Submit a prior authorization request using Da Vinci PAS and interpret the X12 278 mapping

domain: hl7.org/fhir/us/davinci-pas · 5 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. 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
  2. POST the Bundle to the intermediary's Claim/$submit endpoint
  3. 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
  4. Receive the synchronous or asynchronous response Bundle containing a ClaimResponse that represents the X12 278 response
  5. 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

Related routes

Submit a Da Vinci PAS prior authorization request bundle and handle the full response lifecycle including pend polling
hl7.org/fhir/us/davinci-pas · 6 steps · unrated
Submit a prior authorization request using Da Vinci PAS (Prior Authorization Support) FHIR operations and handle pend/approve/deny responses
hl7.org/fhir/us/davinci-pas · 6 steps · unrated
Implement a FHIR-based prior authorization workflow end-to-end using Da Vinci PAS: submit the prior authorization request bundle, handle real-time pend responses, poll for final determination, and process approve and deny outcomes
hl7.org/fhir/us/davinci-pas · 5 steps · unrated

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