Receive and respond to prior authorization requests

Last updated: Feb 18, 2025

PAYER

PRODUCT OWNER

You can use this API action to process and respond to prior authorization requests. To kick off your workflow, your connection must submit a prior authorization request.

Use cases

This API action may be a good fit for your organization if you perform any of these use cases:

Approve or decline prior authorization requests.
Streamline or digitize your process for receiving prior authorization requests.

Check out our case study for more details about the problems you can solve with this API action.

Supported systems

You can use this API action with a query-based API that can also exchange X12. Your responses to prior authorization requests can be either synchronous or asynchronous, depending on your own system’s capabilities.

Things you need to know

Support for service and prescription requests

Implementation notes for payers and vendors

Payer prior authorization codes

Filtering not supported

What's next?

Does this API action seem like a good fit for your unique workflow? Let your Technical Account Manager know! To start development, download the resource schema noted in the related action step. Then decide which data elements you need.

If you’re new to Redox, use the Quickstart guide to dive in. If you’re not engaged with our sales team yet, talk to a Redoxer to get started.

Action steps

1
Respond to a medication prior authorization request
optional
2
Respond to a service prior authorization request
optional

Respond to a medication prior authorization request

This step requires that you support receiving Claim$submit-preauthorization and Claim$attach from your connection. You can decide what that processing looks like when you're ready to respond. Refer to these schemas for more details:

In the response, you must include whether your connection's request is accepted, pending, or declined.

ClaimResponse/$respond

Payload

json

1
{
2
  "id": "RedoxClaimResponseBundleComprehensiveExample",
3
  "type": "collection",
4
  "entry": [
5
    {
6
      "resource": {
7
        "id": "RedoxPAClaimResponseExample",
8
        "use": "preauthorization",
9
        "item": [
10
          {
11
            "extension": [
12
              {
13
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
14
                "valueString": "REF456"
15
              },
16
              {
17
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
18
                "valueDate": "2021-08-23"
19
              },
20
              {
21
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
22
                "valuePeriod": {
23
                  "end": "2021-09-23",
24
                  "start": "2021-08-23"
25
                }
26
              },
27
              {
28
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
29
                "valueIdentifier": {
30
                  "value": "23462346"
31
                }
32
              },
33
              {
34
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail",
35
                "extension": [
36
                  {
37
                    "url": "productOrServiceCode",
38
                    "valueCodeableConcept": {
39
                      "text": "Right heart catheterization",
40
                      "coding": [
41
                        {
42
                          "code": "93451",
43
                          "system": "http://www.ama-assn.org/go/cpt"
44
                        }
45
                      ]
46
                    }
47
                  },
48
                  {
49
                    "url": "quantity",
50
                    "valueQuantity": {
51
                      "value": 1
52
                    }
53
                  },
54
                  {
55
                    "url": "unitPrice",
56
                    "valueMoney": {
57
                      "value": 4966,
58
                      "currency": "USD"
59
                    }
60
                  }
61
                ]
62
              }
63
            ],
64
            "adjudication": [
65
              {
66
                "category": {
67
                  "coding": [
68
                    {
69
                      "code": "submitted",
70
                      "system": "http://terminology.hl7.org/CodeSystem/adjudication"
71
                    }
72
                  ]
73
                },
74
                "extension": [
75
                  {
76
                    "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction",
77
                    "extension": [
78
                      {
79
                        "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
80
                        "valueCodeableConcept": {
81
                          "coding": [
82
                            {
83
                              "code": "A1",
84
                              "system": "https://codesystem.x12.org/005010/306",
85
                              "display": "Certified in total"
86
                            }
87
                          ]
88
                        }
89
                      },
90
                      {
91
                        "url": "number",
92
                        "valueString": "AUTH1001"
93
                      }
94
                    ]
95
                  }
96
                ]
97
              }
98
            ],
99
            "itemSequence": 1
100
          }
101
        ],
102
        "type": {
103
          "coding": [
104
            {
105
              "code": "professional",
106
              "system": "http://terminology.hl7.org/CodeSystem/claim-type"
107
            }
108
          ]
109
        },
110
        "status": "active",
111
        "created": "2021-08-23T16:35:54.648Z",
112
        "insurer": {
113
          "reference": "Organization/RedoxPAInsurerOrganizationExample"
114
        },
115
        "outcome": "complete",
116
        "patient": {
117
          "reference": "Patient/RedoxPABeneficiaryExample"
118
        },
119
        "request": {
120
          "reference": "Claim/RedoxPAServiceClaimExample",
121
          "identifier": {
122
            "type": {
123
              "coding": [
124
                {
125
                  "code": "ClaimID"
126
                }
127
              ]
128
            },
129
            "value": "urn:uuid:97b8d6d0-ac3d-411a-b32a-e1d237aceb6a"
130
          }
131
        },
132
        "requestor": {
133
          "reference": "Organization/RedoxPARequestorOrganizationExample"
134
        },
135
        "processNote": [
136
          {
137
            "text": "Covered under extended benefits"
138
          }
139
        ],
140
        "resourceType": "ClaimResponse"
141
      }
142
    },
143
    {
144
      "resource": {
145
        "id": "RedoxPABeneficiaryExample",
146
        "name": [
147
          {
148
            "given": [
149
              "Timothy",
150
              "Paul"
151
            ],
152
            "family": "Bixby"
153
          }
154
        ],
155
        "gender": "male",
156
        "birthDate": "2008-01-06",
157
        "identifier": [
158
          {
159
            "value": "M23462346",
160
            "system": "urn:redox:MRN"
161
          }
162
        ],
163
        "resourceType": "Patient"
164
      }
165
    },
166
    {
167
      "resource": {
168
        "id": "RedoxPACoverageWithRelatedSubscriberExample",
169
        "class": [
170
          {
171
            "type": {
172
              "coding": [
173
                {
174
                  "code": "group",
175
                  "system": "http://terminology.hl7.org/CodeSystem/coverage-class"
176
                }
177
              ]
178
            },
179
            "value": "GRP2245"
180
          }
181
        ],
182
        "payor": [
183
          {
184
            "reference": "Organization/RedoxPAInsurerOrganizationExample"
185
          }
186
        ],
187
        "status": "active",
188
        "subscriber": {
189
          "reference": "RelatedPerson/RedoxPASubscriberExample"
190
        },
191
        "beneficiary": {
192
          "reference": "Patient/RedoxPABeneficiaryExample"
193
        },
194
        "resourceType": "Coverage",
195
        "subscriberId": "M2346623"
196
      }
197
    },
198
    {
199
      "resource": {
200
        "id": "RedoxPARequestorOrganizationExample",
201
        "name": "Good Health Clinics",
202
        "active": true,
203
        "address": [
204
          {
205
            "city": "Madison",
206
            "line": [
207
              "123 Main St."
208
            ],
209
            "state": "WI",
210
            "country": "USA",
211
            "district": "Dane",
212
            "postalCode": "53703"
213
          }
214
        ],
215
        "resourceType": "Organization"
216
      }
217
    },
218
    {
219
      "resource": {
220
        "id": "RedoxPAInsurerOrganizationExample",
221
        "name": "Aetna",
222
        "active": true,
223
        "address": [
224
          {
225
            "city": "Lexington",
226
            "line": [
227
              "PO Box 14080"
228
            ],
229
            "state": "KY",
230
            "country": "USA",
231
            "district": "Fayette",
232
            "postalCode": "40512-4079"
233
          }
234
        ],
235
        "resourceType": "Organization"
236
      }
237
    },
238
    {
239
      "resource": {
240
        "id": "RedoxPAPractitionerRoleExamplePat",
241
        "location": [
242
          {
243
            "display": "1st Street Family Clinic"
244
          }
245
        ],
246
        "specialty": [
247
          {
248
            "coding": [
249
              {
250
                "code": "394579002",
251
                "system": "http://snomed.info/sct",
252
                "display": "Cardiology"
253
              }
254
            ]
255
          }
256
        ],
257
        "organization": {
258
          "reference": "Organization/RedoxPARequestorOrganizationExample"
259
        },
260
        "practitioner": {
261
          "reference": "Practitioner/RedoxPAPractitionerExamplePat"
262
        },
263
        "resourceType": "PractitionerRole"
264
      }
265
    },
266
    {
267
      "resource": {
268
        "id": "RedoxPAPractitionerExamplePat",
269
        "name": [
270
          {
271
            "given": [
272
              "Pat"
273
            ],
274
            "family": "Granite"
275
          }
276
        ],
277
        "address": [
278
          {
279
            "city": "Madison",
280
            "line": [
281
              "123 Main St."
282
            ],
283
            "state": "WI",
284
            "country": "USA",
285
            "district": "Dane",
286
            "postalCode": "53703"
287
          }
288
        ],
289
        "telecom": [
290
          {
291
            "value": "+16085551234"
292
          }
293
        ],
294
        "identifier": [
295
          {
296
            "value": "4356789876",
297
            "system": "http://hl7.org/fhir/sid/us-npi"
298
          }
299
        ],
300
        "resourceType": "Practitioner"
301
      }
302
    },
303
    {
304
      "resource": {
305
        "id": "RedoxPASubscriberExample",
306
        "name": [
307
          {
308
            "given": [
309
              "Barbara"
310
            ],
311
            "family": "Bixby"
312
          }
313
        ],
314
        "patient": {
315
          "reference": "RedoxPABeneficiary"
316
        },
317
        "relationship": [
318
          {
319
            "text": "Mother"
320
          }
321
        ],
322
        "resourceType": "RelatedPerson"
323
      }
324
    },
325
    {
326
      "resource": {
327
        "id": "RedoxPAServiceClaimExample",
328
        "use": "preauthorization",
329
        "item": [
330
          {
331
            "sequence": 1,
332
            "extension": [
333
              {
334
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService",
335
                "valueReference": {
336
                  "reference": "ServiceRequest/RedoxPAServiceRequestExample"
337
                }
338
              },
339
              {
340
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
341
                "valueIdentifier": {
342
                  "value": "23462346"
343
                }
344
              }
345
            ],
346
            "productOrService": {
347
              "text": "Coronary angiography with right heart catheterization",
348
              "coding": [
349
                {
350
                  "code": "93456",
351
                  "system": "http://www.ama-assn.org/go/cpt"
352
                }
353
              ]
354
            }
355
          }
356
        ],
357
        "type": {
358
          "coding": [
359
            {
360
              "code": "professional",
361
              "system": "http://terminology.hl7.org/CodeSystem/claim-type"
362
            }
363
          ]
364
        },
365
        "status": "active",
366
        "created": "2021-09-02T18:44:13.307Z",
367
        "enterer": {
368
          "reference": "PractitionerRole/RedoxPAPractitionerRoleExamplePat"
369
        },
370
        "insurer": {
371
          "reference": "Organization/RedoxPAInsurerOrganizationExample"
372
        },
373
        "patient": {
374
          "reference": "Patient/RedoxPABeneficiaryExample"
375
        },
376
        "priority": {
377
          "coding": [
378
            {
379
              "code": "normal",
380
              "system": "http://terminology.hl7.org/CodeSystem/processpriority"
381
            }
382
          ]
383
        },
384
        "provider": {
385
          "reference": "Organization/RedoxPARequestorOrganizationExample"
386
        },
387
        "diagnosis": [
388
          {
389
            "sequence": 1,
390
            "diagnosisCodeableConcept": {
391
              "coding": [
392
                {
393
                  "code": "I42.9",
394
                  "system": "http://hl7.org/fhir/sid/icd-10-cm",
395
                  "display": "Cardiomyopathy, unspecified"
396
                }
397
              ]
398
            }
399
          }
400
        ],
401
        "insurance": [
402
          {
403
            "focal": true,
404
            "coverage": {
405
              "reference": "Coverage/RedoxPACoverageExample"
406
            },
407
            "sequence": 1
408
          }
409
        ],
410
        "identifier": [
411
          {
412
            "type": {
413
              "coding": [
414
                {
415
                  "code": "ClaimID"
416
                }
417
              ]
418
            },
419
            "value": "urn:uuid:97b8d6d0-ac3d-411a-b32a-e1d237aceb6a"
420
          }
421
        ],
422
        "resourceType": "Claim",
423
        "supportingInfo": [
424
          {
425
            "category": {
426
              "coding": [
427
                {
428
                  "code": "additionalInformation",
429
                  "system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType",
430
                  "display": "Send additional paperwork or supporting information is sent for the request."
431
                }
432
              ]
433
            },
434
            "sequence": 1,
435
            "valueReference": {
436
              "reference": "DocumentReference/RedoxPADocumentReferenceExample"
437
            }
438
          },
439
          {
440
            "category": {
441
              "coding": [
442
                {
443
                  "code": "freeFormMessage",
444
                  "system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType",
445
                  "display": "Written Confirmation."
446
                }
447
              ]
448
            },
449
            "sequence": 2,
450
            "valueString": "1"
451
          }
452
        ]
453
      }
454
    }
455
  ],
456
  "timestamp": "2021-10-21T19:09:02.452Z",
457
  "identifier": {
458
    "value": "urn:uuid:59f129cf-2eca-4965-88f2-452558af1934",
459
    "system": "urn:ietf:rfc:3986"
460
  },
461
  "resourceType": "Bundle"
462
}

Respond to a service prior authorization request

This action step requires that you support receiving Claim$submit-preauthorization and Claim$attach from your connection. You can decide what that processing looks like when you're ready to respond. Refer to these schemas for more details:

In the response, you must include whether your connection's request is accepted, pending, or declined.

ClaimResponse/$respond

Payload

json

1
{
2
  "id": "RedoxClaimResponseBundleComprehensiveExample",
3
  "type": "collection",
4
  "entry": [
5
    {
6
      "resource": {
7
        "id": "RedoxPAClaimResponseExample",
8
        "use": "preauthorization",
9
        "item": [
10
          {
11
            "extension": [
12
              {
13
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
14
                "valueString": "REF456"
15
              },
16
              {
17
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
18
                "valueDate": "2021-08-23"
19
              },
20
              {
21
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
22
                "valuePeriod": {
23
                  "end": "2021-09-23",
24
                  "start": "2021-08-23"
25
                }
26
              },
27
              {
28
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
29
                "valueIdentifier": {
30
                  "value": "23462346"
31
                }
32
              },
33
              {
34
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail",
35
                "extension": [
36
                  {
37
                    "url": "productOrServiceCode",
38
                    "valueCodeableConcept": {
39
                      "text": "Right heart catheterization",
40
                      "coding": [
41
                        {
42
                          "code": "93451",
43
                          "system": "http://www.ama-assn.org/go/cpt"
44
                        }
45
                      ]
46
                    }
47
                  },
48
                  {
49
                    "url": "quantity",
50
                    "valueQuantity": {
51
                      "value": 1
52
                    }
53
                  },
54
                  {
55
                    "url": "unitPrice",
56
                    "valueMoney": {
57
                      "value": 4966,
58
                      "currency": "USD"
59
                    }
60
                  }
61
                ]
62
              }
63
            ],
64
            "adjudication": [
65
              {
66
                "category": {
67
                  "coding": [
68
                    {
69
                      "code": "submitted",
70
                      "system": "http://terminology.hl7.org/CodeSystem/adjudication"
71
                    }
72
                  ]
73
                },
74
                "extension": [
75
                  {
76
                    "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction",
77
                    "extension": [
78
                      {
79
                        "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
80
                        "valueCodeableConcept": {
81
                          "coding": [
82
                            {
83
                              "code": "A1",
84
                              "system": "https://codesystem.x12.org/005010/306",
85
                              "display": "Certified in total"
86
                            }
87
                          ]
88
                        }
89
                      },
90
                      {
91
                        "url": "number",
92
                        "valueString": "AUTH1001"
93
                      }
94
                    ]
95
                  }
96
                ]
97
              }
98
            ],
99
            "itemSequence": 1
100
          }
101
        ],
102
        "type": {
103
          "coding": [
104
            {
105
              "code": "professional",
106
              "system": "http://terminology.hl7.org/CodeSystem/claim-type"
107
            }
108
          ]
109
        },
110
        "status": "active",
111
        "created": "2021-08-23T16:35:54.648Z",
112
        "insurer": {
113
          "reference": "Organization/RedoxPAInsurerOrganizationExample"
114
        },
115
        "outcome": "complete",
116
        "patient": {
117
          "reference": "Patient/RedoxPABeneficiaryExample"
118
        },
119
        "request": {
120
          "reference": "Claim/RedoxPAServiceClaimExample",
121
          "identifier": {
122
            "type": {
123
              "coding": [
124
                {
125
                  "code": "ClaimID"
126
                }
127
              ]
128
            },
129
            "value": "urn:uuid:97b8d6d0-ac3d-411a-b32a-e1d237aceb6a"
130
          }
131
        },
132
        "requestor": {
133
          "reference": "Organization/RedoxPARequestorOrganizationExample"
134
        },
135
        "processNote": [
136
          {
137
            "text": "Covered under extended benefits"
138
          }
139
        ],
140
        "resourceType": "ClaimResponse"
141
      }
142
    },
143
    {
144
      "resource": {
145
        "id": "RedoxPABeneficiaryExample",
146
        "name": [
147
          {
148
            "given": [
149
              "Timothy",
150
              "Paul"
151
            ],
152
            "family": "Bixby"
153
          }
154
        ],
155
        "gender": "male",
156
        "birthDate": "2008-01-06",
157
        "identifier": [
158
          {
159
            "value": "M23462346",
160
            "system": "urn:redox:MRN"
161
          }
162
        ],
163
        "resourceType": "Patient"
164
      }
165
    },
166
    {
167
      "resource": {
168
        "id": "RedoxPACoverageWithRelatedSubscriberExample",
169
        "class": [
170
          {
171
            "type": {
172
              "coding": [
173
                {
174
                  "code": "group",
175
                  "system": "http://terminology.hl7.org/CodeSystem/coverage-class"
176
                }
177
              ]
178
            },
179
            "value": "GRP2245"
180
          }
181
        ],
182
        "payor": [
183
          {
184
            "reference": "Organization/RedoxPAInsurerOrganizationExample"
185
          }
186
        ],
187
        "status": "active",
188
        "subscriber": {
189
          "reference": "RelatedPerson/RedoxPASubscriberExample"
190
        },
191
        "beneficiary": {
192
          "reference": "Patient/RedoxPABeneficiaryExample"
193
        },
194
        "resourceType": "Coverage",
195
        "subscriberId": "M2346623"
196
      }
197
    },
198
    {
199
      "resource": {
200
        "id": "RedoxPARequestorOrganizationExample",
201
        "name": "Good Health Clinics",
202
        "active": true,
203
        "address": [
204
          {
205
            "city": "Madison",
206
            "line": [
207
              "123 Main St."
208
            ],
209
            "state": "WI",
210
            "country": "USA",
211
            "district": "Dane",
212
            "postalCode": "53703"
213
          }
214
        ],
215
        "resourceType": "Organization"
216
      }
217
    },
218
    {
219
      "resource": {
220
        "id": "RedoxPAInsurerOrganizationExample",
221
        "name": "Aetna",
222
        "active": true,
223
        "address": [
224
          {
225
            "city": "Lexington",
226
            "line": [
227
              "PO Box 14080"
228
            ],
229
            "state": "KY",
230
            "country": "USA",
231
            "district": "Fayette",
232
            "postalCode": "40512-4079"
233
          }
234
        ],
235
        "resourceType": "Organization"
236
      }
237
    },
238
    {
239
      "resource": {
240
        "id": "RedoxPAPractitionerRoleExamplePat",
241
        "location": [
242
          {
243
            "display": "1st Street Family Clinic"
244
          }
245
        ],
246
        "specialty": [
247
          {
248
            "coding": [
249
              {
250
                "code": "394579002",
251
                "system": "http://snomed.info/sct",
252
                "display": "Cardiology"
253
              }
254
            ]
255
          }
256
        ],
257
        "organization": {
258
          "reference": "Organization/RedoxPARequestorOrganizationExample"
259
        },
260
        "practitioner": {
261
          "reference": "Practitioner/RedoxPAPractitionerExamplePat"
262
        },
263
        "resourceType": "PractitionerRole"
264
      }
265
    },
266
    {
267
      "resource": {
268
        "id": "RedoxPAPractitionerExamplePat",
269
        "name": [
270
          {
271
            "given": [
272
              "Pat"
273
            ],
274
            "family": "Granite"
275
          }
276
        ],
277
        "address": [
278
          {
279
            "city": "Madison",
280
            "line": [
281
              "123 Main St."
282
            ],
283
            "state": "WI",
284
            "country": "USA",
285
            "district": "Dane",
286
            "postalCode": "53703"
287
          }
288
        ],
289
        "telecom": [
290
          {
291
            "value": "+16085551234"
292
          }
293
        ],
294
        "identifier": [
295
          {
296
            "value": "4356789876",
297
            "system": "http://hl7.org/fhir/sid/us-npi"
298
          }
299
        ],
300
        "resourceType": "Practitioner"
301
      }
302
    },
303
    {
304
      "resource": {
305
        "id": "RedoxPASubscriberExample",
306
        "name": [
307
          {
308
            "given": [
309
              "Barbara"
310
            ],
311
            "family": "Bixby"
312
          }
313
        ],
314
        "patient": {
315
          "reference": "RedoxPABeneficiary"
316
        },
317
        "relationship": [
318
          {
319
            "text": "Mother"
320
          }
321
        ],
322
        "resourceType": "RelatedPerson"
323
      }
324
    },
325
    {
326
      "resource": {
327
        "id": "RedoxPAServiceClaimExample",
328
        "use": "preauthorization",
329
        "item": [
330
          {
331
            "sequence": 1,
332
            "extension": [
333
              {
334
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService",
335
                "valueReference": {
336
                  "reference": "ServiceRequest/RedoxPAServiceRequestExample"
337
                }
338
              },
339
              {
340
                "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
341
                "valueIdentifier": {
342
                  "value": "23462346"
343
                }
344
              }
345
            ],
346
            "productOrService": {
347
              "text": "Coronary angiography with right heart catheterization",
348
              "coding": [
349
                {
350
                  "code": "93456",
351
                  "system": "http://www.ama-assn.org/go/cpt"
352
                }
353
              ]
354
            }
355
          }
356
        ],
357
        "type": {
358
          "coding": [
359
            {
360
              "code": "professional",
361
              "system": "http://terminology.hl7.org/CodeSystem/claim-type"
362
            }
363
          ]
364
        },
365
        "status": "active",
366
        "created": "2021-09-02T18:44:13.307Z",
367
        "enterer": {
368
          "reference": "PractitionerRole/RedoxPAPractitionerRoleExamplePat"
369
        },
370
        "insurer": {
371
          "reference": "Organization/RedoxPAInsurerOrganizationExample"
372
        },
373
        "patient": {
374
          "reference": "Patient/RedoxPABeneficiaryExample"
375
        },
376
        "priority": {
377
          "coding": [
378
            {
379
              "code": "normal",
380
              "system": "http://terminology.hl7.org/CodeSystem/processpriority"
381
            }
382
          ]
383
        },
384
        "provider": {
385
          "reference": "Organization/RedoxPARequestorOrganizationExample"
386
        },
387
        "diagnosis": [
388
          {
389
            "sequence": 1,
390
            "diagnosisCodeableConcept": {
391
              "coding": [
392
                {
393
                  "code": "I42.9",
394
                  "system": "http://hl7.org/fhir/sid/icd-10-cm",
395
                  "display": "Cardiomyopathy, unspecified"
396
                }
397
              ]
398
            }
399
          }
400
        ],
401
        "insurance": [
402
          {
403
            "focal": true,
404
            "coverage": {
405
              "reference": "Coverage/RedoxPACoverageExample"
406
            },
407
            "sequence": 1
408
          }
409
        ],
410
        "identifier": [
411
          {
412
            "type": {
413
              "coding": [
414
                {
415
                  "code": "ClaimID"
416
                }
417
              ]
418
            },
419
            "value": "urn:uuid:97b8d6d0-ac3d-411a-b32a-e1d237aceb6a"
420
          }
421
        ],
422
        "resourceType": "Claim",
423
        "supportingInfo": [
424
          {
425
            "category": {
426
              "coding": [
427
                {
428
                  "code": "additionalInformation",
429
                  "system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType",
430
                  "display": "Send additional paperwork or supporting information is sent for the request."
431
                }
432
              ]
433
            },
434
            "sequence": 1,
435
            "valueReference": {
436
              "reference": "DocumentReference/RedoxPADocumentReferenceExample"
437
            }
438
          },
439
          {
440
            "category": {
441
              "coding": [
442
                {
443
                  "code": "freeFormMessage",
444
                  "system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType",
445
                  "display": "Written Confirmation."
446
                }
447
              ]
448
            },
449
            "sequence": 2,
450
            "valueString": "1"
451
          }
452
        ]
453
      }
454
    }
455
  ],
456
  "timestamp": "2021-10-21T19:09:02.452Z",
457
  "identifier": {
458
    "value": "urn:uuid:59f129cf-2eca-4965-88f2-452558af1934",
459
    "system": "urn:ietf:rfc:3986"
460
  },
461
  "resourceType": "Bundle"
462
}

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