Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.1 - STU 2.2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.2.1: 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 Bundle: PAS Subscription Notification example

Language: en

Bundle PASSubscriptionNotification of type history

Entry 1 - fullUrl = http://example.org/Parameters/SubscriptionNotificationParameters

Resource Parameters:

Language: en

Parameters

subscriptionSubscription: status = requested; reason = Receive notifications about claim responses for my organization.; criteria = http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic
topicPAS Subscription Topic
typeevent-notification
notification-event
 event-number2
 timestamp2020-05-29 11:44:33-0500
 focusBundle: identifier = http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER#A12345; type = collection; timestamp = 2005-05-02 11:02:00+0500

Request:

GET https://example.org/Subscription/PAS/$status

Response:

200

Entry 2 - fullUrl = http://example.org/Bundle/ReferralAuthorizationResponseBundleExample

Resource Bundle:

Language: en

Profile: PAS Response Bundle

Bundle ReferralAuthorizationResponseBundleExample of type collection

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

Resource ClaimResponse:

Language: en

Profile: PAS Claim Response

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

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

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

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

requestor: PractitionerRole: telecom = ph: 4029993456

request: Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal

outcome: Processing Complete

item

Item Requested Service Date: 2005-05-02 --> 2005-06-02

Item Preauthorization Issue Date: 2005-05-02

Item Preauthorization Period: 2005-05-02 --> 2005-06-02

Item Authorized Provider

Item Authorized Detail

  • productOrServiceCode: Consultation
  • unitPrice: $100.00 (USD)
  • quantity: 1

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount

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

Resource Organization:

Language: en

Profile: PAS Requestor Organization

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:

Language: en

Profile: PAS Insurer Organization

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:

Language: en

Profile: PAS Subscriber Patient

JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

Military StatusRU

Entry 5 - fullUrl = http://example.org/fhir/Practitioner/ReferralPractitionerExample

Resource Practitioner:

Language: en

Profile: PAS Practitioner

identifier: United States National Provider Identifier/1234567893

name: SUSAN WATSON

Request:

GET https://example.org/Bundle/ReferralAuthorizationResponseBundleExample

Response:

200