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

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Example Bundle: Referral Authorization Bundle Example

Bundle ReferralAuthorizationBundleExample of type collection

Entry 1 - Full URL = http://example.org/fhir/Claim/ReferralAuthorizationExample

Resource Claim:

Generated Narrative

Texts

-
*

identifier: id: 111099

status: ACTIVE

type: Professional

use: PREAUTHORIZATION

patient: Generated Summary: id: 12345678901; JOE SMITH ; gender: male

created: May 2, 2005 6:01:00 AM

insurer: Generated Summary: id: 789312; active; PR; name: MARYLAND CAPITAL INSURANCE COMPANY

provider: Generated Summary: id: 8189991234; active; X3; name: DR. JOE SMITH CORPORATION

priority: Normal

CareTeams

-SequenceProvider
*1Generated Summary: id: 987654321; SUSAN WATSON ; Phone: 4029993456

Diagnoses

-SequenceDiagnosis[x]
*1Chronic pain syndrome

Insurances

-SequenceFocalCoverage
*1trueGenerated Summary: status: active

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceProductOrServiceLocation[x]
*, , 111Consultation11

Entry 2 - Full URL = http://example.org/fhir/Organization/UMOExample

Resource Organization:

Generated Narrative

Texts

-
*

identifier: id: 8189991234

active: true

type: X3

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

Entry 3 - Full URL = http://example.org/fhir/Organization/InsurerExample

Resource Organization:

Generated Narrative

Texts

-
*

identifier: id: 789312

active: true

type: PR

name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 4 - Full URL = http://example.org/fhir/Coverage/InsuranceExample

Resource Coverage:

Generated Narrative

Texts

-
*

status: ACTIVE

beneficiary: Generated Summary: id: 12345678901; JOE SMITH ; gender: male

payor: Generated Summary: id: 789312; active; PR; name: MARYLAND CAPITAL INSURANCE COMPANY

Entry 5 - Full URL = http://example.org/fhir/Patient/SubscriberExample

Resource Patient:

JOE SMITH Male ( id: 12345678901)

Entry 6 - Full URL = http://example.org/fhir/ServiceRequest/ReferralRequestExample

Resource ServiceRequest:

Generated Narrative

Texts

-
*

status: ACTIVE

intent: ORDER

code: Consultation

quantity: 1 {visit}

subject: Generated Summary: id: 12345678901; JOE SMITH ; gender: male