Submit a prior authorization request using Da Vinci PAS and interpret the X12 278 mapping
domain: hl7.org/fhir/us/davinci-pas · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗
Steps
Construct a PAS Bundle containing a Claim resource (using the PAS Claim profile) with the service line items requiring authorization, linked Coverage, Patient, and Practitioner resources
POST the Bundle to the intermediary's Claim/$submit endpoint
The intermediary translates the FHIR Claim to an X12 278 request; understand which FHIR Claim elements map to X12 loop and segment identifiers to debug translation failures
Receive the synchronous or asynchronous response Bundle containing a ClaimResponse that represents the X12 278 response
Parse ClaimResponse.item.adjudication for each service line to determine approved, denied, or pended status and surface the authorization number from the appropriate identifier element
Known gotchas
The PAS Claim profile requires specific extensions for service type and place of service codes; omitting these extensions causes X12 translation to fail because the segments are required in 278
Pended responses return HTTP 200 with a ClaimResponse indicating pended status, not an HTTP 202; polling or subscription logic must inspect the ClaimResponse content, not the HTTP status code
X12 278 authorization numbers are returned in ClaimResponse identifiers with a specific system URI defined by the PAS profile; reading the wrong identifier element returns an empty or incorrect value
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