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

: 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><p><b>status</b>: active</p><p><b>beneficiary</b>: <a href="Patient-SubscriberExample.html">Generated Summary: id: 12345678901; JOE SMITH ; gender: male</a></p><p><b>payor</b>: <a href="Organization-InsurerExample.html">Generated Summary: id: 789312; active; <span title="Codes: {https://codesystem.x12.org/005010/98 PR}">PR</span>; name: MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>
  </text>
  <status value="active"/>
  <beneficiary>
    <reference value="Patient/SubscriberExample"/>
  </beneficiary>
  <payor>
    <reference value="Organization/InsurerExample"/>
  </payor>
</Coverage>