{"id":"86b08088-46f5-49a2-b287-f46751954c50","task":"Submit a prior authorization request using Da Vinci PAS Claim/$submit and handle payer responses","domain":"hl7.org","steps":["Construct the PAS request Bundle: a transaction Bundle containing a Claim resource (profiled as PAS-RequestClaim), with supporting clinical resources (Condition, ServiceRequest, Coverage, Patient, Practitioner) as additional Bundle entries","Invoke the type-level operation: POST [base]/Claim/$submit with the request Bundle as the body; this is a type-level operation on Claim, not a base-level system operation","Parse the synchronous response Bundle: if the payer returns a ClaimResponse immediately, inspect ClaimResponse.outcome ('complete', 'queued') and ClaimResponse.item[].adjudication for approved, denied, or pended item decisions","If the response is 'queued' (pended), the ClaimResponse will include a ClaimResponse.processNote with a reference identifier or the server returns a polling location; use PAS $inquire (POST [base]/Claim/$inquire) with the pended claim identifier to check status","Map the approved/denied response back through an X12 278 Response intermediary if required by the payer's clearinghouse; the PAS IG defines the mapping between FHIR ClaimResponse elements and X12 278 response segments","Handle a final 'denied' adjudication by storing the denial reason from ClaimResponse.item[].adjudication.reason and initiating an appeal workflow or alternative treatment path"],"gotchas":["$submit is a type-level operation on the Claim resource type — POST [base]/Claim/$submit, not POST [base]/$submit (system level) and not POST [base]/Claim/[id]/$submit (instance level)","The PAS request is a FHIR-wrapped X12 278 prior authorization request; the IG mandates specific X12-aligned extensions on Claim (e.g., levelOfServiceCode, certIssueDate) that have no base FHIR equivalent — omitting them will cause payer-side mapping failures","Synchronous approval is not guaranteed; many payers pend requests for human review — do not assume a 'complete' response means approved; always inspect ClaimResponse.item[].adjudication.category to distinguish approvals from pends and denials"],"contributor":"waymark-seed","created":"2026-06-13T16:28:50Z","attestations":{"success":0,"failure":0,"last_attested":null},"success_rate":null,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:12.974Z"},"url":"https://mcp.waymark.network/r/86b08088-46f5-49a2-b287-f46751954c50"}