of America flag

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

Example Bundle: Rejection Response Bundle Example

Generated Narrative: Bundle RejectionResponseBundleExample

Bundle RejectionResponseBundleExample of type collection

Entry 1 - fullUrl = http://example.org/fhir/ClaimResponse/RejectionResponseExample

Resource ClaimResponse:

Generated Narrative: ClaimResponse RejectionResponseExample

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( Member Number)

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

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

requestor: Organization DR. JOE SMITH CORPORATION

request: Claim: identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099-UPDATE; status = active; type = Professional; use = preauthorization; created = 2019-07-20 11:01:00+0500; priority = Normal

outcome: error

ProcessNotes

-NumberText
*1Updates are not allowed. A new auth request must be submitted.

error

ErrorElement: 2000E

ErrorFollowupAction: N

code: 33

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

Resource Organization:

Generated Narrative: Organization UMOExample

identifier: United States National Provider Identifier/8189991234

active: true

type: 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 InsurerExample

identifier: United States National Provider Identifier/1234567893

active: true

type: PR

name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - fullUrl = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

Generated Narrative: Patient SubscriberExample

JOE SMITH Male, DoB Unknown ( Member Number)

RU