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 in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example Claim: PAS Claim Inquiry Example

Page standards status: Informative

Generated Narrative: Claim PASClaimInquiryExample

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

status: Active

type: Professional

use: Preauthorization

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

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

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; subscriberId = 1122334455; relationship = Self

item

ServiceItemRequestType: Health Services Review

CertificationType: Initial

sequence: 1

productOrService: G0154

item

ServiceItemRequestType: Health Services Review

CertificationType: Initial

CertificationIssueDate: 2019-07-01

CertificationEffectiveDate: 2019-07-01

CertificationExpirationDate: 2019-07-31

ReviewActionCode: Certified in total

ProductOrServiceCodeEnd: B4190

sequence: 2

productOrService: B4184