FHIR IG analytics| Package | hl7.fhir.us.davinci-pas |
| Resource Type | Claim |
| Id | Claim-SurgicalAuthorizationRequestExample.json |
| FHIR Version | R4 |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Claim SurgicalAuthorizationRequestExample
Language: en
Profile: PAS Claim
LevelOfServiceCode: Elective
Extension Definition for Claim.encounter for Version 5.0: Encounter: extension = Still a patient; status = planned; class = ambulatory (ActCode#AMB); type = 2; period = 2020-07-02 --> 2020-07-09
ConditionCode
- category: 07
- indicator: true
- code: 09
identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/16139462398
status: Active
type: Institutional
use: Preauthorization
patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
created: 2020-06-24 07:34:00+0500
insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY
provider: Organization DR. JOE SMITH CORPORATION
priority: Normal
| Extension | Sequence | Provider |
| 1 | PractitionerRole: telecom = ph: 4029993456 |
| Sequence | Category | Timing[x] |
| 1 | Admission Dates | 2020-07-02 --> 2020-07-09 |
| Extension | Sequence | Diagnosis[x] |
| 1 | Malignant neoplasm of colon, unspecified |
| Sequence | Focal | Coverage |
| 1 | true | Coverage: status = active; subscriberId = 1122334455; relationship = Self |
item
ServiceItemRequestType: Admission Review
CertificationType: Initial
ItemTraceNumber:
http://example.org/ITEM_TRACE_NUMBER/1122334AuthorizationNumber: 1122445
AdministrationReferenceNumber: 9988311
sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
category: Surgical
productOrService: Under Venous Grafting Only for Coronary Artery Bypass
location: Inpatient Hospital
FHIR
FHIRsmith{
"resourceType": "Claim",
"id": "SurgicalAuthorizationRequestExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
]
},
"language": "en",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1338",
"code": "E",
"display": "Elective"
}
]
}
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter",
"valueReference": {
"reference": "Encounter/SurgicalEncounterExample"
}
},
{
"extension": [
{
"url": "category",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1136",
"code": "07"
}
]
}
},
{
"url": "indicator",
"valueBoolean": true
},
{
"url": "code",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1321",
"code": "09"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode"
}
],
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "16139462398",
"assigner": {
"identifier": {
"system": "http://example.org/USER_ASSIGNED",
"value": "3030240928"
}
}
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/SubscriberExample"
},
"created": "2020-06-24T07:34:00+05:00",
"insurer": {
"reference": "Organization/InsurerExample"
},
"provider": {
"reference": "Organization/UMOExample"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"careTeam": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope",
"valueBoolean": true
}
],
"sequence": 1,
"provider": {
"reference": "PractitionerRole/SurgicalPractitionerRoleExample"
}
}
],
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
"code": "admissionDates"
}
]
},
"timingPeriod": {
"start": "2020-07-02",
"end": "2020-07-09"
}
}
],
"diagnosis": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate",
"valueDate": "2020-06-24"
}
],
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "C18.9"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/InsuranceExample"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1525",
"code": "AR",
"display": "Admission Review"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1322",
"code": "I",
"display": "Initial"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
"valueIdentifier": {
"system": "http://example.org/ITEM_TRACE_NUMBER",
"value": "1122334"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "1122445"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
"valueString": "9988311"
}
],
"sequence": 1,
"careTeamSequence": [
1
],
"diagnosisSequence": [
1
],
"category": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "2",
"display": "Surgical"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "33510",
"display": "Under Venous Grafting Only for Coronary Artery Bypass"
}
]
},
"locationCodeableConcept": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
"code": "21"
}
]
}
}
]
}