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: Referral Pending Authorization Response Bundle Example

Language: en

Profile: PAS Response Bundle

Bundle ReferralPendingAuthorizationResponseBundleExample of type collection

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

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

Administration Reference Number: PEND0001

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