davinci_pas_test_kit 0.15.1 → 0.15.2

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
Files changed (98) hide show
  1. checksums.yaml +4 -4
  2. data/config/presets/pas_client_example.json +2 -2
  3. data/config/presets/pas_client_v201_run_against_pas_server.json +2 -2
  4. data/config/presets/pas_client_v221_run_against_pas_server.json +3 -3
  5. data/config/presets/pas_ri.json +6 -6
  6. data/config/presets/pas_server_v201_run_against_pas_client.json.erb +6 -6
  7. data/config/presets/pas_server_v221_run_against_pas_client.json.erb +10 -10
  8. data/lib/davinci_pas_test_kit/client/abstract_gather_must_support_test.rb +2 -48
  9. data/lib/davinci_pas_test_kit/client/client_input_descriptions.rb +29 -0
  10. data/lib/davinci_pas_test_kit/client/endpoints/claim_endpoint.rb +25 -9
  11. data/lib/davinci_pas_test_kit/client/user_input_response.rb +25 -6
  12. data/lib/davinci_pas_test_kit/client/v2.0.1/client_suite.rb +1 -1
  13. data/lib/davinci_pas_test_kit/client/v2.2.1/client_suite.rb +1 -1
  14. data/lib/davinci_pas_test_kit/cross_suite/fhirpath_utils.rb +13 -3
  15. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/beneficiary/metadata.yml +4 -0
  16. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/claim_inquiry/metadata.yml +15 -0
  17. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/claim_update/metadata.yml +17 -0
  18. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/claiminquiryresponse/metadata.yml +15 -0
  19. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/claimresponse/metadata.yml +15 -0
  20. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/communication_request/metadata.yml +4 -0
  21. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/coverage/metadata.yml +1 -0
  22. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/device_request/metadata.yml +2 -0
  23. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/encounter/metadata.yml +3 -0
  24. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/insurer/metadata.yml +1 -0
  25. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/medication_request/metadata.yml +2 -0
  26. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/metadata.yml +143 -0
  27. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/nutrition_order/metadata.yml +2 -0
  28. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/pas_inquiry_request_bundle/metadata.yml +2 -0
  29. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/pas_inquiry_response_bundle/metadata.yml +2 -0
  30. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/pas_request_bundle/metadata.yml +2 -0
  31. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/pas_response_bundle/metadata.yml +2 -0
  32. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/practitioner/metadata.yml +1 -0
  33. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/practitioner_role/metadata.yml +1 -0
  34. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/requestor/metadata.yml +1 -0
  35. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/service_request/metadata.yml +3 -0
  36. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/subscriber/metadata.yml +4 -0
  37. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.0.1/task/metadata.yml +1 -0
  38. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/beneficiary/metadata.yml +1 -0
  39. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/claim_inquiry/metadata.yml +23 -0
  40. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/claim_update/metadata.yml +31 -0
  41. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/claiminquiryresponse/metadata.yml +42 -0
  42. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/claimresponse/metadata.yml +42 -0
  43. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/communication_request/metadata.yml +4 -0
  44. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/coverage/metadata.yml +1 -0
  45. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/device_request/metadata.yml +2 -0
  46. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/encounter/metadata.yml +3 -0
  47. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/insurer/metadata.yml +1 -0
  48. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/medication_request/metadata.yml +2 -0
  49. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/metadata.yml +265 -0
  50. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/nutrition_order/metadata.yml +2 -0
  51. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/pas_inquiry_request_bundle/metadata.yml +2 -0
  52. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/pas_inquiry_response_bundle/metadata.yml +2 -0
  53. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/pas_request_bundle/metadata.yml +2 -0
  54. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/pas_response_bundle/metadata.yml +2 -0
  55. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/practitioner/metadata.yml +1 -0
  56. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/practitioner_role/metadata.yml +1 -0
  57. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/requestor/metadata.yml +1 -0
  58. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/service_request/metadata.yml +3 -0
  59. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/subscriber/metadata.yml +1 -0
  60. data/lib/davinci_pas_test_kit/cross_suite/generated/v2.2.1/task/metadata.yml +4 -0
  61. data/lib/davinci_pas_test_kit/cross_suite/pas_bundle_validation.rb +97 -39
  62. data/lib/davinci_pas_test_kit/cross_suite/pas_constants.rb +6 -0
  63. data/lib/davinci_pas_test_kit/cross_suite/pas_datatype_constraints.rb +166 -0
  64. data/lib/davinci_pas_test_kit/cross_suite/response_selection_utils.rb +26 -10
  65. data/lib/davinci_pas_test_kit/cross_suite/validator_suppressions.rb +206 -146
  66. data/lib/davinci_pas_test_kit/docs/demo/PAS Client Suite Demonstration.postman_collection.json +4 -4
  67. data/lib/davinci_pas_test_kit/generator/must_support_test_generator.rb +6 -0
  68. data/lib/davinci_pas_test_kit/generator/pas_must_support_metadata_extractor.rb +1 -2
  69. data/lib/davinci_pas_test_kit/generator/server_must_support_group_generator.rb +23 -0
  70. data/lib/davinci_pas_test_kit/generator/server_suite_generator.rb +6 -0
  71. data/lib/davinci_pas_test_kit/generator/templates/must_support.rb.erb +3 -2
  72. data/lib/davinci_pas_test_kit/generator/templates/server_must_support_group.rb.erb +22 -0
  73. data/lib/davinci_pas_test_kit/generator/templates/server_suite.rb.erb +4 -5
  74. data/lib/davinci_pas_test_kit/generator/templates/use_case_group.rb.erb +3 -0
  75. data/lib/davinci_pas_test_kit/generator/use_case_group_generator.rb +14 -8
  76. data/lib/davinci_pas_test_kit/requirements/generated/davinci_pas_server_suite_v221_requirements_coverage.csv +28 -28
  77. data/lib/davinci_pas_test_kit/server/generated/v2.0.1/pas_server_approval_use_case_group.rb +1 -0
  78. data/lib/davinci_pas_test_kit/server/generated/v2.0.1/pas_server_denial_use_case_group.rb +1 -0
  79. data/lib/davinci_pas_test_kit/server/generated/v2.0.1/pas_server_pended_use_case_group.rb +1 -0
  80. data/lib/davinci_pas_test_kit/server/generated/v2.0.1/server_suite.rb +4 -5
  81. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/claiminquiryresponse/server_inquire_response_must_support_claiminquiryresponse_test.rb +2 -0
  82. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/claimresponse/server_submit_response_must_support_claimresponse_test.rb +2 -0
  83. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/pas_server_approval_use_case_group.rb +2 -0
  84. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/pas_server_denial_use_case_group.rb +2 -0
  85. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/pas_server_must_support_group.rb +12 -0
  86. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/pas_server_pended_use_case_group.rb +5 -0
  87. data/lib/davinci_pas_test_kit/server/generated/v2.2.1/server_suite.rb +4 -5
  88. data/lib/davinci_pas_test_kit/server/server_response_bundle_validation_test.rb +14 -5
  89. data/lib/davinci_pas_test_kit/server/v2.2.1/claim_inquiry/server_claim_inquiry_response_tests.rb +89 -0
  90. data/lib/davinci_pas_test_kit/server/v2.2.1/pas_error_group.rb +2 -0
  91. data/lib/davinci_pas_test_kit/server/v2.2.1/pas_server_claim_inquiry_responses_group.rb +17 -0
  92. data/lib/davinci_pas_test_kit/server/v2.2.1/pas_server_no_custom_extensions_test.rb +241 -0
  93. data/lib/davinci_pas_test_kit/server/v2.2.1/pas_server_subscription_capability_statement_test.rb +40 -0
  94. data/lib/davinci_pas_test_kit/server/v2.2.1/pas_server_subscription_setup.rb +14 -9
  95. data/lib/davinci_pas_test_kit/server/v2.2.1/server_replaced_pa_inquire_reference_input_test.rb +63 -0
  96. data/lib/davinci_pas_test_kit/server/v2.2.1/server_replaced_pa_inquire_reference_test.rb +109 -0
  97. data/lib/davinci_pas_test_kit/version.rb +2 -2
  98. metadata +9 -2
data/config/presets/pas_client_v221_run_against_pas_server.json CHANGED
@@ -41,15 +41,15 @@
41
41
  "optional": true,
42
42
  "title": "Claim approved response JSON",
43
43
  "type": "textarea",
44
- "value": "{\r\n \"id\": \"b0000001-0000-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle\"\r\n ]\r\n },\r\n \"identifier\": {\r\n \"system\": \"urn:ietf:rfc:3986\",\r\n \"value\": \"urn:uuid:b0000001-0000-0000-0000-000000000001\"\r\n },\r\n \"type\": \"collection\",\r\n \"timestamp\": \"2024-01-30T13:29:32Z\",\r\n \"entry\": [\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0001-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0001-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse\"\r\n ]\r\n },\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\r\n \"extension\": [\r\n {\r\n \"url\": \"applicationSenderCode\",\r\n \"valueString\": \"SENDER01\"\r\n },\r\n {\r\n \"url\": \"applicationReceiverCode\",\r\n \"valueString\": \"RECEIVER01\"\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer\",\r\n \"extension\": [\r\n {\r\n \"url\": \"wasHumanReviewedFlag\",\r\n \"valueBoolean\": true\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\r\n \"extension\": [\r\n {\r\n \"url\": \"provider\",\r\n \"valueReference\": {\r\n \"display\": \"Mock Authorized Provider\"\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"identifier\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\r\n \"valueString\": \"SUBDEPT01\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://www.usps.com/\",\r\n \"code\": \"CA\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\r\n \"value\": \"111366\",\r\n \"assigner\": {\r\n \"identifier\": {\r\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\r\n \"value\": \"5556667771\"\r\n }\r\n }\r\n }\r\n ],\r\n \"status\": \"active\",\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\r\n \"code\": \"professional\"\r\n }\r\n ]\r\n },\r\n \"use\": \"preauthorization\",\r\n \"patient\": {\r\n \"reference\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\"\r\n },\r\n \"created\": \"2024-01-30T13:29:32Z\",\r\n \"insurer\": {\r\n \"reference\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\"\r\n },\r\n \"requestor\": {\r\n \"reference\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\"\r\n },\r\n \"request\": {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/StructureDefinition/data-absent-reason\",\r\n \"valueCode\": \"unknown\"\r\n }\r\n ]\r\n },\r\n \"outcome\": \"complete\",\r\n \"preAuthPeriod\": {\r\n \"start\": \"2024-01-30\",\r\n \"end\": \"2024-02-29\"\r\n },\r\n \"communicationRequest\": [\r\n {\r\n \"reference\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\"\r\n }\r\n ],\r\n \"item\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\r\n \"valueDate\": \"2024-01-30\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\r\n \"valuePeriod\": {\r\n \"start\": \"2024-01-30\",\r\n \"end\": \"2024-02-29\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\r\n \"value\": \"1\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\r\n \"valueString\": \"AUTH123\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\r\n \"valueString\": \"ADMIN123\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate\",\r\n \"valuePeriod\": {\r\n \"start\": \"2024-01-30\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail\",\r\n \"extension\": [\r\n {\r\n \"url\": \"productOrServiceCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1365\",\r\n \"code\": \"G0153\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\r\n \"extension\": [\r\n {\r\n \"url\": \"provider\",\r\n \"valueReference\": {\r\n \"display\": \"Mock Item Provider\"\r\n }\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\r\n \"valuePeriod\": {\r\n \"start\": \"2023-01-01\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\r\n \"valueDate\": \"2023-01-10\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\r\n \"code\": \"J06.9\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"itemSequence\": 1,\r\n \"noteNumber\": [\r\n 1\r\n ],\r\n \"adjudication\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/306\",\r\n \"code\": \"A1\",\r\n \"display\": \"Certified in total\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"category\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\r\n \"code\": \"submitted\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"addItem\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\r\n \"value\": \"TRACE001\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\r\n \"valueDate\": \"2024-01-30\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\r\n \"valuePeriod\": {\r\n \"start\": \"2024-01-30\",\r\n \"end\": \"2024-02-29\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\r\n \"valueString\": \"AUTH456\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\r\n \"valueString\": \"ADMIN456\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\r\n \"valueBoolean\": false\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/01/00/1345\",\r\n \"code\": \"2\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/02/00/1306\",\r\n \"code\": \"2\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1365\",\r\n \"code\": \"G0153\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://www.nubc.org/CodeSystem/RevenueCodes\",\r\n \"code\": \"0300\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\r\n \"valueDecimal\": 100.0\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\r\n \"valueReference\": {\r\n \"display\": \"Mock Requested Service\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1525\",\r\n \"code\": \"SC\",\r\n \"display\": \"Specialty Care Review\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1322\",\r\n \"code\": \"I\",\r\n \"display\": \"Initial\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\r\n \"valuePeriod\": {\r\n \"start\": \"2023-01-01\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\r\n \"valueDate\": \"2023-01-10\"\r\n }\r\n ],\r\n \"itemSequence\": [\r\n 1\r\n ],\r\n \"provider\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/98\",\r\n \"code\": \"IL\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"display\": \"Mock AddItem Provider\"\r\n }\r\n ],\r\n \"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1365\",\r\n \"code\": \"G0153\"\r\n }\r\n ]\r\n },\r\n \"modifier\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://www.ama-assn.org/go/cpt\",\r\n \"code\": \"25\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"servicedDate\": \"2024-01-30\",\r\n \"locationCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\r\n \"code\": \"11\"\r\n }\r\n ]\r\n },\r\n \"quantity\": {\r\n \"value\": 1\r\n },\r\n \"unitPrice\": {\r\n \"value\": 100.0,\r\n \"currency\": \"USD\"\r\n },\r\n \"adjudication\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/306\",\r\n \"code\": \"A1\",\r\n \"display\": \"Certified in total\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"category\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\r\n \"code\": \"submitted\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"adjudication\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\r\n \"extension\": [\r\n {\r\n \"url\": \"number\",\r\n \"valueString\": \"1\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"category\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\r\n \"code\": \"submitted\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"processNote\": [\r\n {\r\n \"number\": 1,\r\n \"text\": \"Prior authorization processing note\"\r\n }\r\n ],\r\n \"error\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/889\",\r\n \"code\": \"N\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement\",\r\n \"extension\": [\r\n {\r\n \"url\": \"error\",\r\n \"valueString\": \"ClaimResponse.status\"\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath\",\r\n \"valueString\": \"ClaimResponse.status\"\r\n }\r\n ],\r\n \"code\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/901\",\r\n \"code\": \"04\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"resourceType\": \"ClaimResponse\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0002-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest\"\r\n ]\r\n },\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\r\n \"valuePositiveInt\": 1\r\n }\r\n ],\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://davinci-pas.org/fhir/comm-req-id\",\r\n \"value\": \"COMM001\"\r\n }\r\n ],\r\n \"status\": \"active\",\r\n \"category\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/755\",\r\n \"code\": \"15\",\r\n \"display\": \"Justification for Admissions\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"medium\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationMode\",\r\n \"code\": \"WRITTEN\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"subject\": {\r\n \"display\": \"Mock Patient\"\r\n },\r\n \"payload\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\r\n \"code\": \"J06.9\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://loinc.org\",\r\n \"code\": \"18804-5\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"contentString\": \"18776-5\"\r\n }\r\n ],\r\n \"requester\": {\r\n \"display\": \"Mock Requester\"\r\n },\r\n \"recipient\": [\r\n {\r\n \"display\": \"Mock Recipient\"\r\n }\r\n ],\r\n \"sender\": {\r\n \"display\": \"Mock Sender\"\r\n },\r\n \"resourceType\": \"CommunicationRequest\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0003-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"1234567893\"\r\n }\r\n ],\r\n \"name\": [\r\n {\r\n \"family\": \"WATSON\",\r\n \"given\": [\r\n \"SUSAN\"\r\n ]\r\n }\r\n ],\r\n \"address\": [\r\n {\r\n \"line\": [\r\n \"123 Main St\"\r\n ],\r\n \"city\": \"Springfield\",\r\n \"state\": \"IL\",\r\n \"postalCode\": \"62701\",\r\n \"country\": \"US\"\r\n }\r\n ],\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"value\": \"5555550100\"\r\n }\r\n ],\r\n \"resourceType\": \"Practitioner\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0004-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0004-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\r\n ]\r\n },\r\n \"practitioner\": {\r\n \"reference\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\"\r\n },\r\n \"organization\": {\r\n \"display\": \"Mock Organization\"\r\n },\r\n \"code\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://nucc.org/provider-taxonomy\",\r\n \"code\": \"208D00000X\",\r\n \"display\": \"General Practice Physician\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"specialty\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://nucc.org/provider-taxonomy\",\r\n \"code\": \"208D00000X\",\r\n \"display\": \"General Practice Physician\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"location\": [\r\n {\r\n \"display\": \"Mock Location\"\r\n }\r\n ],\r\n \"endpoint\": [\r\n {\r\n \"display\": \"Mock Endpoint\"\r\n }\r\n ],\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"value\": \"5555550100\"\r\n }\r\n ],\r\n \"resourceType\": \"PractitionerRole\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0005-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0005-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\r\n \"value\": \"TASK001\"\r\n }\r\n ],\r\n \"status\": \"requested\",\r\n \"statusReason\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"priorAuthorization\"\r\n }\r\n ]\r\n },\r\n \"intent\": \"order\",\r\n \"code\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"attachment-request-code\"\r\n }\r\n ]\r\n },\r\n \"for\": {\r\n \"display\": \"Mock Patient\"\r\n },\r\n \"requester\": {\r\n \"identifier\": {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"1234567893\"\r\n }\r\n },\r\n \"owner\": {\r\n \"identifier\": {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"1234567893\"\r\n }\r\n },\r\n \"reasonCode\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"priorAuthorization\"\r\n }\r\n ]\r\n },\r\n \"reasonReference\": {\r\n \"display\": \"Mock Claim\"\r\n },\r\n \"restriction\": {\r\n \"period\": {\r\n \"start\": \"2023-01-01\",\r\n \"end\": \"2023-12-31\"\r\n }\r\n },\r\n \"input\": [\r\n {\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"payer-url\"\r\n }\r\n ]\r\n },\r\n \"valueUrl\": \"https://prior-auth.davinci.hl7.org/fhir/payer\"\r\n },\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\r\n \"valuePositiveInt\": 1\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://loinc.org\",\r\n \"code\": \"18804-5\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"attachments-needed\"\r\n }\r\n ]\r\n },\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://loinc.org\",\r\n \"code\": \"28570-0\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\r\n \"valuePositiveInt\": 1\r\n }\r\n ],\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"questionnaire-context\"\r\n }\r\n ]\r\n },\r\n \"valueString\": \"http://example.org/questionnaire\"\r\n }\r\n ],\r\n \"resourceType\": \"Task\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\",\r\n \"resource\": {\r\n \"id\": \"0b321e9e-571b-4f83-8cea-fa23424383bb\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary\"\r\n ]\r\n },\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/584\",\r\n \"code\": \"RU\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://notreal.com/MIN\",\r\n \"value\": \"12345678901\"\r\n }\r\n ],\r\n \"name\": [\r\n {\r\n \"family\": \"SMITH\",\r\n \"given\": [\r\n \"JOE\"\r\n ]\r\n }\r\n ],\r\n \"gender\": \"male\",\r\n \"resourceType\": \"Patient\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\",\r\n \"resource\": {\r\n \"id\": \"ff7adc9d-8854-4947-874a-8b61bca953c1\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"7893120007\"\r\n }\r\n ],\r\n \"active\": true,\r\n \"type\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/98\",\r\n \"code\": \"PR\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\r\n \"resourceType\": \"Organization\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\",\r\n \"resource\": {\r\n \"id\": \"b0881003-0d22-499d-840b-91dc7f6f4479\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"8189991234\"\r\n }\r\n ],\r\n \"active\": true,\r\n \"type\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/98\",\r\n \"code\": \"X3\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"name\": \"DR. JOE SMITH CORPORATION\",\r\n \"address\": [\r\n {\r\n \"line\": [\r\n \"111 1ST STREET\"\r\n ],\r\n \"city\": \"SAN DIEGO\",\r\n \"state\": \"CA\",\r\n \"postalCode\": \"92101\",\r\n \"country\": \"US\"\r\n }\r\n ],\r\n \"resourceType\": \"Organization\"\r\n }\r\n }\r\n ],\r\n \"resourceType\": \"Bundle\"\r\n}"
44
+ "value": "{\r\n \"id\": \"b0000001-0000-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle\"\r\n ]\r\n },\r\n \"identifier\": {\r\n \"system\": \"urn:ietf:rfc:3986\",\r\n \"value\": \"urn:uuid:b0000001-0000-0000-0000-000000000001\"\r\n },\r\n \"type\": \"collection\",\r\n \"timestamp\": \"2024-01-30T13:29:32Z\",\r\n \"entry\": [\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0001-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0001-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse\"\r\n ]\r\n },\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\r\n \"extension\": [\r\n {\r\n \"url\": \"applicationSenderCode\",\r\n \"valueString\": \"SENDER01\"\r\n },\r\n {\r\n \"url\": \"applicationReceiverCode\",\r\n \"valueString\": \"RECEIVER01\"\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer\",\r\n \"extension\": [\r\n {\r\n \"url\": \"wasHumanReviewedFlag\",\r\n \"valueBoolean\": true\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\r\n \"extension\": [\r\n {\r\n \"url\": \"provider\",\r\n \"valueReference\": {\r\n \"display\": \"Mock Authorized Provider\"\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"identifier\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\r\n \"valueString\": \"SUBDEPT01\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://www.usps.com/\",\r\n \"code\": \"CA\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\r\n \"value\": \"111366\",\r\n \"assigner\": {\r\n \"identifier\": {\r\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\r\n \"value\": \"5556667771\"\r\n }\r\n }\r\n }\r\n ],\r\n \"status\": \"active\",\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\r\n \"code\": \"professional\"\r\n }\r\n ]\r\n },\r\n \"use\": \"preauthorization\",\r\n \"patient\": {\r\n \"reference\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\"\r\n },\r\n \"created\": \"2024-01-30T13:29:32Z\",\r\n \"insurer\": {\r\n \"reference\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\"\r\n },\r\n \"requestor\": {\r\n \"reference\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\"\r\n },\r\n \"request\": {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/StructureDefinition/data-absent-reason\",\r\n \"valueCode\": \"unknown\"\r\n }\r\n ]\r\n },\r\n \"outcome\": \"complete\",\r\n \"preAuthPeriod\": {\r\n \"start\": \"2024-01-30\",\r\n \"end\": \"2024-02-29\"\r\n },\r\n \"communicationRequest\": [\r\n {\r\n \"reference\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\"\r\n }\r\n ],\r\n \"item\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\r\n \"valueDate\": \"2024-01-30\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\r\n \"valuePeriod\": {\r\n \"start\": \"2024-01-30\",\r\n \"end\": \"2024-02-29\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\r\n \"value\": \"1\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\r\n \"valueString\": \"AUTH123\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\r\n \"valueString\": \"ADMIN123\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate\",\r\n \"valuePeriod\": {\r\n \"start\": \"2024-01-30\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail\",\r\n \"extension\": [\r\n {\r\n \"url\": \"productOrServiceCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1365\",\r\n \"code\": \"G0153\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\r\n \"extension\": [\r\n {\r\n \"url\": \"provider\",\r\n \"valueReference\": {\r\n \"display\": \"Mock Item Provider\"\r\n }\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\r\n \"valuePeriod\": {\r\n \"start\": \"2023-01-01\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\r\n \"valueDate\": \"2023-01-10\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\r\n \"code\": \"J06.9\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"itemSequence\": 1,\r\n \"noteNumber\": [\r\n 1\r\n ],\r\n \"adjudication\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/306\",\r\n \"code\": \"A1\",\r\n \"display\": \"Certified in total\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"category\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\r\n \"code\": \"submitted\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"addItem\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\r\n \"value\": \"TRACE001\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\r\n \"valueDate\": \"2024-01-30\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\r\n \"valuePeriod\": {\r\n \"start\": \"2024-01-30\",\r\n \"end\": \"2024-02-29\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\r\n \"valueString\": \"AUTH456\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\r\n \"valueString\": \"ADMIN456\"\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\r\n \"valueBoolean\": false\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/01/00/1345\",\r\n \"code\": \"2\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/02/00/1306\",\r\n \"code\": \"2\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1365\",\r\n \"code\": \"G0153\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://www.nubc.org/CodeSystem/RevenueCodes\",\r\n \"code\": \"0300\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\r\n \"valueDecimal\": 100.0\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\r\n \"valueReference\": {\r\n \"display\": \"Mock Requested Service\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1525\",\r\n \"code\": \"SC\",\r\n \"display\": \"Specialty Care Review\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1322\",\r\n \"code\": \"I\",\r\n \"display\": \"Initial\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\r\n \"valuePeriod\": {\r\n \"start\": \"2023-01-01\"\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\r\n \"valueDate\": \"2023-01-10\"\r\n }\r\n ],\r\n \"itemSequence\": [\r\n 1\r\n ],\r\n \"provider\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/98\",\r\n \"code\": \"IL\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"display\": \"Mock AddItem Provider\"\r\n }\r\n ],\r\n \"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/1365\",\r\n \"code\": \"G0153\"\r\n }\r\n ]\r\n },\r\n \"modifier\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://www.ama-assn.org/go/cpt\",\r\n \"code\": \"25\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"servicedDate\": \"2024-01-30\",\r\n \"locationCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\r\n \"code\": \"11\"\r\n }\r\n ]\r\n },\r\n \"quantity\": {\r\n \"value\": 1,\r\n \"unit\": \"visit\"\r\n },\r\n \"unitPrice\": {\r\n \"value\": 100.0,\r\n \"currency\": \"USD\"\r\n },\r\n \"adjudication\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/306\",\r\n \"code\": \"A1\",\r\n \"display\": \"Certified in total\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"category\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\r\n \"code\": \"submitted\"\r\n }\r\n ]\r\n }\r\n }\r\n ]\r\n }\r\n ],\r\n \"adjudication\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\r\n \"extension\": [\r\n {\r\n \"url\": \"number\",\r\n \"valueString\": \"1\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"category\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\r\n \"code\": \"submitted\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"processNote\": [\r\n {\r\n \"number\": 1,\r\n \"text\": \"Prior authorization processing note\"\r\n }\r\n ],\r\n \"error\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/889\",\r\n \"code\": \"N\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement\",\r\n \"extension\": [\r\n {\r\n \"url\": \"error\",\r\n \"valueString\": \"ClaimResponse.status\"\r\n }\r\n ]\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath\",\r\n \"valueString\": \"ClaimResponse.status\"\r\n }\r\n ],\r\n \"code\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/901\",\r\n \"code\": \"04\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"resourceType\": \"ClaimResponse\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0002-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest\"\r\n ]\r\n },\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\r\n \"valuePositiveInt\": 1\r\n }\r\n ],\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://davinci-pas.org/fhir/comm-req-id\",\r\n \"value\": \"COMM001\"\r\n }\r\n ],\r\n \"status\": \"active\",\r\n \"category\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/755\",\r\n \"code\": \"15\",\r\n \"display\": \"Justification for Admissions\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"medium\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationMode\",\r\n \"code\": \"WRITTEN\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"subject\": {\r\n \"display\": \"Mock Patient\"\r\n },\r\n \"payload\": [\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\r\n \"code\": \"J06.9\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://loinc.org\",\r\n \"code\": \"18804-5\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"contentString\": \"18776-5\"\r\n }\r\n ],\r\n \"requester\": {\r\n \"display\": \"Mock Requester\"\r\n },\r\n \"recipient\": [\r\n {\r\n \"display\": \"Mock Recipient\"\r\n }\r\n ],\r\n \"sender\": {\r\n \"display\": \"Mock Sender\"\r\n },\r\n \"resourceType\": \"CommunicationRequest\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0003-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"7644195407\"\r\n }\r\n ],\r\n \"name\": [\r\n {\r\n \"family\": \"WATSON\",\r\n \"given\": [\r\n \"SUSAN\"\r\n ]\r\n }\r\n ],\r\n \"address\": [\r\n {\r\n \"line\": [\r\n \"123 Main St\"\r\n ],\r\n \"city\": \"Springfield\",\r\n \"state\": \"IL\",\r\n \"postalCode\": \"62701\",\r\n \"country\": \"US\"\r\n }\r\n ],\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"value\": \"5555550100\"\r\n }\r\n ],\r\n \"resourceType\": \"Practitioner\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0004-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0004-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\r\n ]\r\n },\r\n \"practitioner\": {\r\n \"reference\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\"\r\n },\r\n \"organization\": {\r\n \"display\": \"Mock Organization\"\r\n },\r\n \"code\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://nucc.org/provider-taxonomy\",\r\n \"code\": \"208D00000X\",\r\n \"display\": \"General Practice Physician\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"specialty\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://nucc.org/provider-taxonomy\",\r\n \"code\": \"208D00000X\",\r\n \"display\": \"General Practice Physician\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"location\": [\r\n {\r\n \"display\": \"Mock Location\"\r\n }\r\n ],\r\n \"endpoint\": [\r\n {\r\n \"display\": \"Mock Endpoint\"\r\n }\r\n ],\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"value\": \"5555550100\"\r\n }\r\n ],\r\n \"resourceType\": \"PractitionerRole\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0005-0000-0000-000000000001\",\r\n \"resource\": {\r\n \"id\": \"a1b2c3d4-0005-0000-0000-000000000001\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\r\n \"value\": \"TASK001\"\r\n }\r\n ],\r\n \"status\": \"requested\",\r\n \"statusReason\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"priorAuthorization\"\r\n }\r\n ]\r\n },\r\n \"intent\": \"order\",\r\n \"code\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"attachment-request-code\"\r\n }\r\n ]\r\n },\r\n \"for\": {\r\n \"display\": \"Mock Patient\"\r\n },\r\n \"requester\": {\r\n \"identifier\": {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"1234567893\"\r\n }\r\n },\r\n \"owner\": {\r\n \"identifier\": {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"1234567893\"\r\n }\r\n },\r\n \"reasonCode\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"priorAuthorization\"\r\n }\r\n ]\r\n },\r\n \"reasonReference\": {\r\n \"display\": \"Mock Claim\"\r\n },\r\n \"restriction\": {\r\n \"period\": {\r\n \"start\": \"2023-01-01\",\r\n \"end\": \"2023-12-31\"\r\n }\r\n },\r\n \"input\": [\r\n {\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"payer-url\"\r\n }\r\n ]\r\n },\r\n \"valueUrl\": \"https://prior-auth.davinci.hl7.org/fhir/payer\"\r\n },\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\r\n \"valuePositiveInt\": 1\r\n },\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://loinc.org\",\r\n \"code\": \"18804-5\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"attachments-needed\"\r\n }\r\n ]\r\n },\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://loinc.org\",\r\n \"code\": \"28570-0\"\r\n }\r\n ]\r\n }\r\n },\r\n {\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\r\n \"valuePositiveInt\": 1\r\n }\r\n ],\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\r\n \"code\": \"questionnaire-context\"\r\n }\r\n ]\r\n },\r\n \"valueString\": \"http://example.org/questionnaire\"\r\n }\r\n ],\r\n \"resourceType\": \"Task\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\",\r\n \"resource\": {\r\n \"id\": \"0b321e9e-571b-4f83-8cea-fa23424383bb\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary\"\r\n ]\r\n },\r\n \"extension\": [\r\n {\r\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\r\n \"valueCodeableConcept\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/584\",\r\n \"code\": \"RU\"\r\n }\r\n ]\r\n }\r\n }\r\n ],\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://notreal.com/MIN\",\r\n \"value\": \"12345678901\"\r\n }\r\n ],\r\n \"name\": [\r\n {\r\n \"family\": \"SMITH\",\r\n \"given\": [\r\n \"JOE\"\r\n ]\r\n }\r\n ],\r\n \"gender\": \"male\",\r\n \"resourceType\": \"Patient\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\",\r\n \"resource\": {\r\n \"id\": \"ff7adc9d-8854-4947-874a-8b61bca953c1\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"7893120007\"\r\n }\r\n ],\r\n \"active\": true,\r\n \"type\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/98\",\r\n \"code\": \"PR\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\r\n \"resourceType\": \"Organization\"\r\n }\r\n },\r\n {\r\n \"fullUrl\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\",\r\n \"resource\": {\r\n \"id\": \"b0881003-0d22-499d-840b-91dc7f6f4479\",\r\n \"meta\": {\r\n \"profile\": [\r\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\r\n ]\r\n },\r\n \"identifier\": [\r\n {\r\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\r\n \"value\": \"8189991234\"\r\n }\r\n ],\r\n \"active\": true,\r\n \"type\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://codesystem.x12.org/005010/98\",\r\n \"code\": \"X3\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"name\": \"DR. JOE SMITH CORPORATION\",\r\n \"address\": [\r\n {\r\n \"line\": [\r\n \"111 1ST STREET\"\r\n ],\r\n \"city\": \"SAN DIEGO\",\r\n \"state\": \"CA\",\r\n \"postalCode\": \"92101\",\r\n \"country\": \"US\"\r\n }\r\n ],\r\n \"resourceType\": \"Organization\"\r\n }\r\n }\r\n ],\r\n \"resourceType\": \"Bundle\"\r\n}"
45
45
  },
46
46
  {
47
47
  "name": "ms_inquire_responses",
48
- "value": "[\n {\n \"id\": \"b0000002-0000-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:uuid:b0000002-0000-0000-0000-000000000001\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2024-01-30T13:29:32Z\",\n \"entry\": [\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0006-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0006-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n \"extension\": [\n {\n \"url\": \"applicationSenderCode\",\n \"valueString\": \"SENDER01\"\n },\n {\n \"url\": \"applicationReceiverCode\",\n \"valueString\": \"RECEIVER01\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer\",\n \"extension\": [\n {\n \"url\": \"wasHumanReviewedFlag\",\n \"valueBoolean\": true\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Authorized Provider\"\n }\n }\n ]\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"SUBDEPT01\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"CA\"\n }\n ]\n }\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111366\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"5556667771\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\"\n },\n \"created\": \"2024-01-30T13:29:32Z\",\n \"insurer\": {\n \"reference\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\"\n },\n \"requestor\": {\n \"reference\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\"\n },\n \"request\": {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/StructureDefinition/data-absent-reason\",\n \"valueCode\": \"unknown\"\n }\n ]\n },\n \"outcome\": \"complete\",\n \"preAuthPeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n },\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"1\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail\",\n \"extension\": [\n {\n \"url\": \"productOrServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Item Provider\"\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"J06.9\"\n }\n ]\n }\n }\n ],\n \"itemSequence\": 1,\n \"noteNumber\": [\n 1\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"addItem\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TRACE001\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/01/00/1345\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/02/00/1306\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/RevenueCodes\",\n \"code\": \"0300\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100.0\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"display\": \"Mock Requested Service\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n }\n ],\n \"itemSequence\": [\n 1\n ],\n \"provider\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"IL\"\n }\n ]\n }\n }\n ],\n \"display\": \"Mock AddItem Provider\"\n }\n ],\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.ama-assn.org/go/cpt\",\n \"code\": \"25\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2024-01-30\",\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"quantity\": {\n \"value\": 1\n },\n \"unitPrice\": {\n \"value\": 100.0,\n \"currency\": \"USD\"\n },\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"number\",\n \"valueString\": \"1\"\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ],\n \"processNote\": [\n {\n \"number\": 1,\n \"text\": \"Prior authorization processing note\"\n }\n ],\n \"error\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/889\",\n \"code\": \"N\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement\",\n \"extension\": [\n {\n \"url\": \"error\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ],\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/901\",\n \"code\": \"04\"\n }\n ]\n }\n }\n ],\n \"resourceType\": \"ClaimResponse\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0003-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"123 Main St\"\n ],\n \"city\": \"Springfield\",\n \"state\": \"IL\",\n \"postalCode\": \"62701\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"Practitioner\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0004-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0004-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"practitioner\": {\n \"reference\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\"\n },\n \"organization\": {\n \"display\": \"Mock Organization\"\n },\n \"code\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"specialty\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"location\": [\n {\n \"display\": \"Mock Location\"\n }\n ],\n \"endpoint\": [\n {\n \"display\": \"Mock Endpoint\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"PractitionerRole\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0005-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0005-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TASK001\"\n }\n ],\n \"status\": \"requested\",\n \"statusReason\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachment-request-code\"\n }\n ]\n },\n \"for\": {\n \"display\": \"Mock Patient\"\n },\n \"requester\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"owner\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"reasonCode\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"reasonReference\": {\n \"display\": \"Mock Claim\"\n },\n \"restriction\": {\n \"period\": {\n \"start\": \"2023-01-01\",\n \"end\": \"2023-12-31\"\n }\n },\n \"input\": [\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"payer-url\"\n }\n ]\n },\n \"valueUrl\": \"https://prior-auth.davinci.hl7.org/fhir/payer\"\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"18804-5\"\n }\n ]\n }\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachments-needed\"\n }\n ]\n },\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"28570-0\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"questionnaire-context\"\n }\n ]\n },\n \"valueString\": \"http://example.org/questionnaire\"\n }\n ],\n \"resourceType\": \"Task\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"resource\": {\n \"id\": \"0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr.\"\n ],\n \"suffix\": [\n \"Jr.\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"resourceType\": \"Patient\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\",\n \"use\": \"home\"\n }\n ],\n \"birthDate\": \"1980-01-01\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"district\": \"SAN DIEGO COUNTY\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"en\"\n }\n ]\n }\n }\n ],\n \"multipleBirthInteger\": 1\n }\n },\n {\n \"fullUrl\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"resource\": {\n \"id\": \"ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"7893120007\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"123456789\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"value\": \"PI-7893120007\",\n \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"resource\": {\n \"id\": \"b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"987654321\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"value\": \"PI-8189991234\",\n \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"contact\": [\n {\n \"name\": {\n \"text\": \"DR. JOE SMITH\"\n },\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ]\n }\n ]\n }\n }\n ],\n \"resourceType\": \"Bundle\"\n }\n]"
48
+ "value": "[\n {\n \"id\": \"b0000002-0000-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:uuid:b0000002-0000-0000-0000-000000000001\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2024-01-30T13:29:32Z\",\n \"entry\": [\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0006-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0006-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n \"extension\": [\n {\n \"url\": \"applicationSenderCode\",\n \"valueString\": \"SENDER01\"\n },\n {\n \"url\": \"applicationReceiverCode\",\n \"valueString\": \"RECEIVER01\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer\",\n \"extension\": [\n {\n \"url\": \"wasHumanReviewedFlag\",\n \"valueBoolean\": true\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Authorized Provider\"\n }\n }\n ]\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"SUBDEPT01\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"CA\"\n }\n ]\n }\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111366\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"5556667771\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\"\n },\n \"created\": \"2024-01-30T13:29:32Z\",\n \"insurer\": {\n \"reference\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\"\n },\n \"requestor\": {\n \"reference\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\"\n },\n \"request\": {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/StructureDefinition/data-absent-reason\",\n \"valueCode\": \"unknown\"\n }\n ]\n },\n \"outcome\": \"complete\",\n \"preAuthPeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n },\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"1\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail\",\n \"extension\": [\n {\n \"url\": \"productOrServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Item Provider\"\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"J06.9\"\n }\n ]\n }\n }\n ],\n \"itemSequence\": 1,\n \"noteNumber\": [\n 1\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"addItem\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TRACE001\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/01/00/1345\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/02/00/1306\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/RevenueCodes\",\n \"code\": \"0300\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100.0\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"display\": \"Mock Requested Service\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n }\n ],\n \"itemSequence\": [\n 1\n ],\n \"provider\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"IL\"\n }\n ]\n }\n }\n ],\n \"display\": \"Mock AddItem Provider\"\n }\n ],\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.ama-assn.org/go/cpt\",\n \"code\": \"25\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2024-01-30\",\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"quantity\": {\n \"value\": 1,\n \"unit\": \"visit\"\n },\n \"unitPrice\": {\n \"value\": 100.0,\n \"currency\": \"USD\"\n },\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"number\",\n \"valueString\": \"1\"\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ],\n \"processNote\": [\n {\n \"number\": 1,\n \"text\": \"Prior authorization processing note\"\n }\n ],\n \"error\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/889\",\n \"code\": \"N\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement\",\n \"extension\": [\n {\n \"url\": \"error\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ],\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/901\",\n \"code\": \"04\"\n }\n ]\n }\n }\n ],\n \"resourceType\": \"ClaimResponse\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0003-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"7644195407\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"123 Main St\"\n ],\n \"city\": \"Springfield\",\n \"state\": \"IL\",\n \"postalCode\": \"62701\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"Practitioner\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0004-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0004-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"practitioner\": {\n \"reference\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\"\n },\n \"organization\": {\n \"display\": \"Mock Organization\"\n },\n \"code\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"specialty\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"location\": [\n {\n \"display\": \"Mock Location\"\n }\n ],\n \"endpoint\": [\n {\n \"display\": \"Mock Endpoint\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"PractitionerRole\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0005-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0005-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TASK001\"\n }\n ],\n \"status\": \"requested\",\n \"statusReason\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachment-request-code\"\n }\n ]\n },\n \"for\": {\n \"display\": \"Mock Patient\"\n },\n \"requester\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"owner\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"reasonCode\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"reasonReference\": {\n \"display\": \"Mock Claim\"\n },\n \"restriction\": {\n \"period\": {\n \"start\": \"2023-01-01\",\n \"end\": \"2023-12-31\"\n }\n },\n \"input\": [\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"payer-url\"\n }\n ]\n },\n \"valueUrl\": \"https://prior-auth.davinci.hl7.org/fhir/payer\"\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"18804-5\"\n }\n ]\n }\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachments-needed\"\n }\n ]\n },\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"28570-0\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"questionnaire-context\"\n }\n ]\n },\n \"valueString\": \"http://example.org/questionnaire\"\n }\n ],\n \"resourceType\": \"Task\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"resource\": {\n \"id\": \"0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr.\"\n ],\n \"suffix\": [\n \"Jr.\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"resourceType\": \"Patient\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\",\n \"use\": \"home\"\n }\n ],\n \"birthDate\": \"1980-01-01\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"district\": \"SAN DIEGO COUNTY\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"en\"\n }\n ]\n }\n }\n ],\n \"multipleBirthInteger\": 1\n }\n },\n {\n \"fullUrl\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"resource\": {\n \"id\": \"ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"7893120007\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"123456789\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"value\": \"PI-7893120007\",\n \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"resource\": {\n \"id\": \"b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"987654321\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"value\": \"PI-8189991234\",\n \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"contact\": [\n {\n \"name\": {\n \"text\": \"DR. JOE SMITH\"\n },\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ]\n }\n ]\n }\n }\n ],\n \"resourceType\": \"Bundle\"\n }\n]"
49
49
  },
50
50
  {
51
51
  "name": "ms_submit_responses",
52
- "value": "[\n {\n \"id\": \"b0000001-0000-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:uuid:b0000001-0000-0000-0000-000000000001\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2024-01-30T13:29:32Z\",\n \"entry\": [\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0001-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0001-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n \"extension\": [\n {\n \"url\": \"applicationSenderCode\",\n \"valueString\": \"SENDER01\"\n },\n {\n \"url\": \"applicationReceiverCode\",\n \"valueString\": \"RECEIVER01\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer\",\n \"extension\": [\n {\n \"url\": \"wasHumanReviewedFlag\",\n \"valueBoolean\": true\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Authorized Provider\"\n }\n }\n ]\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"SUBDEPT01\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"CA\"\n }\n ]\n }\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111366\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"5556667771\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\"\n },\n \"created\": \"2024-01-30T13:29:32Z\",\n \"insurer\": {\n \"reference\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\"\n },\n \"requestor\": {\n \"reference\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\"\n },\n \"request\": {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/StructureDefinition/data-absent-reason\",\n \"valueCode\": \"unknown\"\n }\n ]\n },\n \"outcome\": \"complete\",\n \"preAuthPeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n },\n \"communicationRequest\": [\n {\n \"reference\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\"\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"1\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail\",\n \"extension\": [\n {\n \"url\": \"productOrServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Item Provider\"\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"J06.9\"\n }\n ]\n }\n }\n ],\n \"itemSequence\": 1,\n \"noteNumber\": [\n 1\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"addItem\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TRACE001\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/01/00/1345\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/02/00/1306\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/RevenueCodes\",\n \"code\": \"0300\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100.0\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"display\": \"Mock Requested Service\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n }\n ],\n \"itemSequence\": [\n 1\n ],\n \"provider\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"IL\"\n }\n ]\n }\n }\n ],\n \"display\": \"Mock AddItem Provider\"\n }\n ],\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.ama-assn.org/go/cpt\",\n \"code\": \"25\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2024-01-30\",\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"quantity\": {\n \"value\": 1\n },\n \"unitPrice\": {\n \"value\": 100.0,\n \"currency\": \"USD\"\n },\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"number\",\n \"valueString\": \"1\"\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ],\n \"processNote\": [\n {\n \"number\": 1,\n \"text\": \"Prior authorization processing note\"\n }\n ],\n \"error\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/889\",\n \"code\": \"N\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement\",\n \"extension\": [\n {\n \"url\": \"error\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ],\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/901\",\n \"code\": \"04\"\n }\n ]\n }\n }\n ],\n \"resourceType\": \"ClaimResponse\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0002-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/fhir/comm-req-id\",\n \"value\": \"COMM001\"\n }\n ],\n \"status\": \"active\",\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/755\",\n \"code\": \"15\",\n \"display\": \"Justification for Admissions\"\n }\n ]\n }\n ],\n \"medium\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationMode\",\n \"code\": \"WRITTEN\"\n }\n ]\n }\n ],\n \"subject\": {\n \"display\": \"Mock Patient\"\n },\n \"payload\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"J06.9\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"18804-5\"\n }\n ]\n }\n }\n ],\n \"contentString\": \"18776-5\"\n }\n ],\n \"requester\": {\n \"display\": \"Mock Requester\"\n },\n \"recipient\": [\n {\n \"display\": \"Mock Recipient\"\n }\n ],\n \"sender\": {\n \"display\": \"Mock Sender\"\n },\n \"resourceType\": \"CommunicationRequest\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0003-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"123 Main St\"\n ],\n \"city\": \"Springfield\",\n \"state\": \"IL\",\n \"postalCode\": \"62701\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"Practitioner\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0004-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0004-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"practitioner\": {\n \"reference\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\"\n },\n \"organization\": {\n \"display\": \"Mock Organization\"\n },\n \"code\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"specialty\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"location\": [\n {\n \"display\": \"Mock Location\"\n }\n ],\n \"endpoint\": [\n {\n \"display\": \"Mock Endpoint\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"PractitionerRole\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0005-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0005-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TASK001\"\n }\n ],\n \"status\": \"requested\",\n \"statusReason\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachment-request-code\"\n }\n ]\n },\n \"for\": {\n \"display\": \"Mock Patient\"\n },\n \"requester\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"owner\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"reasonCode\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"reasonReference\": {\n \"display\": \"Mock Claim\"\n },\n \"restriction\": {\n \"period\": {\n \"start\": \"2023-01-01\",\n \"end\": \"2023-12-31\"\n }\n },\n \"input\": [\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"payer-url\"\n }\n ]\n },\n \"valueUrl\": \"https://prior-auth.davinci.hl7.org/fhir/payer\"\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"18804-5\"\n }\n ]\n }\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachments-needed\"\n }\n ]\n },\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"28570-0\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"questionnaire-context\"\n }\n ]\n },\n \"valueString\": \"http://example.org/questionnaire\"\n }\n ],\n \"resourceType\": \"Task\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"resource\": {\n \"id\": \"0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Ms.\"\n ],\n \"suffix\": [\n \"Jr.\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"resourceType\": \"Patient\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5551234567\",\n \"use\": \"home\"\n }\n ],\n \"birthDate\": \"1980-06-15\",\n \"address\": [\n {\n \"line\": [\n \"456 OAK AVE\"\n ],\n \"city\": \"CHICAGO\",\n \"district\": \"COOK\",\n \"state\": \"IL\",\n \"postalCode\": \"60601\",\n \"country\": \"US\"\n }\n ],\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"en\"\n }\n ]\n }\n }\n ],\n \"multipleBirthInteger\": 1\n }\n },\n {\n \"fullUrl\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"resource\": {\n \"id\": \"ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"7893120007\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"123456789\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"system\": \"http://notreal.com/payerid\",\n \"value\": \"PAYER001\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5552223333\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"789 INSURANCE BLVD\"\n ],\n \"city\": \"BALTIMORE\",\n \"state\": \"MD\",\n \"postalCode\": \"21201\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"resource\": {\n \"id\": \"b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"987654321\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"system\": \"http://notreal.com/providerid\",\n \"value\": \"PROV001\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5554445555\"\n }\n ],\n \"contact\": [\n {\n \"name\": {\n \"text\": \"Jane Contact\"\n },\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5556667777\"\n }\n ]\n }\n ]\n }\n }\n ],\n \"resourceType\": \"Bundle\"\n }\n]"
52
+ "value": "[\n {\n \"id\": \"b0000001-0000-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:uuid:b0000001-0000-0000-0000-000000000001\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2024-01-30T13:29:32Z\",\n \"entry\": [\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0001-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0001-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n \"extension\": [\n {\n \"url\": \"applicationSenderCode\",\n \"valueString\": \"SENDER01\"\n },\n {\n \"url\": \"applicationReceiverCode\",\n \"valueString\": \"RECEIVER01\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer\",\n \"extension\": [\n {\n \"url\": \"wasHumanReviewedFlag\",\n \"valueBoolean\": true\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Authorized Provider\"\n }\n }\n ]\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"SUBDEPT01\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"CA\"\n }\n ]\n }\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111366\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"5556667771\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\"\n },\n \"created\": \"2024-01-30T13:29:32Z\",\n \"insurer\": {\n \"reference\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\"\n },\n \"requestor\": {\n \"reference\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\"\n },\n \"request\": {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/StructureDefinition/data-absent-reason\",\n \"valueCode\": \"unknown\"\n }\n ]\n },\n \"outcome\": \"complete\",\n \"preAuthPeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n },\n \"communicationRequest\": [\n {\n \"reference\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\"\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"1\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN123\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail\",\n \"extension\": [\n {\n \"url\": \"productOrServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider\",\n \"extension\": [\n {\n \"url\": \"provider\",\n \"valueReference\": {\n \"display\": \"Mock Item Provider\"\n }\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"J06.9\"\n }\n ]\n }\n }\n ],\n \"itemSequence\": 1,\n \"noteNumber\": [\n 1\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"addItem\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TRACE001\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate\",\n \"valueDate\": \"2024-01-30\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod\",\n \"valuePeriod\": {\n \"start\": \"2024-01-30\",\n \"end\": \"2024-02-29\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"AUTH456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"ADMIN456\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/01/00/1345\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://valueset.x12.org/x217/005010/response/2000F/NX1/1/02/00/1306\",\n \"code\": \"2\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/RevenueCodes\",\n \"code\": \"0300\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100.0\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"display\": \"Mock Requested Service\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-admissionDates\",\n \"valuePeriod\": {\n \"start\": \"2023-01-01\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-dischargeDate\",\n \"valueDate\": \"2023-01-10\"\n }\n ],\n \"itemSequence\": [\n 1\n ],\n \"provider\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"IL\"\n }\n ]\n }\n }\n ],\n \"display\": \"Mock AddItem Provider\"\n }\n ],\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"G0153\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.ama-assn.org/go/cpt\",\n \"code\": \"25\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2024-01-30\",\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"quantity\": {\n \"value\": 1,\n \"unit\": \"visit\"\n },\n \"unitPrice\": {\n \"value\": 100.0,\n \"currency\": \"USD\"\n },\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ]\n }\n ],\n \"adjudication\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction\",\n \"extension\": [\n {\n \"url\": \"number\",\n \"valueString\": \"1\"\n }\n ]\n }\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/adjudication\",\n \"code\": \"submitted\"\n }\n ]\n }\n }\n ],\n \"processNote\": [\n {\n \"number\": 1,\n \"text\": \"Prior authorization processing note\"\n }\n ],\n \"error\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/889\",\n \"code\": \"N\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement\",\n \"extension\": [\n {\n \"url\": \"error\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ]\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath\",\n \"valueString\": \"ClaimResponse.status\"\n }\n ],\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/901\",\n \"code\": \"04\"\n }\n ]\n }\n }\n ],\n \"resourceType\": \"ClaimResponse\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0002-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0002-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/fhir/comm-req-id\",\n \"value\": \"COMM001\"\n }\n ],\n \"status\": \"active\",\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/755\",\n \"code\": \"15\",\n \"display\": \"Justification for Admissions\"\n }\n ]\n }\n ],\n \"medium\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationMode\",\n \"code\": \"WRITTEN\"\n }\n ]\n }\n ],\n \"subject\": {\n \"display\": \"Mock Patient\"\n },\n \"payload\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"J06.9\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"18804-5\"\n }\n ]\n }\n }\n ],\n \"contentString\": \"18776-5\"\n }\n ],\n \"requester\": {\n \"display\": \"Mock Requester\"\n },\n \"recipient\": [\n {\n \"display\": \"Mock Recipient\"\n }\n ],\n \"sender\": {\n \"display\": \"Mock Sender\"\n },\n \"resourceType\": \"CommunicationRequest\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0003-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"7644195407\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"123 Main St\"\n ],\n \"city\": \"Springfield\",\n \"state\": \"IL\",\n \"postalCode\": \"62701\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"Practitioner\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0004-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0004-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"practitioner\": {\n \"reference\": \"urn:uuid:a1b2c3d4-0003-0000-0000-000000000001\"\n },\n \"organization\": {\n \"display\": \"Mock Organization\"\n },\n \"code\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"specialty\": [\n {\n \"coding\": [\n {\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"code\": \"208D00000X\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n ],\n \"location\": [\n {\n \"display\": \"Mock Location\"\n }\n ],\n \"endpoint\": [\n {\n \"display\": \"Mock Endpoint\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5555550100\"\n }\n ],\n \"resourceType\": \"PractitionerRole\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:a1b2c3d4-0005-0000-0000-000000000001\",\n \"resource\": {\n \"id\": \"a1b2c3d4-0005-0000-0000-000000000001\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"https://prior-auth.davinci.hl7.org/fhir/ITEM_TRACE_NUMBER\",\n \"value\": \"TASK001\"\n }\n ],\n \"status\": \"requested\",\n \"statusReason\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachment-request-code\"\n }\n ]\n },\n \"for\": {\n \"display\": \"Mock Patient\"\n },\n \"requester\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"owner\": {\n \"identifier\": {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"1234567893\"\n }\n },\n \"reasonCode\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"priorAuthorization\"\n }\n ]\n },\n \"reasonReference\": {\n \"display\": \"Mock Claim\"\n },\n \"restriction\": {\n \"period\": {\n \"start\": \"2023-01-01\",\n \"end\": \"2023-12-31\"\n }\n },\n \"input\": [\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"payer-url\"\n }\n ]\n },\n \"valueUrl\": \"https://prior-auth.davinci.hl7.org/fhir/payer\"\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-contentModifier\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"18804-5\"\n }\n ]\n }\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"attachments-needed\"\n }\n ]\n },\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"28570-0\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber\",\n \"valuePositiveInt\": 1\n }\n ],\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"questionnaire-context\"\n }\n ]\n },\n \"valueString\": \"http://example.org/questionnaire\"\n }\n ],\n \"resourceType\": \"Task\"\n }\n },\n {\n \"fullUrl\": \"urn:uuid:0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"resource\": {\n \"id\": \"0b321e9e-571b-4f83-8cea-fa23424383bb\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary\"\n ]\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Ms.\"\n ],\n \"suffix\": [\n \"Jr.\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"resourceType\": \"Patient\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5551234567\",\n \"use\": \"home\"\n }\n ],\n \"birthDate\": \"1980-06-15\",\n \"address\": [\n {\n \"line\": [\n \"456 OAK AVE\"\n ],\n \"city\": \"CHICAGO\",\n \"district\": \"COOK\",\n \"state\": \"IL\",\n \"postalCode\": \"60601\",\n \"country\": \"US\"\n }\n ],\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"en\"\n }\n ]\n }\n }\n ],\n \"multipleBirthInteger\": 1\n }\n },\n {\n \"fullUrl\": \"urn:uuid:ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"resource\": {\n \"id\": \"ff7adc9d-8854-4947-874a-8b61bca953c1\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"7893120007\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"123456789\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"system\": \"http://notreal.com/payerid\",\n \"value\": \"PAYER001\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5552223333\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"789 INSURANCE BLVD\"\n ],\n \"city\": \"BALTIMORE\",\n \"state\": \"MD\",\n \"postalCode\": \"21201\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"urn:uuid:b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"resource\": {\n \"id\": \"b0881003-0d22-499d-840b-91dc7f6f4479\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"987654321\"\n },\n {\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n \"code\": \"payerid\"\n }\n ]\n },\n \"system\": \"http://notreal.com/providerid\",\n \"value\": \"PROV001\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"resourceType\": \"Organization\",\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5554445555\"\n }\n ],\n \"contact\": [\n {\n \"name\": {\n \"text\": \"Jane Contact\"\n },\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"5556667777\"\n }\n ]\n }\n ]\n }\n }\n ],\n \"resourceType\": \"Bundle\"\n }\n]"
53
53
  },
54
54
  {
55
55
  "name": "operation_failure_operation_outcome",