Publication Build: This will be filled in by the publication tooling
Generated Narrative
Resource "ReferralAuthorizationResponseExample"
Profile: PAS Claim Response
identifier: id: 111099
status: active
type: Professional (Claim Type Codes#professional)
use: preauthorization
patient: Patient/SubscriberExample " SMITH"
created: 2005-05-02T11:02:00+05:00
insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"
requestor: Organization/UMOExample "DR. JOE SMITH CORPORATION"
outcome: complete
item
ItemAuthorizedDate: 2005-05-02 --> 2005-06-02
ItemPreAuthIssueDate: 2005-05-02
ItemPreAuthPeriod: 2005-05-02 --> 2005-06-02
ItemAuthorizedProvider
value: Practitioner/ReferralPractitionerExample " WATSON"
ItemAuthorizedDetail
value: Consultation (1365#3)
value: $100.00 (USD)
value: 1
itemSequence: 1
Adjudications
- Extension Category * Submitted Amount (Adjudication Value Codes#submitted)