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

Publication Build: This will be filled in by the publication tooling

Example Claim: Referral Authorization Example

Page standards status: Informative

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: Patient/SubscriberExample " SMITH"

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

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

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

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

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

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

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