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 Claim: Homecare Authorization Example

Page standards status: Informative

Language: en

Profile: PAS Claim

Home Health Care Information

  • prognosis: 1
  • date: 2005-05-02

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

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

provider: Organization DR. JOE SMITH CORPORATION

priority: Normal

Insurances

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

item

Service Item Request Type: Health Services Review

Certification Type: Initial

sequence: 1

category: Home Health Care

productOrService: health or hospice setting, each 15 minutes

location: Office

item

Service Item Request Type: Health Services Review

Certification Type: Initial

sequence: 2

category: Home Health Care

productOrService: B4184

location: Office