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

: Submit Claim Insurance Example - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="InsuranceExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <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.html">Patient/SubscriberExample</a> " SMITH"</p><p><b>payor</b>: <a href="Organization-InsurerExample.html">Organization/InsurerExample</a> "MARYLAND CAPITAL INSURANCE COMPANY"</p></div>
  </text>
  <status value="active"/>
  <beneficiary>
    <reference value="Patient/SubscriberExample"/>
  </beneficiary>
  <payor>
    <reference value="Organization/InsurerExample"/>
  </payor>
</Coverage>