Da Vinci Prior Authorization Support (PAS) FHIR IG
1.1.0 - STU 1

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.1.0: STU 1.1) based on FHIR 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

: Homecare Authorization Update Bundle Example - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Bundle;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "HomecareAuthorizationUpdateBundleExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle>     ]
  ];
  fhir:Bundle.identifier [
     fhir:Identifier.system [ fhir:value "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER" ];
     fhir:Identifier.value [ fhir:value "A12345" ]
  ];
  fhir:Bundle.type [ fhir:value "collection"];
  fhir:Bundle.timestamp [ fhir:value "2005-05-02T11:01:00+05:00"^^xsd:dateTime];
  fhir:Bundle.entry [
     fhir:index 0;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample" ];
     fhir:Bundle.entry.resource <http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample>
  ], [
     fhir:index 1;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Organization/UMOExample" ];
     fhir:Bundle.entry.resource <http://example.org/fhir/Organization/UMOExample>
  ], [
     fhir:index 2;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Organization/InsurerExample" ];
     fhir:Bundle.entry.resource <http://example.org/fhir/Organization/InsurerExample>
  ], [
     fhir:index 3;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Coverage/InsuranceExample" ];
     fhir:Bundle.entry.resource <http://example.org/fhir/Coverage/InsuranceExample>
  ], [
     fhir:index 4;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/fhir/Patient/SubscriberExample" ];
     fhir:Bundle.entry.resource <http://example.org/fhir/Patient/SubscriberExample>
  ].

<http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample> a fhir:Claim;
  fhir:Resource.id [ fhir:value "HomecareAuthorizationUpdateExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"HomecareAuthorizationUpdateExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claim-update.html\">PAS Claim Update</a></p></div><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"#Patient_SubscriberExample\">See above (Patient/SubscriberExample)</a></p><p><b>created</b>: 2019-07-20T11:01:00+05:00</p><p><b>insurer</b>: <a href=\"#Organization_InsurerExample\">See above (Organization/InsurerExample)</a></p><p><b>provider</b>: <a href=\"#Organization_UMOExample\">See above (Organization/UMOExample)</a></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"#Coverage_InsuranceExample\">See above (Coverage/InsuranceExample)</a></td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: Health Services Review <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1525#HS)</span></p><p><b>CertificationType</b>: Initial <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1322#I)</span></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: G0154 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT&reg;)</a>#G0154)</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: Health Services Review <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1525#HS)</span></p><p><b>CertificationType</b>: Cancel <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1322#3)</span></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: B4184 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT&reg;)</a>#B4184)</span></p></blockquote><blockquote><p><b>item</b></p><p><b>InfoChanged</b>: added</p><p><b>ServiceItemRequestType</b>: Health Services Review <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1525#HS)</span></p><p><b>CertificationType</b>: Initial <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1322#I)</span></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: B4185 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT&reg;)</a>#B4185)</span></p></blockquote></div>"
  ];
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ];
     fhir:Identifier.value [ fhir:value "111099" ];
     fhir:Identifier.assigner [
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ];
         fhir:Identifier.value [ fhir:value "9012345678" ]       ]     ]
  ];
  fhir:Claim.status [ fhir:value "active"];
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "professional" ]     ]
  ];
  fhir:Claim.use [ fhir:value "preauthorization"];
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "Patient/SubscriberExample" ]
  ];
  fhir:Claim.created [ fhir:value "2019-07-20T11:01:00+05:00"^^xsd:dateTime];
  fhir:Claim.insurer [
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ];
  fhir:Claim.provider [
     fhir:Reference.reference [ fhir:value "Organization/UMOExample" ]
  ];
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
       fhir:Coding.code [ fhir:value "normal" ]     ]
  ];
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/InsuranceExample" ]     ]
  ];
  fhir:Claim.item [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ];
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1525" ];
           fhir:Coding.code [ fhir:value "HS" ];
           fhir:Coding.display [ fhir:value "Health Services Review" ]         ]       ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ];
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1322" ];
           fhir:Coding.code [ fhir:value "I" ];
           fhir:Coding.display [ fhir:value "Initial" ]         ]       ]     ];
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
         fhir:Coding.code [ fhir:value "G0154" ]       ]     ]
  ], [
     fhir:index 1;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ];
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1525" ];
           fhir:Coding.code [ fhir:value "HS" ];
           fhir:Coding.display [ fhir:value "Health Services Review" ]         ]       ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ];
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1322" ];
           fhir:Coding.code [ fhir:value "3" ];
           fhir:Coding.display [ fhir:value "Cancel" ]         ]       ]     ];
     fhir:BackboneElement.modifierExtension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled" ];
       fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]     ];
     fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
         fhir:Coding.code [ fhir:value "B4184" ]       ]     ]
  ], [
     fhir:index 2;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged" ];
       fhir:Extension.valueCode [ fhir:value "added" ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ];
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1525" ];
           fhir:Coding.code [ fhir:value "HS" ];
           fhir:Coding.display [ fhir:value "Health Services Review" ]         ]       ]     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ];
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1322" ];
           fhir:Coding.code [ fhir:value "I" ];
           fhir:Coding.display [ fhir:value "Initial" ]         ]       ]     ];
     fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
         fhir:Coding.code [ fhir:value "B4185" ]       ]     ]
  ].

<http://example.org/fhir/Organization/UMOExample> a fhir:Organization;
  fhir:Resource.id [ fhir:value "UMOExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"UMOExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-requestor.html\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: 8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>"
  ];
  fhir:Organization.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ];
     fhir:Identifier.value [ fhir:value "8189991234" ]
  ];
  fhir:Organization.active [ fhir:value "true"^^xsd:boolean];
  fhir:Organization.type [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/98" ];
       fhir:Coding.code [ fhir:value "X3" ]     ]
  ];
  fhir:Organization.name [ fhir:value "DR. JOE SMITH CORPORATION"];
  fhir:Organization.address [
     fhir:index 0;
     fhir:Address.line [
       fhir:value "111 1ST STREET";
       fhir:index 0     ];
     fhir:Address.city [ fhir:value "SAN DIEGO" ];
     fhir:Address.state [ fhir:value "CA" ];
     fhir:Address.postalCode [ fhir:value "92101" ];
     fhir:Address.country [ fhir:value "US" ]
  ].

<http://example.org/fhir/Organization/InsurerExample> a fhir:Organization;
  fhir:Resource.id [ fhir:value "InsurerExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"InsurerExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-insurer.html\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: 789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
  ];
  fhir:Organization.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://hl7.org/fhir/sid/us-npi" ];
     fhir:Identifier.value [ fhir:value "789312" ]
  ];
  fhir:Organization.active [ fhir:value "true"^^xsd:boolean];
  fhir:Organization.type [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/98" ];
       fhir:Coding.code [ fhir:value "PR" ]     ]
  ];
  fhir:Organization.name [ fhir:value "MARYLAND CAPITAL INSURANCE COMPANY"].

<http://example.org/fhir/Coverage/InsuranceExample> a fhir:Coverage;
  fhir:Resource.id [ fhir:value "InsuranceExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"InsuranceExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-coverage.html\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: <a href=\"#Patient_SubscriberExample\">See above (Patient/SubscriberExample)</a></p><p><b>payor</b>: <a href=\"#Organization_InsurerExample\">See above (Organization/InsurerExample)</a></p></div>"
  ];
  fhir:Coverage.status [ fhir:value "active"];
  fhir:Coverage.beneficiary [
     fhir:Reference.reference [ fhir:value "Patient/SubscriberExample" ]
  ];
  fhir:Coverage.payor [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ].

<http://example.org/fhir/Patient/SubscriberExample> a fhir:Patient;
  fhir:Resource.id [ fhir:value "SubscriberExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"SubscriberExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-subscriber.html\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>"
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus" ];
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "https://codesystem.x12.org/005010/584" ];
         fhir:Coding.code [ fhir:value "RU" ]       ]     ]
  ];
  fhir:Patient.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://example.org/MIN" ];
     fhir:Identifier.value [ fhir:value "12345678901" ]
  ];
  fhir:Patient.name [
     fhir:index 0;
     fhir:HumanName.family [ fhir:value "SMITH" ];
     fhir:HumanName.given [
       fhir:value "JOE";
       fhir:index 0     ]
  ];
  fhir:Patient.gender [ fhir:value "male"].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.