Claim/$submit
Submits a prior authorization request as a FHIR Bundle for adjudication, defined by Da Vinci PAS STU 2.1.0. The response is a FHIR Bundle containing a ClaimResponse, or an OperationOutcome on error.
The Da Vinci PAS Request Bundle profile requires exactly one focal Claim per Bundle — the underlying X12 278 transaction carries one prior authorization per BHT. To submit multiple prior authorizations, make multiple Claim/$submit calls.
Endpoint
POST <base>/fhir/Claim/$submit
Auth
SMART Backend Services. Scope: system/Claim.cu system/ClaimResponse.r. See Authentication.
Parameters
| Direction | Parameter | Type | Cardinality | Description |
|---|---|---|---|---|
| IN | resource | Bundle | 1..1 | PAS Request Bundle containing a single focal Claim and all referenced resources |
| OUT | return | Bundle or OperationOutcome | 1..1 | PAS Response Bundle with ClaimResponse, or OperationOutcome on error |
Example
Submit a prior authorization request:
POST /fhir/Claim/$submit
Content-Type: application/json
Accept: application/json
{
"resourceType": "Bundle",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"
]
},
"type": "collection",
"identifier": {
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "test-bundle-3"
},
"timestamp": "2025-12-08T16:48:02.531010Z",
"entry": [
{
"fullUrl": "urn:uuid:claim-1765213116210",
"resource": {
"resourceType": "Claim",
"id": "claim-1765213116210",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"] },
"identifier": [{ "system": "http://example.org/claim-id", "value": "claim-1765213116210" }],
"status": "active",
"type": { "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" }] },
"use": "preauthorization",
"patient": { "reference": "Patient/patient-1" },
"created": "2025-12-08T16:58:36.210Z",
"insurer": { "reference": "Organization/payer-org-1" },
"provider": { "reference": "Organization/requesting-org-1", "display": "Acme Care Clinic" },
"priority": { "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" }] },
"insurance": [{ "sequence": 1, "focal": true, "coverage": { "reference": "Coverage/coverage-1" } }],
"item": [
{
"sequence": 1,
"category": { "coding": [{ "system": "https://codesystem.x12.org/005010/1365", "code": "42", "display": "Home Health Care" }] },
"productOrService": { "coding": [{ "system": "http://www.ama-assn.org/go/cpt", "code": "99213", "display": "Established patient office visit" }] },
"detail": [
{
"sequence": 1,
"productOrService": { "coding": [{ "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets", "code": "E0250", "display": "Hospital bed, fixed height, with mattress" }] }
}
]
}
]
}
},
{
"fullUrl": "urn:uuid:patient-patient-1",
"resource": {
"resourceType": "Patient",
"id": "patient-1",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary", "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"] },
"identifier": [{ "system": "http://hospital.example.org/patients", "value": "MRN123456" }],
"active": true,
"name": [{ "use": "official", "family": "Smith", "given": ["John", "Robert"] }],
"telecom": [{ "system": "phone", "value": "555-123-4567", "use": "home" }],
"gender": "male",
"birthDate": "1970-05-15",
"address": [{ "use": "home", "line": ["123 Main Street"], "city": "Springfield", "state": "IL", "postalCode": "62701", "country": "USA" }]
}
},
{
"fullUrl": "urn:uuid:coverage-coverage-1",
"resource": {
"resourceType": "Coverage",
"id": "coverage-1",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"] },
"status": "active",
"type": { "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "HIP", "display": "health insurance plan policy" }] },
"subscriber": { "reference": "Patient/patient-1" },
"beneficiary": { "reference": "Patient/patient-1" },
"payor": [{ "reference": "Organization/payer-org-1" }],
"class": [
{
"type": { "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan", "display": "Plan" }] },
"value": "GOLD-PLAN-001",
"name": "Gold Plus Plan"
}
]
}
},
{
"fullUrl": "urn:uuid:org-requesting-org-1",
"resource": {
"resourceType": "Organization",
"id": "requesting-org-1",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"] },
"identifier": [{ "system": "http://hl7.org/fhir/sid/us-npi", "value": "8189991234" }],
"active": true,
"name": "Acme Care Clinic"
}
},
{
"fullUrl": "urn:uuid:org-payer-org-1",
"resource": {
"resourceType": "Organization",
"id": "payer-org-1",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"] },
"identifier": [{ "system": "http://hl7.org/fhir/sid/us-npi", "value": "1234567893" }],
"active": true,
"name": "Acme Health Insurance"
}
}
]
}
{
"resourceType": "Bundle",
"type": "collection",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle"] },
"identifier": { "system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER", "value": "test-bundle-3" },
"timestamp": "2025-12-17T13:34:24.333467Z",
"entry": [
{
"fullUrl": "ClaimResponse/c0d73c37-12ee-4cde-bfc6-aa6ed216f4dd",
"resource": {
"resourceType": "ClaimResponse",
"id": "c0d73c37-12ee-4cde-bfc6-aa6ed216f4dd",
"meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"] },
"status": "active",
"type": { "coding": [{ "code": "professional", "system": "http://terminology.hl7.org/CodeSystem/claim-type" }] },
"use": "preauthorization",
"patient": { "reference": "Patient/patient-1" },
"insurer": { "reference": "Organization/payer-org-1" },
"request": { "reference": "Claim/claim-1765213116210" },
"created": "2025-12-17T13:34:24.316526Z",
"outcome": "queued",
"item": [
{
"itemSequence": 1,
"adjudication": [
{ "category": { "coding": [{ "code": "submitted", "system": "http://terminology.hl7.org/CodeSystem/adjudication" }] } }
]
}
]
}
}
]
}