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

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Resource Profile: PAS Insurer Organization

An organization who provides insurance and is the receiver of a prior authorization request.

Usage:

• Refer to this Resource Profile: PAS Claim Base, PAS Claim Response Base, PAS CommunicationRequest and PAS Coverage
• Examples for this Resource Profile: MARYLAND CAPITAL INSURANCE COMPANY

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from PASOrganization

Name	Flags	Card.	Type	Description & Constraints
Organization			PASOrganization
type	S	0..*	CodeableConcept	Kind of organization Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Organization.type	required	https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98

Name	Flags	Card.	Type	Description & Constraints
Organization	C	0..*	PASOrganization	A grouping of people or organizations with a common purpose
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	0..*	PASIdentifier	Identifies this organization across multiple systems Slice: Unordered, Open by pattern:$this
identifier:NPI	S	0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
identifier:CLIA		0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.7
identifier:TIN	SΣC	0..1	Identifier	The US Employer Identification Number (EIN) or Tax Identification Number (TIN). Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
active	?!SΣ	1..1	boolean	Whether the organization's record is still in active use
type	SΣ	0..*	CodeableConcept	Kind of organization Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
name	SΣC	1..1	string	Name used for the organization
telecom	SC	0..*	ContactPoint	A contact detail for the organization
address	SC	0..*	Address	An address for the organization
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Organization.identifier:TIN.use	required	IdentifierUse
Organization.type	required	https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.use	required	AddressUse
Organization.address.state	extensible	UspsTwoLetterAlphabeticCodes

Name	Flags	Card.	Type	Description & Constraints
Organization	C	0..*	PASOrganization	A grouping of people or organizations with a common purpose
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	0..*	PASIdentifier	Identifies this organization across multiple systems Slice: Unordered, Open by pattern:$this
identifier:NPI	S	0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CLIA		0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.7
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:TIN	SΣC	0..1	Identifier	The US Employer Identification Number (EIN) or Tax Identification Number (TIN). Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!SΣ	1..1	boolean	Whether the organization's record is still in active use
type	SΣ	0..*	CodeableConcept	Kind of organization Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
name	SΣC	1..1	string	Name used for the organization
alias		0..*	string	A list of alternate names that the organization is known as, or was known as in the past
telecom	SC	0..*	ContactPoint	A contact detail for the organization
address	SC	0..*	Address	An address for the organization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
partOf	Σ	0..1	Reference(Organization)	The organization of which this organization forms a part
contact		0..*	BackboneElement	Contact for the organization for a certain purpose
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose		0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
name		0..1	HumanName	A name associated with the contact
telecom		0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
address		0..1	Address	Visiting or postal addresses for the contact
endpoint		0..*	Reference(Endpoint)	Technical endpoints providing access to services operated for the organization
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Organization.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Organization.identifier:TIN.use	required	IdentifierUse
Organization.identifier:TIN.type	extensible	Identifier Type Codes
Organization.type	required	https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.use	required	AddressUse
Organization.address.type	required	AddressType
Organization.address.state	extensible	UspsTwoLetterAlphabeticCodes
Organization.contact.purpose	extensible	ContactEntityType

This structure is derived from PASOrganization

Summary

Must-Support: 1 element

Maturity: 3

Differential View

This structure is derived from PASOrganization

Name	Flags	Card.	Type	Description & Constraints
Organization			PASOrganization
type	S	0..*	CodeableConcept	Kind of organization Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Organization.type	required	https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Organization	C	0..*	PASOrganization	A grouping of people or organizations with a common purpose
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	0..*	PASIdentifier	Identifies this organization across multiple systems Slice: Unordered, Open by pattern:$this
identifier:NPI	S	0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
identifier:CLIA		0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.7
identifier:TIN	SΣC	0..1	Identifier	The US Employer Identification Number (EIN) or Tax Identification Number (TIN). Required Pattern: At least the following
system		1..1	uri	The namespace for the identifier value Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
active	?!SΣ	1..1	boolean	Whether the organization's record is still in active use
type	SΣ	0..*	CodeableConcept	Kind of organization Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
name	SΣC	1..1	string	Name used for the organization
telecom	SC	0..*	ContactPoint	A contact detail for the organization
address	SC	0..*	Address	An address for the organization
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Organization.identifier:TIN.use	required	IdentifierUse
Organization.type	required	https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.use	required	AddressUse
Organization.address.state	extensible	UspsTwoLetterAlphabeticCodes

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Organization	C	0..*	PASOrganization	A grouping of people or organizations with a common purpose
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣC	0..*	PASIdentifier	Identifies this organization across multiple systems Slice: Unordered, Open by pattern:$this
identifier:NPI	S	0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: http://hl7.org/fhir/sid/us-npi
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:CLIA		0..1	PASIdentifier	An identifier intended for computation Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.4.7
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:TIN	SΣC	0..1	Identifier	The US Employer Identification Number (EIN) or Tax Identification Number (TIN). Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual | official | temp | secondary | old (If known)
type		0..1	CodeableConcept	Description of identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	?!SΣ	1..1	boolean	Whether the organization's record is still in active use
type	SΣ	0..*	CodeableConcept	Kind of organization Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
name	SΣC	1..1	string	Name used for the organization
alias		0..*	string	A list of alternate names that the organization is known as, or was known as in the past
telecom	SC	0..*	ContactPoint	A contact detail for the organization
address	SC	0..*	Address	An address for the organization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	SΣ	0..4	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	SΣ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.
postalCode	SΣ	0..1	string	US Zip Codes Example General: 9132
country	SΣ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
partOf	Σ	0..1	Reference(Organization)	The organization of which this organization forms a part
contact		0..*	BackboneElement	Contact for the organization for a certain purpose
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose		0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
name		0..1	HumanName	A name associated with the contact
telecom		0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
address		0..1	Address	Visiting or postal addresses for the contact
endpoint		0..*	Reference(Endpoint)	Technical endpoints providing access to services operated for the organization
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Organization.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Organization.identifier:TIN.use	required	IdentifierUse
Organization.identifier:TIN.type	extensible	Identifier Type Codes
Organization.type	required	https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.use	required	AddressUse
Organization.address.type	required	AddressType
Organization.address.state	extensible	UspsTwoLetterAlphabeticCodes
Organization.contact.purpose	extensible	ContactEntityType

This structure is derived from PASOrganization

Summary

Must-Support: 1 element

Maturity: 3

Other representations of profile: CSV, Excel, Schematron