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 ClaimResponse: PAS Claim Inquiry ResponseExample

Page standards status: Informative

Generated Narrative: ClaimResponse

Resource ClaimResponse "PASClaimInquiryResponseExample"

Profile: PAS Claim Inquiry Response

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"

outcome: complete

item

ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount (Adjudication Value Codes#submitted)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample