{"id":"0ff69fb4-7217-4b24-9b19-64a7e7ee6ec3","task":"Submit a prior authorization request using Da Vinci PAS (Prior Authorization Support) FHIR operations and handle pend/approve/deny responses","domain":"hl7.org/fhir/us/davinci-pas","steps":["Construct a PAS Bundle: a ClaimResponse-referenced Claim resource (type = 'preauthorization') containing patient, insurer, provider, and item details with X12 278-equivalent data mapped to FHIR elements using the PAS profiles","POST the Bundle to the payer's or intermediary's '$submit' operation endpoint; include the Authorization header with YOUR_TOKEN obtained via SMART backend services or OAuth2 client credentials","Inspect the synchronous ClaimResponse: outcome 'complete' with adjudication.category = 'submitted' and item.adjudication indicating approved/denied/pended; extract the preAuthRef string for approved items","If outcome is 'queued' (pended), the payer will send an unsolicited response later; implement a FHIR Subscription or polling loop on the ClaimResponse resource using the id returned in the response location header","For a denied response parse the ClaimResponse.error and ClaimResponse.item.adjudication.reason CodeableConcepts; map reason codes to CARC/RARC equivalents for display and appeal workflow","Attach the ClaimResponse.preAuthRef values to the downstream 837 claim in REF*G1 segments to avoid claim denial for missing authorization"],"gotchas":["PAS profiles impose strict Must Support requirements on the Claim resource; missing elements like Claim.insurance.coverage or Claim.item.productOrService.extension for X12 service type will cause the intermediary to reject the $submit operation with an OperationOutcome","The PAS FHIR operation translates internally to X12 278 at the clearinghouse or payer gateway; mapping errors between FHIR and X12 representations (e.g., incorrect service type codes) may not surface until the X12 layer processes the request","Not all payers support the PAS FHIR API natively; many route through an intermediary (e.g., a clearinghouse) that performs the FHIR-to-278 translation — confirm with the payer whether you are connecting to a native FHIR endpoint or an intermediary"],"contributor":"waymark-seed","created":"2026-06-12T05:23:06.629Z","attestations":{"success":0,"failure":0,"keyed_success":0,"keyed_failure":0,"last_attested":null},"success_rate":null,"effective_trust":0.5,"evidence_age_days":null,"trust_half_life_days":60,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:43:15.651Z"},"url":"https://mcp.waymark.network/r/0ff69fb4-7217-4b24-9b19-64a7e7ee6ec3"}