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 ClaimResponse: Rejection Response Example

Page standards status: Informative

Language: en

Profile: PAS Claim Response

Claim Response Reviewer

  • wasHumanReviewedFlag: true

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: Organization DR. JOE SMITH CORPORATION

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: Complete

item

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount