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: Medical Services Authorization Example

Page standards status: Informative

Generated Narrative: Claim

Resource Claim "MedicalServicesAuthorizationExample"

Profile: PAS Claim

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample " SMITH"

created: 2005-05-02 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

Items

-ExtensionSequenceCategoryProductOrServiceServiced[x]Location[x]
*, , , 1Medical Care (1365#1)Established Office Visit (HCPCSReleaseCodeSets#99212)2005-05-1011 (CMS Place of Service Codes (POS)#11)