---
schema_version: "1"
id: 6da08de147d78587842d1220aa148521c162815a02a0739466dcb945785d6782
title: Prior Authorization
collection: developer
version: current
locale: en-us
portal_url: https://docs.salesforce.com/developer/current/en-us/industries-integrations/health/references/generated-api-specs/prior_auth.md
canonical_url: https://developer.salesforce.com/docs/industries/health/references/prior_auth
source_site: developer.salesforce.com
content_type: documentation
content_hash: 328b69327a71514dd1fa865ccc38996994ba1847ed7eb41c63a39fc6b4e08231
products:
- Salesforce Healthcare API
- Industries Integrations
---
Prior Authorization
# Prior Authorization
Use the Prior Auth Request API to authorize the provisioning of products or services to a patient and manage healthcare processes, such as claim inquiry and claim submission.
**Version:** v1
Protocols: https.
## Operations
### POST Create a claim submission request
`POST /$submit`
Creates a resource to generate a claim submission or claim inquiry request with prior authorization.
#### Parameters
* `Accept` (header, string)
Allowed values: `application/fhir+json`.
* `Access-Token` (header, string, required) Salesforce org access token
Example: `Bearer asvg473tebdjebdsakl!jsjndkcmldcmdcmedj3o9.asd`.
* `Instance-Domain-Name` (header, string, required) Instance domain name of the salesforce org
Example: `orgid.salesforce.com`.
#### Request body
Media type: `application/fhir+json`. Schema: `PASClaimRequestBundle (extended)`.
Contains a collection of resources.
* Rule: total only for search results or history.
* Rule: entry.search only for a search request.
* Rule: entry.request mandatory for batch, transaction, or history, else prohibited.
* Rule: entry.response mandatory for batch-response, transaction-response, or history, else prohibited.
* Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles).
* Rule: A document must have an identifier with a system and a value.
* Rule: A document must have a date.
* Rule: A document must have a Composition resource as the first resource.
* Rule: A message must have a MessageHeader resource as the first resource. Elements defined in Ancestors: id, meta, implicitRules, and language.
Includes all fields of `PASClaimRequestBundle`.
* `signature` (_Signature_) Represents an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature can be a cryptographic type (XML DigSig or a JWT), which is able to provide a non-repudiation proof, or a graphical image that represents a signature or a signature process.
_Example_
```
{
"resourceType": "Bundle",
"type": "collection",
"timestamp": "2005-05-02T11:01:00+05:00",
"entry": [
{
"resource": {
"resourceType": "Claim",
"id": "00001001",
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "111099",
"assigner": {
"reference": "Organization/3"
}
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/1"
},
"created": "2019-07-20",
"insurer": {
"reference": "Organization/1"
},
"provider": {
"reference": "Organization/2"
},
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/1525",
"code": "IN",
"display": "Initial Medical Services Reservation"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/1322",
"code": "I",
"display": "Initial"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
"valueString": "1122344"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
"valueString": "33441122"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService",
"valueReference": {
"reference": "ServiceRequest/1"
}
}
],
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "CPT",
"code": "39334",
"display": "Established Office Visit"
}
]
},
"servicedPeriod": {
"start": "2005-05-10",
"end": "2005-06-10"
},
"locationCodeableConcept": {
"coding": [
{
"system": "CPT1",
"code": "39334"
}
]
}
}
],
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal",
"display": "Normal"
}
]
},
"facility": {
"reference": "Location/1"
},
"careTeam": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope",
"valueBoolean": true
}
],
"sequence": 1,
"provider": {
"reference": "Practitioner/1"
}
}
],
"diagnosis": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate",
"valueDate": "2021-05-10"
}
],
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "CPT",
"code": "39334"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/1"
}
}
],
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info",
"display": "Information"
}
]
},
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/resource-types",
"code": "QuestionnaireResponse",
"display": "Questionnaire Response"
}
]
},
"valueReference": {
"reference": "QuestionnaireResponse/3141"
}
}
]
}
},
{
"resource": {
"resourceType": "QuestionnaireResponse",
"id": "home-o2-questionnaireresponse",
"questionnaire": "Questionnaire/0jNSG000000ByKD2A0",
"status": "completed",
"subject": {
"reference": "Patient/examplepatient",
"display": "Vlad"
},
"authored": "2023-08-21",
"item": [
{
"linkId": "1",
"text": "Patient Information",
"item": [
{
"linkId": "1.1",
"text": "Last Name but Different This Time",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "override"
},
{
"extension": [
{
"url": "role",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/practitioner-role",
"code": "doctor",
"display": "Doctor"
}
]
}
},
{
"url": "practitioner",
"valueReference": {
"reference": "Practitioner/PractitionerExample",
"display": "Dr. Jane Doe"
}
}
],
"url": "author"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Quinton"
}
]
},
{
"linkId": "1.2",
"text": "First Name",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Vlad"
}
]
},
{
"linkId": "1.3",
"text": "Middle Initial",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "A, N"
}
]
},
{
"linkId": "1.4",
"text": "Date Of Birth",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate": "1956-12-01"
}
]
},
{
"linkId": "1.5",
"text": "Gender",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
}
]
},
{
"linkId": "1.6",
"text": "Medicare ID",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "10A3D58WH22"
}
]
}
]
},
{
"linkId": "2",
"text": "Provider who is performing face-to-face evaluation",
"item": [
{
"linkId": "2.1",
"text": "Last Name",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Doe"
}
]
},
{
"linkId": "2.2",
"text": "First Name",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Jane"
}
]
},
{
"linkId": "2.3",
"text": "Middle Initial",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "B"
}
]
},
{
"linkId": "2.4",
"text": "NPI",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "1122334455"
}
]
},
{
"linkId": "2.5",
"text": "Date of Face-To-Face Evaluation",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "override"
},
{
"extension": [
{
"url": "role",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/practitioner-role",
"code": "doctor",
"display": "Doctor"
}
]
}
},
{
"url": "practitioner",
"valueReference": {
"reference": "Practitioner/PractitionerExample",
"display": "Dr. Jane Doe"
}
}
],
"url": "author"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate": "2019-07-18"
}
]
},
{
"linkId": "2.6",
"text": "Record",
"answer": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference",
"valueBoolean": false
}
],
"valueReference": {
"reference": "Patient/examplepatient",
"display": "Mr. Saul Moki"
}
}
]
}
]
},
{
"linkId": "3",
"text": "Coverage Requirements",
"item": [
{
"linkId": "3.1",
"text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "313296004",
"display": "Mild chronic obstructive pulmonary disease"
}
}
]
},
{
"linkId": "3.2",
"text": "Arterial oxygen saturation (Patient on room air while at rest and awake when tested)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 95,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.3",
"text": "Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 83,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.4",
"text": "Arterial oxygen saturation (Patient tested during exercise)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 95,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.5",
"text": "Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 78,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.6",
"text": "Is there a documented improvement of hypoxemia during exercise with oxygen?",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueBoolean": true
}
]
}
]
},
{
"linkId": "4",
"text": "Prescribed Use",
"item": [
{
"linkId": "4.1",
"text": "Start date",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate": "2019-07-18"
}
]
},
{
"linkId": "4.2",
"text": "Length of need: (months) (99 = lifetime)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 99
}
}
]
},
{
"linkId": "4.3",
"text": "Peak Flow Rate",
"item": [
{
"linkId": "4.3.1",
"text": "LPM",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 2
}
}
]
},
{
"linkId": "4.3.2",
"text": "oxygen %",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 98
}
}
]
}
]
},
{
"linkId": "4.4",
"text": "Average Flow Rate",
"item": [
{
"linkId": "4.4.1",
"text": "LPM",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 2
}
}
]
},
{
"linkId": "4.4.2",
"text": "oxygen %",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 97
}
}
]
}
]
},
{
"linkId": "4.5",
"text": "Frequency of use (choose all that apply)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "At rest and awake"
}
]
}
]
},
{
"linkId": "5",
"text": "Oxygen Supply Order Details",
"item": [
{
"linkId": "5.1",
"text": "Current Order Description",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"
}
]
},
{
"linkId": "5.1b",
"text": "Current Order Is For A Portable Device"
},
{
"linkId": "5.2",
"text": "Type",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://example.org",
"code": "122",
"display": "Compressed Gas"
}
}
]
},
{
"linkId": "5.3",
"text": "Means of oxygen delivery and accessories",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://example.org",
"code": "134",
"display": "Mask"
}
}
]
}
]
}
]
}
},
{
"resource": {
"resourceType": "Organization",
"id": "1",
"active": true,
"identifier": [
{
"use": "official",
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1100399991"
},
{
"use": "usual",
"system": "urn:oid:2.16.840.1.113883.2.4.6.1",
"value": "17-0112278"
}
],
"type": [
{
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.2.4.15.1060",
"code": "V6",
"display": "University Medical Hospital"
},
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Burgers University Medical Center",
"telecom": [
{
"system": "phone",
"value": "022-655 2300",
"use": "work"
}
],
"address": [
{
"use": "work",
"line": [
"Galapagosweg 91"
],
"city": "Den Burg",
"postalCode": "9105 PZ",
"country": "NLD"
},
{
"use": "work",
"line": [
"PO Box 2311"
],
"city": "Den Burg",
"postalCode": "9100 AA",
"country": "NLD"
}
],
"contact": [
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PRESS"
}
]
},
"telecom": [
{
"system": "phone",
"value": "022-655 2334"
}
]
},
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PATINF"
}
]
},
"telecom": [
{
"system": "phone",
"value": "022-655 2335"
}
]
}
]
}
},
{
"resource": {
"resourceType": "Organization",
"id": "2",
"active": true,
"identifier": [
{
"use": "official",
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1100399991"
},
{
"use": "usual",
"system": "urn:oid:2.16.840.1.113883.2.4.6.1",
"value": "17-0112278"
}
],
"type": [
{
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.2.4.15.1060",
"code": "V6",
"display": "University Medical Hospital"
},
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Burgers University Medical Center",
"telecom": [
{
"system": "phone",
"value": "022-655 2300",
"use": "work"
}
],
"address": [
{
"use": "work",
"line": [
"Galapagosweg 91"
],
"city": "Den Burg",
"postalCode": "9105 PZ",
"country": "NLD"
},
{
"use": "work",
"line": [
"PO Box 2311"
],
"city": "Den Burg",
"postalCode": "9100 AA",
"country": "NLD"
}
],
"contact": [
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PRESS"
}
]
},
"telecom": [
{
"system": "phone",
"value": "022-655 2334"
}
]
},
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PATINF"
}
]
},
"telecom": [
{
"system": "phone",
"value": "022-655 2335"
}
]
}
]
}
},
{
"resource": {
"resourceType": "Practitioner",
"id": "1",
"identifier": [
{
"use": "official",
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1100399991"
}
],
"active": true,
"name": [
{
"family": "Careful",
"given": [
"Adam"
],
"prefix": [
"Dr"
]
}
],
"address": [
{
"use": "home",
"line": [
"534 Erewhon St"
],
"city": "PleasantVille",
"state": "Vic",
"postalCode": "3999"
}
],
"qualification": [
{
"identifier": [
{
"system": "http://example.org/UniversityIdentifier",
"value": "12345"
}
],
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0360",
"code": "BS",
"display": "Bachelor of Science"
}
],
"text": "Bachelor of Science"
},
"period": {
"start": "1995"
},
"issuer": {
"display": "Example University"
}
}
]
}
},
{
"resource": {
"resourceType": "Coverage",
"id": "1",
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "1640000003",
"assigner": {
"reference": "Organization/3"
}
}
],
"status": "active",
"beneficiary": {
"reference": "Patient/1"
},
"payor": [
{
"reference": "Organization/1"
}
]
}
},
{
"resource": {
"resourceType": "Patient",
"id": "1",
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR"
}
]
},
"system": "urn:oid:1.2.36.146.595.217.0.1",
"value": "001RO0000045Ni3YAE",
"period": {
"start": "2001-05-06"
},
"assigner": {
"display": "Acme Healthcare"
}
}
],
"active": true,
"name": [
{
"use": "official",
"family": "Mychart",
"given": [
"Theodore"
]
}
],
"telecom": [
{
"use": "home"
},
{
"system": "phone",
"value": "(03) 5555 6473",
"use": "work",
"rank": 1
},
{
"system": "phone",
"value": "(03) 3410 5613",
"use": "mobile",
"rank": 2
},
{
"system": "phone",
"value": "(03) 5555 8834",
"use": "old",
"period": {
"end": "2014"
}
}
],
"gender": "male",
"birthDate": "1948-07-07",
"_birthDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
"valueDateTime": "1974-12-25T14:35:45-05:00"
}
]
},
"deceasedBoolean": false,
"address": [
{
"use": "home",
"type": "both",
"text": "534 Erewhon St PeasantVille, Rainbow, Vic 3999",
"line": [
"534 Erewhon St"
],
"city": "PleasantVille",
"district": "Rainbow",
"state": "Vic",
"postalCode": "3999",
"period": {
"start": "1974-12-25"
}
}
],
"contact": [
{
"relationship": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0131",
"code": "N"
}
]
}
],
"name": {
"family": "du Marché",
"_family": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/humanname-own-prefix",
"valueString": "VV"
}
]
},
"given": [
"Bénédicte"
]
},
"telecom": [
{
"system": "phone",
"value": "+33 (237) 998327"
}
],
"address": {
"use": "home",
"type": "both",
"line": [
"534 Erewhon St"
],
"city": "PleasantVille",
"district": "Rainbow",
"state": "Vic",
"postalCode": "3999",
"period": {
"start": "1974-12-25"
}
},
"gender": "female",
"period": {
"start": "2012"
}
}
],
"managingOrganization": {
"reference": "Organization/1"
},
"generalPractitioner": [
{
"reference": "Practitioner/1"
}
]
}
},
{
"resource": {
"resourceType": "Location",
"id": "1",
"identifier": [
{
"use": "official",
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1100399991"
}
],
"status": "active",
"name": "South Wing, second floor",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "RNEU",
"display": "Neuroradiology unit"
}
]
},
"alias": [
"BU MC, SW, F2",
"Burgers University Medical Center, South Wing, second floor"
],
"description": "Second floor of the Old South Wing, formerly in use by Psychiatry",
"mode": "instance",
"telecom": [
{
"system": "phone",
"value": "2328",
"use": "work"
},
{
"system": "fax",
"value": "2329",
"use": "work"
},
{
"system": "email",
"value": "second wing admissions"
},
{
"system": "url",
"value": "http://sampleorg.com/southwing",
"use": "work"
}
],
"address": {
"use": "work",
"line": [
"Galapagosweg 91, Building A"
],
"city": "Den Burg",
"postalCode": "9105 PZ",
"country": "NLD"
},
"physicalType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/location-physical-type",
"code": "wi",
"display": "Wing"
}
]
},
"position": {
"longitude": -83.6945691,
"latitude": 42.25475478,
"altitude": 0
},
"managingOrganization": {
"reference": "Organization/1"
},
"endpoint": [
{
"reference": "Endpoint/1"
}
]
}
},
{
"resource": {
"resourceType": "ServiceRequest",
"id": "1",
"status": "active",
"intent": "order",
"authoredOn": "2015-02-07T13:28:17-05:00",
"code": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/1365",
"code": "3",
"display": "Consultation"
}
]
},
"quantityQuantity": {
"value": 1,
"system": "http://unitsofmeasure.org",
"code": "{visit}"
},
"subject": {
"reference": "Patient/SubscriberExample"
}
}
}
]
}
```
#### Responses
* **201** No match was found. Resource created.
Headers:
* `Location` (string, required)
Example: `http://xxx/\\$PriorAuthClaim`.
Media type: `application/fhir+json`. Schema: `PASClaimResponseBundle (extended)`.
Contains a collection of resources.
* Rule: total only for search results or history.
* Rule: entry.search only for a search request.
* Rule: entry.request mandatory for batch, transaction, or history, else prohibited.
* Rule: entry.response mandatory for batch-response, transaction-response, or history, else prohibited.
* Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles).
* Rule: A document must have an identifier with a system and a value.
* Rule: A document must have a date.
* Rule: A document must have a Composition resource as the first resource.
* Rule: A message must have a MessageHeader resource as the first resource. Elements defined in Ancestors: id, meta, implicitRules, and language.
Includes all fields of `PASClaimResponseBundle`.
* `signature` (_Signature_) Represents an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature can be a cryptographic type (XML DigSig or a JWT), which is able to provide a non-repudiation proof, or a graphical image that represents a signature or a signature process.
_Example_
```
{
"resourceType": "Bundle",
"type": "collection",
"id": "PASClaimResponseExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse"
]
},
"timestamp": "2005-05-02T11:02:00+05:00",
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "1",
"identifier": [
{
"system": "http://example.org/REVIEW_IDENTIFICATION_NUMBER",
"value": "AUTH0001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/1"
},
"created": "2019-07-20",
"insurer": {
"reference": "Organization/1"
},
"outcome": "complete",
"request": {
"reference": "PASClaim/1"
},
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/1"
}
}
],
"item": [
{
"id": "123",
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDate",
"valuePeriod": {
"start": "2005-05-02",
"end": "2005-06-02"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction",
"valueCode": "A1"
},
{
"reviewActionReason": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionReason",
"valueCode": "A2"
}
]
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2005-05-02"
}
],
"itemSequence": 1,
"adjudication": [
{
"id": "12",
"reason": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code": "ar001",
"display": "Not covered"
}
]
},
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
}
}
]
}
],
"addItem": [
{
"id": "123",
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99212",
"display": "Established Office Visit"
}
]
},
"adjudication": [
{
"extension": [
{
"extension": [
{
"url": "number",
"valueString": "AUTH0001"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://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"
}
]
}
}
],
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "2141",
"display": "Radiograph, bitewing"
}
],
"text": "Product Or Service"
}
}
],
"processNote": [
{
"text": "sample Note explanatory text for the claim submitted"
}
]
}
},
{
"resource": {
"resourceType": "QuestionnaireResponse",
"id": "home-o2-questionnaireresponse",
"questionnaire": "Questionnaire/0jNSG000000ByKD2A0",
"status": "completed",
"subject": {
"reference": "Patient/examplepatient",
"display": "Vlad"
},
"authored": "2023-08-21",
"item": [
{
"linkId": "1",
"text": "Patient Information",
"item": [
{
"linkId": "1.1",
"text": "Last Name but Different This Time",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "override"
},
{
"extension": [
{
"url": "role",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/practitioner-role",
"code": "doctor",
"display": "Doctor"
}
]
}
},
{
"url": "practitioner",
"valueReference": {
"reference": "Practitioner/PractitionerExample",
"display": "Dr. Jane Doe"
}
}
],
"url": "author"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Quinton"
}
]
},
{
"linkId": "1.2",
"text": "First Name",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Vlad"
}
]
},
{
"linkId": "1.3",
"text": "Middle Initial",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "A, N"
}
]
},
{
"linkId": "1.4",
"text": "Date Of Birth",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate": "1956-12-01"
}
]
},
{
"linkId": "1.5",
"text": "Gender",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
}
]
},
{
"linkId": "1.6",
"text": "Medicare ID",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "10A3D58WH22"
}
]
}
]
},
{
"linkId": "2",
"text": "Provider who is performing face-to-face evaluation",
"item": [
{
"linkId": "2.1",
"text": "Last Name",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Doe"
}
]
},
{
"linkId": "2.2",
"text": "First Name",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "Jane"
}
]
},
{
"linkId": "2.3",
"text": "Middle Initial",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "B"
}
]
},
{
"linkId": "2.4",
"text": "NPI",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "1122334455"
}
]
},
{
"linkId": "2.5",
"text": "Date of Face-To-Face Evaluation",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "override"
},
{
"extension": [
{
"url": "role",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/practitioner-role",
"code": "doctor",
"display": "Doctor"
}
]
}
},
{
"url": "practitioner",
"valueReference": {
"reference": "Practitioner/PractitionerExample",
"display": "Dr. Jane Doe"
}
}
],
"url": "author"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate": "2019-07-18"
}
]
},
{
"linkId": "2.6",
"text": "Record",
"answer": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference",
"valueBoolean": false
}
],
"valueReference": {
"reference": "Patient/examplepatient",
"display": "Mr. Saul Moki"
}
}
]
}
]
},
{
"linkId": "3",
"text": "Coverage Requirements",
"item": [
{
"linkId": "3.1",
"text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "313296004",
"display": "Mild chronic obstructive pulmonary disease"
}
}
]
},
{
"linkId": "3.2",
"text": "Arterial oxygen saturation (Patient on room air while at rest and awake when tested)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 95,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.3",
"text": "Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 83,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.4",
"text": "Arterial oxygen saturation (Patient tested during exercise)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 95,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.5",
"text": "Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 78,
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "3.6",
"text": "Is there a documented improvement of hypoxemia during exercise with oxygen?",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueBoolean": true
}
]
}
]
},
{
"linkId": "4",
"text": "Prescribed Use",
"item": [
{
"linkId": "4.1",
"text": "Start date",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate": "2019-07-18"
}
]
},
{
"linkId": "4.2",
"text": "Length of need: (months) (99 = lifetime)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 99
}
}
]
},
{
"linkId": "4.3",
"text": "Peak Flow Rate",
"item": [
{
"linkId": "4.3.1",
"text": "LPM",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 2
}
}
]
},
{
"linkId": "4.3.2",
"text": "oxygen %",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 98
}
}
]
}
]
},
{
"linkId": "4.4",
"text": "Average Flow Rate",
"item": [
{
"linkId": "4.4.1",
"text": "LPM",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 2
}
}
]
},
{
"linkId": "4.4.2",
"text": "oxygen %",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity": {
"value": 97
}
}
]
}
]
},
{
"linkId": "4.5",
"text": "Frequency of use (choose all that apply)",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "At rest and awake"
}
]
}
]
},
{
"linkId": "5",
"text": "Oxygen Supply Order Details",
"item": [
{
"linkId": "5.1",
"text": "Current Order Description",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString": "HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"
}
]
},
{
"linkId": "5.1b",
"text": "Current Order Is For A Portable Device"
},
{
"linkId": "5.2",
"text": "Type",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://example.org",
"code": "122",
"display": "Compressed Gas"
}
}
]
},
{
"linkId": "5.3",
"text": "Means of oxygen delivery and accessories",
"answer": [
{
"extension": [
{
"extension": [
{
"url": "source",
"valueCode": "auto"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://example.org",
"code": "134",
"display": "Mask"
}
}
]
}
]
}
]
}
},
{
"resource": {
"resourceType": "Organization",
"id": "1",
"identifier": [
{
"use": "official",
"system": "urn:oid:2.16.528.1",
"value": "91654"
},
{
"use": "usual",
"system": "urn:oid:2.16.840.1.113883.2.4.6.1",
"value": "17-0112278"
}
],
"type": [
{
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.2.4.15.1060",
"code": "V6",
"display": "University Medical Hospital"
},
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Burgers University Medical Center",
"active": true,
"telecom": [
{
"system": "phone",
"value": "022-655 2300",
"use": "work"
}
],
"address": [
{
"use": "work",
"line": [
"Galapagosweg 91"
],
"city": "Den Burg",
"postalCode": "9105 PZ",
"country": "NLD"
},
{
"use": "work",
"line": [
"PO Box 2311"
],
"city": "Den Burg",
"postalCode": "9100 AA",
"country": "NLD"
}
],
"contact": [
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PRESS"
}
]
},
"telecom": [
{
"system": "phone",
"value": "022-655 2334"
}
]
},
{
"purpose": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/contactentity-type",
"code": "PATINF"
}
]
},
"telecom": [
{
"system": "phone",
"value": "022-655 2335"
}
]
}
]
}
},
{
"resource": {
"resourceType": "Practitioner",
"id": "1",
"identifier": [
{
"system": "http://www.acme.org/practitioners",
"value": "23"
}
],
"active": true,
"name": [
{
"family": "Careful",
"given": [
"Adam"
],
"prefix": [
"Dr"
]
}
],
"address": [
{
"use": "home",
"line": [
"534 Erewhon St"
],
"city": "PleasantVille",
"state": "Vic",
"postalCode": "3999"
}
],
"qualification": [
{
"identifier": [
{
"system": "http://example.org/UniversityIdentifier",
"value": "12345"
}
],
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0360",
"code": "BS",
"display": "Bachelor of Science"
}
],
"text": "Bachelor of Science"
},
"period": {
"start": "1995"
},
"issuer": {
"display": "Example University"
}
}
]
}
},
{
"resource": {
"resourceType": "Coverage",
"id": "1",
"status": "active",
"beneficiary": {
"reference": "Patient/1"
},
"payor": [
{
"reference": "Organization/1"
}
]
}
},
{
"resource": {
"resourceType": "Patient",
"id": "1",
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR"
}
]
},
"system": "urn:oid:1.2.36.146.595.217.0.1",
"value": "12345",
"period": {
"start": "2001-05-06"
},
"assigner": {
"display": "Acme Healthcare"
}
}
],
"active": true,
"name": [
{
"use": "official",
"family": "Chalmers",
"given": [
"Peter",
"James"
]
},
{
"use": "usual",
"family": "Rings",
"given": [
"Jim"
]
},
{
"use": "maiden",
"family": "Windsor",
"given": [
"Peter",
"James"
],
"period": {
"end": "2002"
}
}
],
"telecom": [
{
"use": "home"
},
{
"system": "phone",
"value": "(03) 5555 6473",
"use": "work",
"rank": 1
},
{
"system": "phone",
"value": "(03) 3410 5613",
"use": "mobile",
"rank": 2
},
{
"system": "phone",
"value": "(03) 5555 8834",
"use": "old",
"period": {
"end": "2014"
}
}
],
"gender": "male",
"birthDate": "1974-12-25",
"_birthDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
"valueDateTime": "1974-12-25T14:35:45-05:00"
}
]
},
"deceasedBoolean": false,
"address": [
{
"use": "home",
"type": "both",
"text": "534 Erewhon St PeasantVille, Rainbow, Vic 3999",
"line": [
"534 Erewhon St"
],
"city": "PleasantVille",
"district": "Rainbow",
"state": "Vic",
"postalCode": "3999",
"period": {
"start": "1974-12-25"
}
}
],
"contact": [
{
"relationship": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0131",
"code": "N"
}
]
}
],
"name": {
"family": "du Marché",
"_family": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/humanname-own-prefix",
"valueString": "VV"
}
]
},
"given": [
"Bénédicte"
]
},
"telecom": [
{
"system": "phone",
"value": "+33 (237) 998327"
}
],
"address": {
"use": "home",
"type": "both",
"line": [
"534 Erewhon St"
],
"city": "PleasantVille",
"district": "Rainbow",
"state": "Vic",
"postalCode": "3999",
"period": {
"start": "1974-12-25"
}
},
"gender": "female",
"period": {
"start": "2012"
}
}
],
"managingOrganization": {
"reference": "Organization/1"
},
"generalPractitioner": [
{
"reference": "Practitioner/1"
}
]
}
}
]
}
```
* **500**
Media type: `application/fhir+json`. Schema: `OperationOutcome`.
_Example_
```
{
"resourceType": "OperationOutcome",
"issue": [
{
"severity": "error",
"code": "exception",
"details": {
"text": "An unexpected error occured while submitting the claim. Failed for \"label\""
}
}
]
}
```
* **400**
Media type: `application/fhir+json`. Schema: `any`.
Type: `any`.
_Example_
```
{
"resourceType": "Bundle",
"type": "collection",
"id": "PASClaimErrorExample",
"timestamp": "2005-05-02T11:02:00+05:00",
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "1",
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "111099"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/1"
},
"created": "2005-05-02T11:02:00+05:00",
"insurer": {
"reference": "Organization/1"
},
"outcome": "error",
"error": [
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication-error",
"code": "a001",
"display": "Missing Identifier"
},
{
"display": "Missing Practitioner"
},
{
"display": "Given Facility not found"
}
]
}
}
]
}
}
]
}
```
* **404**
Media type: `application/fhir+json`. Schema: `any`.
Type: `any`.
_Example_
```
{
"resourceType": "Bundle",
"type": "collection",
"id": "PASClaimErrorExample",
"timestamp": "2005-05-02T11:02:00+05:00",
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "1",
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "111099"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/1"
},
"created": "2005-05-02T11:02:00+05:00",
"insurer": {
"reference": "Organization/1"
},
"outcome": "error",
"error": [
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication-error",
"code": "a001",
"display": "Missing Identifier"
},
{
"display": "Missing Practitioner"
},
{
"display": "Given Facility not found"
}
]
}
}
]
}
}
]
}
```
### POST Create a claim inquiry request
`POST /$inquiry`
Creates a resource to generate a claim submission or claim inquiry request with prior authorization.
#### Parameters
* `Accept` (header, string)
Allowed values: `application/fhir+json`.
* `Access-Token` (header, string, required) Salesforce org access token
Example: `Bearer asvg473tebdjebdsakl!jsjndkcmldcmdcmedj3o9.asd`.
* `Instance-Domain-Name` (header, string, required) Instance domain name of the salesforce org
Example: `orgid.salesforce.com`.
#### Request body
Media type: `application/fhir+json`. Schema: `PASClaimInquiryRequestBundle (extended)`.
Contains a collection of resources.
* Rule: total only for search results or history.
* Rule: entry.search only for a search request.
* Rule: entry.request mandatory for batch, transaction, or history, else prohibited.
* Rule: entry.response mandatory for batch-response, transaction-response, or history, else prohibited.
* Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles).
* Rule: A document must have an identifier with a system and a value.
* Rule: A document must have a date.
* Rule: A document must have a Composition resource as the first resource.
* Rule: A message must have a MessageHeader resource as the first resource. Elements defined in Ancestors: id, meta, implicitRules, and language.
Includes all fields of `PASClaimInquiryRequestBundle`.
* `signature` (_Signature_) Represents an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature can be a cryptographic type (XML DigSig or a JWT), which is able to provide a non-repudiation proof, or a graphical image that represents a signature or a signature process.
_Example_
```
{
"resourceType": "Bundle",
"id": "PASClaimInquiryBundleExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-request-bundle"
]
},
"identifier": {
"system": "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER",
"value": "5269367"
},
"type": "collection",
"timestamp": "2005-05-02T11:01:00+05:00",
"entry": [
{
"fullUrl": "http://example.org/fhir/Claim/PASClaimInquiryExample",
"resource": {
"resourceType": "Claim",
"id": "PASClaimInquiryExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry"
]
},
"text": {
"status": "extensions",
"div": ""
},
"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": "2019-07-20T11:01:00+05:00",
"insurer": {
"reference": "Organization/InsurerExample"
},
"provider": {
"reference": "Organization/UMOExample"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"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": "http://codesystem.x12.org/005010/1525",
"code": "HS",
"display": "Health Services Review"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/1322",
"code": "I",
"display": "Initial"
}
]
}
}
],
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "G0154"
}
]
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/1525",
"code": "HS",
"display": "Health Services Review"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/1322",
"code": "I",
"display": "Initial"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate",
"valueDate": "2019-07-01"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate",
"valueDate": "2019-07-01"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate",
"valueDate": "2019-07-31"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"system": "http://codesystem.x12.org/005010/306",
"code": "A1",
"display": "Certified in total"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd",
"valueCodeableConcept": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "B4190"
}
]
}
}
],
"sequence": 2,
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "B4184"
}
]
}
}
]
}
},
{
"fullUrl": "http://example.org/fhir/Organization/UMOExample",
"resource": {
"resourceType": "Organization",
"id": "UMOExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
]
},
"text": {
"status": "generated",
"div": "Generated Narrative
identifier: id: 8189991234
active: true
type: X3 (98#X3)
name: DR. JOE SMITH CORPORATION
address: 111 1ST STREET SAN DIEGO CA 92101 US
Generated Narrative
identifier: id: 789312
active: true
type: PR (98#PR)
name: MARYLAND CAPITAL INSURANCE COMPANY
Generated Narrative
MilitaryStatus: RU (584#RU)
identifier: id: 12345678901
name: JOE SMITH
gender: male
Generated Narrative
identifier: id: 8189991234
active: true
type: X3 (98#X3)
name: DR. JOE SMITH CORPORATION
address: 111 1ST STREET SAN DIEGO CA 92101 US
Generated Narrative
identifier: id: 789312
active: true
type: PR (98#PR)
name: MARYLAND CAPITAL INSURANCE COMPANY
Generated Narrative
MilitaryStatus: RU (584#RU)
identifier: id: 12345678901
name: JOE SMITH
gender: male