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 ClaimResponse: Referral Authorization Response Example

Page standards status: Informative

Generated Narrative: ClaimResponse

Resource ClaimResponse "ReferralAuthorizationResponseExample"

Profile: PAS Claim Response

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample " SMITH"

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

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

requestor: Organization/UMOExample "DR. JOE SMITH CORPORATION"

outcome: complete

item

ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02

ItemPreAuthIssueDate: 2005-05-02

ItemPreAuthPeriod: 2005-05-02 --> 2005-06-02

ItemAuthorizedProvider

url

provider

value: Practitioner/ReferralPractitionerExample " WATSON"

ItemAuthorizedDetail

url

productOrServiceCode

value: Consultation (1365#3)

url

unitPrice

value: US$100.00 (USD)

url

quantity

value: 1

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount (Adjudication Value Codes#submitted)