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 Requestor Example - JSON Representation

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{
  "resourceType" : "Organization",
  "id" : "UMOExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes: {https://codesystem.x12.org/005010/98 X3}\">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>"
  },
  "identifier" : [
    {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "8189991234"
    }
  ],
  "active" : true,
  "type" : [
    {
      "coding" : [
        {
          "system" : "https://codesystem.x12.org/005010/98",
          "code" : "X3"
        }
      ]
    }
  ],
  "name" : "DR. JOE SMITH CORPORATION",
  "address" : [
    {
      "line" : [
        "111 1ST STREET"
      ],
      "city" : "SAN DIEGO",
      "state" : "CA",
      "postalCode" : "92101",
      "country" : "US"
    }
  ]
}