Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) 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

Example Bundle: Referral Authorization Bundle Example

Bundle ReferralAuthorizationBundleExample of type collection

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

Resource Claim:

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: ACTIVE

type: Professional (Claim Type Codes#professional)

use: PREAUTHORIZATION

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1G89.4 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)

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

Resource Organization:

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

Contacts

-Address
*111 1ST STREET SAN DIEGO CA 92101 US

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

Resource Organization:

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

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

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: ACTIVE

beneficiary: See above (Patient/SubscriberExample)

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

Resource Patient:

JOE SMITH Male, DoB: ( id: 12345678901)

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

Resource ServiceRequest:

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: ACTIVE

intent: ORDER

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: See above (Patient/SubscriberExample)

Entry 7 - fullUrl = http://example.org/fhir/PractitionerRole/ReferralPractitionerRoleExample

Resource PractitionerRole:

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

Entry 8 - fullUrl = http://example.org/fhir/Practitioner/ReferralPractitionerExample

Resource Practitioner:

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

Entry 9 - fullUrl = http://example.org/fhir/Location/ReferralLocationExample

Resource Location:

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US