{
  "resourceType" : "Bundle",
  "id" : "PASSubscriptionNotification",
  "language" : "en",
  "type" : "history",
  "timestamp" : "2020-05-29T11:44:33.188-05:00",
  "entry" : [{
    "fullUrl" : "http://example.org/Parameters/SubscriptionNotificationParameters",
    "resource" : {
      "resourceType" : "Parameters",
      "id" : "SubscriptionNotificationParameters",
      "language" : "en",
      "parameter" : [{
        "name" : "subscription",
        "valueReference" : {
          "reference" : "Subscription/PASSubscriptionExample"
        }
      },
      {
        "name" : "topic",
        "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic"
      },
      {
        "name" : "type",
        "valueCode" : "event-notification"
      },
      {
        "name" : "notification-event",
        "part" : [{
          "name" : "event-number",
          "valueString" : "2"
        },
        {
          "name" : "timestamp",
          "valueInstant" : "2020-05-29T11:44:33.188-05:00"
        },
        {
          "name" : "focus",
          "valueReference" : {
            "reference" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
          }
        }]
      }]
    },
    "request" : {
      "method" : "GET",
      "url" : "https://example.org/Subscription/PAS/$status"
    },
    "response" : {
      "status" : "200"
    }
  },
  {
    "fullUrl" : "http://example.org/Bundle/ReferralAuthorizationResponseBundleExample",
    "resource" : {
      "resourceType" : "Bundle",
      "id" : "ReferralAuthorizationResponseBundleExample",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"]
      },
      "language" : "en",
      "identifier" : {
        "system" : "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
        "value" : "A12345"
      },
      "type" : "collection",
      "timestamp" : "2005-05-02T11:02:00+05:00",
      "entry" : [{
        "fullUrl" : "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample",
        "resource" : {
          "resourceType" : "ClaimResponse",
          "id" : "PractitionerRequestorResponseExample",
          "meta" : {
            "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"]
          },
          "language" : "en",
          "identifier" : [{
            "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
            "value" : "111099",
            "assigner" : {
              "identifier" : {
                "system" : "http://example.org/USER_ASSIGNED",
                "value" : "9012345678"
              }
            }
          }],
          "status" : "active",
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
              "code" : "professional"
            }]
          },
          "use" : "preauthorization",
          "patient" : {
            "reference" : "Patient/SubscriberExample"
          },
          "created" : "2005-05-02T11:02:00+05:00",
          "insurer" : {
            "reference" : "Organization/InsurerExample"
          },
          "requestor" : {
            "reference" : "PractitionerRole/ReferralPractitionerRoleExample"
          },
          "request" : {
            "reference" : "Claim/ReferralAuthorizationExample"
          },
          "outcome" : "complete",
          "item" : [{
            "extension" : [{
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
              "valuePeriod" : {
                "start" : "2005-05-02",
                "end" : "2005-06-02"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
              "valueDate" : "2005-05-02"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
              "valuePeriod" : {
                "start" : "2005-05-02",
                "end" : "2005-06-02"
              }
            },
            {
              "extension" : [{
                "url" : "provider",
                "valueReference" : {
                  "reference" : "Practitioner/ReferralPractitionerExample"
                }
              }],
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
            },
            {
              "extension" : [{
                "url" : "productOrServiceCode",
                "valueCodeableConcept" : {
                  "coding" : [{
                    "system" : "https://codesystem.x12.org/005010/1365",
                    "code" : "3",
                    "display" : "Consultation"
                  }]
                }
              },
              {
                "url" : "unitPrice",
                "valueMoney" : {
                  "value" : 100,
                  "currency" : "USD"
                }
              },
              {
                "url" : "quantity",
                "valueQuantity" : {
                  "value" : 1
                }
              }],
              "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
            }],
            "itemSequence" : 1,
            "adjudication" : [{
              "extension" : [{
                "extension" : [{
                  "url" : "number",
                  "valueString" : "AUTH0001"
                },
                {
                  "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
                  "valueCodeableConcept" : {
                    "coding" : [{
                      "system" : "https://codesystem.x12.org/005010/306",
                      "code" : "A1",
                      "display" : "Certified in total"
                    }]
                  }
                }],
                "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
              }],
              "category" : {
                "coding" : [{
                  "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                  "code" : "submitted"
                }]
              }
            }]
          }]
        }
      },
      {
        "fullUrl" : "http://example.org/fhir/Organization/UMOExample",
        "resource" : {
          "resourceType" : "Organization",
          "id" : "UMOExample",
          "meta" : {
            "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"]
          },
          "language" : "en",
          "identifier" : [{
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "8189991234"
          }],
          "active" : true,
          "type" : [{
            "coding" : [{
              "system" : "https://codesystem.x12.org/005010/98",
              "code" : "X3"
            }]
          }],
          "name" : "DR. JOE SMITH CORPORATION",
          "address" : [{
            "line" : ["111 1ST STREET"],
            "city" : "SAN DIEGO",
            "state" : "CA",
            "postalCode" : "92101",
            "country" : "US"
          }]
        }
      },
      {
        "fullUrl" : "http://example.org/fhir/Organization/InsurerExample",
        "resource" : {
          "resourceType" : "Organization",
          "id" : "InsurerExample",
          "meta" : {
            "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"]
          },
          "language" : "en",
          "identifier" : [{
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1234567893"
          }],
          "active" : true,
          "type" : [{
            "coding" : [{
              "system" : "https://codesystem.x12.org/005010/98",
              "code" : "PR"
            }]
          }],
          "name" : "MARYLAND CAPITAL INSURANCE COMPANY"
        }
      },
      {
        "fullUrl" : "http://example.org/fhir/Patient/SubscriberExample",
        "resource" : {
          "resourceType" : "Patient",
          "id" : "SubscriberExample",
          "meta" : {
            "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"]
          },
          "language" : "en",
          "extension" : [{
            "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
            "valueCodeableConcept" : {
              "coding" : [{
                "system" : "https://codesystem.x12.org/005010/584",
                "code" : "RU"
              }]
            }
          }],
          "identifier" : [{
            "system" : "http://example.org/MIN",
            "value" : "12345678901"
          }],
          "name" : [{
            "family" : "SMITH",
            "given" : ["JOE"]
          }],
          "gender" : "male"
        }
      },
      {
        "fullUrl" : "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
        "resource" : {
          "resourceType" : "Practitioner",
          "id" : "ReferralPractitionerExample",
          "meta" : {
            "profile" : ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"]
          },
          "language" : "en",
          "identifier" : [{
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1234567893"
          }],
          "name" : [{
            "family" : "WATSON",
            "given" : ["SUSAN"]
          }]
        }
      }]
    },
    "request" : {
      "method" : "GET",
      "url" : "https://example.org/Bundle/ReferralAuthorizationResponseBundleExample"
    },
    "response" : {
      "status" : "200"
    }
  }]
}