Da Vinci Prior Authorization Support (PAS) FHIR IG
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Da Vinci Prior Authorization Support (PAS) FHIR IG - Downloaded Version 2.2.0-ballot See the Directory of published versions

Example Claim: PAS Claim Inquiry Example

Page standards status: Informative

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

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( Member Number)

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: status = active; subscriberId = 1122334455; relationship = Self

item

ServiceItemRequestType: Health Services Review

CertificationType: Initial

sequence: 1

productOrService: G0154

item

ServiceItemRequestType: Health Services Review

CertificationType: Initial

CertificationIssueDate: 2019-07-01

CertificationEffectiveDate: 2019-07-01

CertificationExpirationDate: 2019-07-31

ReviewActionCode: Certified in total

ProductOrServiceCodeEnd: B4190

sequence: 2

productOrService: B4184