FHIR IG analytics| Package | davinci.pas.fhir.validator |
| Resource Type | Bundle |
| Id | Test Example1.json |
| FHIR Version | R4 |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle"
]
},
"type": "collection",
"timestamp": "2026-06-02T12:51:08.3051708+00:00",
"entry": [
{
"fullUrl": "http://example.org/fhir/ClaimResponse/1",
"resource": {
"resourceType": "ClaimResponse",
"id": "1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse"
]
},
"identifier": [
{
"system": "App.BaseUrl",
"value": "1"
},
{
"system": "http://example.org/payer/PATIENT_EVENT_TRACE_NUMBER",
"value": "1547380"
},
{
"type": {
"coding": [
{
"code": "CDR"
}
]
},
"value": "111099"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional",
"display": "Professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/SubscriberExample"
},
"created": "2026-06-02",
"insurer": {
"reference": "Organization/InsurerExample"
},
"requestor": {
"reference": "Organization/UMOExample"
},
"request": {
"reference": "Claim/MedicalServicesAuthorizationExample"
},
"outcome": "complete",
"preAuthRef": "100004513",
"preAuthPeriod": {
"start": "2019-09-22",
"end": "2019-10-20"
},
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2019-10-29"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "100004513"
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Organization/UMOExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99204"
}
],
"text": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family."
}
},
{
"url": "quantity",
"valueQuantity": {
"unit": "1"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R07.9",
"display": "CHEST PAIN UNSPECIFIED"
}
]
}
}
],
"itemSequence": 1,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2019-10-29"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "100004513"
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Organization/UMOExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "93000"
}
],
"text": "Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report"
}
},
{
"url": "quantity",
"valueQuantity": {
"unit": "1"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R07.9",
"display": "CHEST PAIN UNSPECIFIED"
}
]
}
}
],
"itemSequence": 2,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2019-10-29"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "100004513"
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Organization/UMOExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99205"
}
],
"text": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family."
}
},
{
"url": "quantity",
"valueQuantity": {
"unit": "1"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R07.9",
"display": "CHEST PAIN UNSPECIFIED"
}
]
}
}
],
"itemSequence": 3,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2019-10-29"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "100004513"
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Organization/UMOExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "93452"
}
],
"text": "Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed"
}
},
{
"url": "quantity",
"valueQuantity": {
"unit": "1"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R07.9",
"display": "CHEST PAIN UNSPECIFIED"
}
]
}
}
],
"itemSequence": 4,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2019-10-29"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "100004513"
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Organization/UMOExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "93454"
}
],
"text": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;"
}
},
{
"url": "quantity",
"valueQuantity": {
"unit": "1"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R07.9",
"display": "CHEST PAIN UNSPECIFIED"
}
]
}
}
],
"itemSequence": 5,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
]
}
],
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "number",
"valueString": "100004513"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
],
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
],
"communicationRequest": [
{
"reference": "CommunicationRequest/1"
}
]
}
},
{
"fullUrl": "App.BaseUrl/CommunicationRequest/1",
"resource": {
"resourceType": "CommunicationRequest",
"id": "1",
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R55.",
"display": "SYNCOPE AND COLLAPSE"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "R06.02",
"display": "SHORTNESS OF BREATH"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis",
"code": "I20.9",
"display": "ANGINA PECTORIS UNSPECIFIED"
}
]
}
}
],
"status": "active"
}
},
{
"fullUrl": "http://example.org/fhir/claim",
"resource": {
"resourceType": "Claim",
"id": "MedicalServicesAuthorizationExample",
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService",
"valueReference": {
"reference": "ServiceRequest/ServiceRequest"
}
}
],
"identifier": [
{
"type": {
"coding": [
{
"code": "CDR"
}
]
},
"value": "111099"
}
],
"status": "active",
"type": {
"coding": [
{
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/SubscriberExample"
},
"created": "2025",
"insurer": {
"reference": "Organization/InsurerExample"
},
"provider": {
"reference": "Organization/UMOExample"
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"careTeam": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope",
"valueBoolean": true
}
],
"sequence": 1,
"provider": {
"reference": "Practitioner/ReferralPractitionerExample"
},
"role": {
"coding": [
{
"code": "QB",
"display": "Purchase Service Provider"
}
]
},
"qualification": {
"coding": [
{
"code": "193200000X"
}
]
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope",
"valueBoolean": true
}
],
"sequence": 2,
"provider": {
"reference": "Organization/UMOExample"
},
"role": {
"coding": [
{
"code": "FA",
"display": "Facility"
}
]
},
"qualification": {
"coding": [
{
"code": "19320000X"
}
]
}
}
],
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"code": "additionalInformation"
}
]
},
"valueAttachment": {
"contentType": "application/pdf",
"title": "myfile.pdf",
"creation": "2025-03-30"
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"code": "patientEvent"
}
]
},
"timingPeriod": {
"start": "2026-03-05",
"end": "2026-03-05"
}
},
{
"sequence": 3,
"category": {
"coding": [
{
"code": "additionalInformation"
}
]
},
"valueReference": {
"reference": "DocumentReference/DocumentReference"
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "A0104"
}
]
},
"type": [
{
"coding": [
{
"code": "ABF"
}
]
}
]
},
{
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "A0101"
}
]
},
"type": [
{
"coding": [
{
"code": "ABF"
}
]
}
]
},
{
"sequence": 3,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "A0102"
}
]
},
"type": [
{
"coding": [
{
"code": "ABF"
}
]
}
]
},
{
"sequence": 4,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "A0103"
}
]
},
"type": [
{
"coding": [
{
"code": "ABF"
}
]
}
]
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/InsuranceExample"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "100004513"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "HS",
"display": "Health Services Review"
}
]
}
}
],
"sequence": 1,
"category": {
"coding": [
{
"code": "1"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99212"
}
]
},
"servicedPeriod": {
"start": "2026-03-05",
"end": "2026-03-05"
},
"locationCodeableConcept": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
"code": "22"
}
]
},
"quantity": {
"value": 125,
"unit": "UN"
}
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/UMOExample",
"resource": {
"resourceType": "Organization",
"id": "UMOExample",
"identifier": [
{
"type": {
"coding": [
{
"code": "NPI"
}
]
},
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1326085424"
},
{
"type": {
"coding": [
{
"code": "TIN"
}
]
},
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "157892419"
}
],
"active": false,
"name": "JFK MEDICAL CENTER",
"address": [
{
"line": [
"5301 S CONGRESS AVE"
],
"city": "ATLANTIS",
"state": "FL",
"postalCode": "33462",
"country": "US"
}
],
"contact": [
{
"name": {
"family": "LARSON"
},
"telecom": [
{
"system": "phone",
"value": "5615482673"
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/InsurerExample",
"resource": {
"resourceType": "Organization",
"id": "InsurerExample",
"identifier": [
{
"type": {
"coding": [
{
"code": "NPI"
}
]
},
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1578924155"
},
{
"type": {
"coding": [
{
"code": "TIN"
}
]
},
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "157892419"
}
],
"active": true,
"type": [
{
"coding": [
{
"code": "professional"
}
]
}
],
"name": "HUMANA"
}
},
{
"fullUrl": "http://example.org/fhir/Coverage/InsuranceExample",
"resource": {
"resourceType": "Coverage",
"id": "InsuranceExample",
"status": "cancelled",
"subscriberId": "8779034545",
"beneficiary": {
"reference": "Patient/SubscriberExample"
},
"relationship": {
"coding": [
{
"code": "18"
}
],
"text": "Negative for Chlamydia Trachomatis rRNA"
},
"period": {
"start": "2025-03-27",
"end": "2025-03-28"
},
"payor": [
{
"reference": "Organization/InsurerExample"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Patient/SubscriberExample",
"resource": {
"resourceType": "Patient",
"id": "SubscriberExample",
"identifier": [
{
"type": {
"coding": [
{
"code": "MI"
}
]
},
"system": "http://example.org/MIN",
"value": "H5026770000"
}
],
"name": [
{
"family": "WATERIDGE",
"given": [
"SUSBETH"
]
}
],
"gender": "male",
"birthDate": "1948-11-15",
"address": [
{
"line": [
"9677 GREEN HILL ROAD"
],
"city": "SHELBYVILLE",
"state": "KY",
"postalCode": "40065",
"country": "US"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
"resource": {
"resourceType": "Practitioner",
"id": "ReferralPractitionerExample",
"identifier": [
{
"type": {
"coding": [
{
"code": "NPI"
}
]
},
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1295852101"
},
{
"type": {
"coding": [
{
"code": "TIN"
}
]
},
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "157892419"
}
],
"name": [
{
"family": "AARON",
"given": [
"JOSHUA"
]
}
],
"telecom": [
{
"system": "phone",
"value": "8124248231"
},
{
"system": "fax",
"value": "8124358794"
}
],
"address": [
{
"line": [
"520 MARY ST STE 520"
],
"city": "EVANSVILLE",
"state": "IN",
"postalCode": "47710",
"country": "US"
}
]
}
}
]
}