API Example Prior Authorization
{
"bundle": {
"resourceType": "Bundle",
"type": "collection",
"entry": [
{
"fullUrl": "urn:uuid:claim-inq-001",
"resource": {
"resourceType": "Claim",
"id": "claim-inq-001",
"status": "active",
"use": "preauthorization",
"identifier": [
{
"system": "https://prior-auth.example.com/claim",
"value": "prior-auth-ref-001"
}
],
"patient": {
"reference": "Patient/pat-001"
},
"created": "2026-01-01",
"insurer": {
"reference": "Organization/payer-001"
},
"provider": {
"reference": "Practitioner/prac-001"
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/cov-001"
}
}
]
}
}
]
},
"pas_version": "2.1"
}
{
"bundle": {
"resourceType": "Bundle",
"id": "ReferralAuthorizationResponseBundleExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"
]
},
"type": "collection",
"timestamp": "2005-05-02T06:02:00.000Z",
"entry": [
{
"fullUrl": "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample",
"resource": {
"resourceType": "ClaimResponse",
"id": "PractitionerRequestorResponseExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
]
},
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "111099",
"assigner": {
"identifier": {
"system": "http://example.org/USER_ASSIGNED",
"value": "9012345678"
}
}
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/SubscriberExample"
},
"created": "2005-05-02T06:02:00.000Z",
"insurer": {
"reference": "Organization/InsurerExample"
},
"requestor": {
"reference": "PractitionerRole/ReferralPractitionerRoleExample"
},
"request": {
"reference": "Claim/ReferralAuthorizationExample"
},
"outcome": "complete",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
"valuePeriod": {
"start": "2005-05-02T00:00:00.000Z",
"end": "2005-06-02T00:00:00.000Z"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2005-05-02T00:00:00.000Z"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
"valuePeriod": {
"start": "2005-05-02T00:00:00.000Z",
"end": "2005-06-02T00:00:00.000Z"
}
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Practitioner/ReferralPractitionerExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "3",
"display": "Consultation"
}
]
}
},
{
"url": "unitPrice",
"valueMoney": {
"value": 100,
"currency": "USD"
}
},
{
"url": "quantity",
"valueQuantity": {
"value": 1
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
}
],
"itemSequence": 1,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "number",
"valueString": "AUTH0001"
},
{
"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"
}
]
}
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/UMOExample",
"resource": {
"resourceType": "Organization",
"id": "UMOExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "8189991234"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "https://codesystem.x12.org/005010/98",
"code": "X3"
}
]
}
],
"name": "DR. JOE SMITH CORPORATION",
"address": [
{
"line": [
"111 1ST STREET"
],
"city": "SAN DIEGO",
"state": "CA",
"postalCode": "92101",
"country": "US"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/InsurerExample",
"resource": {
"resourceType": "Organization",
"id": "InsurerExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1234567893"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "https://codesystem.x12.org/005010/98",
"code": "PR"
}
]
}
],
"name": "MARYLAND CAPITAL INSURANCE COMPANY"
}
},
{
"fullUrl": "http://example.org/fhir/Patient/SubscriberExample",
"resource": {
"resourceType": "Patient",
"id": "SubscriberExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/584",
"code": "RU"
}
]
}
}
],
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MB"
}
]
},
"system": "http://example.org/MIN",
"value": "12345678901"
}
],
"name": [
{
"family": "SMITH",
"given": [
"JOE"
]
}
],
"gender": "male"
}
},
{
"fullUrl": "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
"resource": {
"resourceType": "Practitioner",
"id": "ReferralPractitionerExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1234567893"
}
],
"name": [
{
"family": "WATSON",
"given": [
"SUSAN"
]
}
],
"telecom": [
{
"system": "phone",
"value": "4029993456"
}
]
}
}
]
},
"pas_version": "2.1"
}
{
"bundle": {
"resourceType": "Bundle",
"type": "collection",
"entry": [
{
"fullUrl": "urn:uuid:claim-001",
"resource": {
"resourceType": "Claim",
"id": "claim-001",
"status": "active",
"use": "preauthorization",
"patient": {
"reference": "Patient/pat-001"
},
"created": "2026-01-01",
"insurer": {
"reference": "Organization/payer-001"
},
"provider": {
"reference": "Practitioner/prac-001"
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/cov-001"
}
}
]
}
}
]
},
"pas_version": "2.1"
}
{
"bundle": {
"resourceType": "Bundle",
"id": "ReferralAuthorizationResponseBundleExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"
]
},
"type": "collection",
"timestamp": "2005-05-02T06:02:00.000Z",
"entry": [
{
"fullUrl": "http://example.org/fhir/ClaimResponse/PractitionerRequestorResponseExample",
"resource": {
"resourceType": "ClaimResponse",
"id": "PractitionerRequestorResponseExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
]
},
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "111099",
"assigner": {
"identifier": {
"system": "http://example.org/USER_ASSIGNED",
"value": "9012345678"
}
}
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/SubscriberExample"
},
"created": "2005-05-02T06:02:00.000Z",
"insurer": {
"reference": "Organization/InsurerExample"
},
"requestor": {
"reference": "PractitionerRole/ReferralPractitionerRoleExample"
},
"request": {
"reference": "Claim/ReferralAuthorizationExample"
},
"outcome": "complete",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
"valuePeriod": {
"start": "2005-05-02T00:00:00.000Z",
"end": "2005-06-02T00:00:00.000Z"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2005-05-02T00:00:00.000Z"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
"valuePeriod": {
"start": "2005-05-02T00:00:00.000Z",
"end": "2005-06-02T00:00:00.000Z"
}
},
{
"extension": [
{
"url": "provider",
"valueReference": {
"reference": "Practitioner/ReferralPractitionerExample"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "3",
"display": "Consultation"
}
]
}
},
{
"url": "unitPrice",
"valueMoney": {
"value": 100,
"currency": "USD"
}
},
{
"url": "quantity",
"valueQuantity": {
"value": 1
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
}
],
"itemSequence": 1,
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "number",
"valueString": "AUTH0001"
},
{
"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"
}
]
}
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/UMOExample",
"resource": {
"resourceType": "Organization",
"id": "UMOExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "8189991234"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "https://codesystem.x12.org/005010/98",
"code": "X3"
}
]
}
],
"name": "DR. JOE SMITH CORPORATION",
"address": [
{
"line": [
"111 1ST STREET"
],
"city": "SAN DIEGO",
"state": "CA",
"postalCode": "92101",
"country": "US"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/InsurerExample",
"resource": {
"resourceType": "Organization",
"id": "InsurerExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1234567893"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "https://codesystem.x12.org/005010/98",
"code": "PR"
}
]
}
],
"name": "MARYLAND CAPITAL INSURANCE COMPANY"
}
},
{
"fullUrl": "http://example.org/fhir/Patient/SubscriberExample",
"resource": {
"resourceType": "Patient",
"id": "SubscriberExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/584",
"code": "RU"
}
]
}
}
],
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MB"
}
]
},
"system": "http://example.org/MIN",
"value": "12345678901"
}
],
"name": [
{
"family": "SMITH",
"given": [
"JOE"
]
}
],
"gender": "male"
}
},
{
"fullUrl": "http://example.org/fhir/Practitioner/ReferralPractitionerExample",
"resource": {
"resourceType": "Practitioner",
"id": "ReferralPractitionerExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner"
]
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1234567893"
}
],
"name": [
{
"family": "WATSON",
"given": [
"SUSAN"
]
}
],
"telecom": [
{
"system": "phone",
"value": "4029993456"
}
]
}
}
]
},
"pas_version": "2.1"
}
Updated about 2 hours ago
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