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 Claim: Homecare Authorization Differential Update Example

Page standards status: Informative

Generated Narrative: Claim

Resource Claim "HomecareAuthorizationDifferentialExample"

Profile: PAS Claim Update

Security Labels: http://terminology.hl7.org/CodeSystem/v3-ObservationValue

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample " SMITH"

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

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

provider: Organization/UMOExample "DR. JOE SMITH CORPORATION"

priority: Normal (Process Priority Codes#normal)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

item

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

modifierExtension[http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled]

sequence: 2

category: Home Health Care (1365#42)

productOrService: B4184 (HCPCSReleaseCodeSets#B4184)

item

InfoChanged: added

ServiceItemRequestType: Health Services Review (1525#HS)

CertificationType: Initial (1322#I)

sequence: 3

category: Home Health Care (1365#42)

productOrService: B4185 (HCPCSReleaseCodeSets#B4185)