Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1
Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1
Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry | Version: 2.1.0 | |||
| Standards status: Trial-use | Maturity Level: 3 | Computable Name: PASClaimInquiry | ||
| Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.47 | ||||
PAS constraints on Claim resource when submitting an inquiry for existing authorizations.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from PASClaimBase
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim |
0..* | PASClaimBase | Query for Preauthorizations | |
  Slices for extension |
Content/Rules for all slices | |||
   certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
  identifier |
1..1 | PASIdentifier | Business identifier for claim | |
| billablePeriod |
S | 0..1 | Period | Relevant time frame for the claim |
| provider |
1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | This is the submitter of the inquiry. | |
| diagnosis |
0..* | BackboneElement | Pertinent diagnosis information | |
 item |
||||
 Slices for extension |
Content/Rules for all slices | |||
 certIssueDate |
S | 0..1 | date | The specific date or period within when which item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate |
| certExpirationDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization expires. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate |
| certEffectiveDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization became effective. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate |
| reviewActionCode |
S | 0..1 | CodeableConcept | The code describing the result of the review. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim |
0..* | PASClaimBase | Query for Preauthorizations dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
 implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
Content/Rules for all slices | |||
| levelOfServiceType |
S | 0..1 | CodeableConcept | A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| conditionCode |
S | 0..* | (Complex) | Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| homeHealthCareInformation |
S | 0..1 | (Complex) | Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
 identifier |
S | 1..1 | PASIdentifier | Business identifier for claim ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
Content/Rules for all slices | |||
| subDepartment |
S | 0..1 | string | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| jurisdiction |
S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: USPS Two Letter Alphabetic Codes (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children |
| system |
SΣ | 1..1 | uri | SHOULD use a scheme of 'urn:trnorg:<TRN03>' ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient |
 value |
SΣ | 1..1 | string | The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 |
| status |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active |
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children |
| use |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. ele-1: All FHIR elements must have a @value or children Required Pattern: preauthorization |
 patient |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services ele-1: All FHIR elements must have a @value or children |
| billablePeriod |
SΣ | 0..1 | Period | Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children |
| created |
Σ | 1..1 | dateTime | Resource creation date ele-1: All FHIR elements must have a @value or children |
| insurer |
SΣ | 1..1 | Reference(PAS Insurer Organization) | Target ele-1: All FHIR elements must have a @value or children |
| provider |
SΣ | 1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | This is the submitter of the inquiry. ele-1: All FHIR elements must have a @value or children |
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. ele-1: All FHIR elements must have a @value or children |
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean) ele-1: All FHIR elements must have a @value or children |
 careTeam:All Slices |
Content/Rules for all slices | |||
  Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| careTeamClaimScope |
S | 1..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children |
| provider |
S | 1..1 | Reference(PAS Organization Base Profile | PAS PractitionerRole) | Practitioner or organization ele-1: All FHIR elements must have a @value or children |
| role |
S | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. ele-1: All FHIR elements must have a @value or children |
| qualification |
S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children |
| careTeam:OverallClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request. ele-1: All FHIR elements must have a @value or children |
 Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
  careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
 extension |
0..0 | |||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |
 value[x] |
S | 0..1 | boolean | Value of extension ele-1: All FHIR elements must have a @value or children Fixed Value: true |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization ele-1: All FHIR elements must have a @value or children | |
| careTeam:ItemClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request. ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| extension |
0..0 | |||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |
| value[x] |
S | 0..1 | boolean | Value of extension ele-1: All FHIR elements must have a @value or children Fixed Value: false |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization ele-1: All FHIR elements must have a @value or children | |
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category ele-1: All FHIR elements must have a @value or children |
| supportingInfo:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children |
| category |
S | 1..1 | CodeableConcept | Classification of the supplied information Binding: PAS Supporting Info Type Value Set (extensible) ele-1: All FHIR elements must have a @value or children |
| supportingInfo:PatientEvent |
S | 0..1 | BackboneElement | Information about the dates of the event that are being requested. ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
 coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |
 Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| timingDate |
date | |||
| timingPeriod |
Period | |||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred ele-1: All FHIR elements must have a @value or children |
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| supportingInfo:AdmissionDates |
S | 0..1 | BackboneElement | Information about the admission dates of a hospital admission being requested. ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionDates | |
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| timingDate |
date | |||
| timingPeriod |
Period | |||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred ele-1: All FHIR elements must have a @value or children |
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| supportingInfo:DischargeDates |
S | 0..1 | BackboneElement | Information about the discharge dates of a hospital admission being requested. ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: dischargeDates | |
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| timingDate |
date | |||
| timingPeriod |
Period | |||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred ele-1: All FHIR elements must have a @value or children |
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| diagnosis |
S | 0..* | BackboneElement | Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children |
| diagnosis[x] |
S | 1..1 | CodeableConcept | Nature of illness or problem Binding: X12 278 Diagnosis Code Value Set (required) ele-1: All FHIR elements must have a @value or children |
| type |
S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: X12 278 Diagnosis Type Value Set (required) ele-1: All FHIR elements must have a @value or children |
| insurance |
SΣ | 1..* | BackboneElement | Patient insurance information ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
SΣ | 1..1 | positiveInt | Insurance instance identifier ele-1: All FHIR elements must have a @value or children |
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children Required Pattern: true |
| coverage |
SΣ | 1..1 | Reference(PAS Coverage) | Insurance information ele-1: All FHIR elements must have a @value or children |
| accident |
S | 0..1 | BackboneElement | Details of the event ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| date |
SC | 1..1 | date | When the incident occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| type |
S | 0..1 | CodeableConcept | The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children |
| location[x] |
S | 0..1 | Address | Where the event occurred ele-1: All FHIR elements must have a @value or children |
| item |
S | 0..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
Content/Rules for all slices | |||
| itemTraceNumber |
S | 0..* | PASIdentifier | Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| authorizationNumber |
S | 0..1 | string | A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| administrationReferenceNumber |
S | 0..1 | string | A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| requestType |
S | 0..1 | CodeableConcept | A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| productOrServiceCodeEnd |
S | 0..1 | CodeableConcept | Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certIssueDate |
S | 0..1 | date | The specific date or period within when which item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certExpirationDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization expires. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certEffectiveDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization became effective. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| reviewActionCode |
S | 0..1 | CodeableConcept | The code describing the result of the review. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children |
| careTeamSequence |
S | 0..* | positiveInt | Applicable careTeam members ele-1: All FHIR elements must have a @value or children |
| diagnosisSequence |
S | 0..* | positiveInt | Applicable diagnoses ele-1: All FHIR elements must have a @value or children |
| informationSequence |
S | 0..* | positiveInt | Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children |
| revenue |
S | 0..1 | CodeableConcept | Revenue or cost center code Binding: AHA NUBC Revenue Value Set (required) ele-1: All FHIR elements must have a @value or children |
| category |
S | 0..1 | CodeableConcept | Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children |
| productOrService |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: X12 278 Requested Service Type (required) ele-1: All FHIR elements must have a @value or children |
| modifier |
S | 0..* | CodeableConcept | Product or service billing modifiers Binding: X12 278 Requested Service Modifier Type (required) ele-1: All FHIR elements must have a @value or children |
| Slices for serviced[x] |
S | 0..1 | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| servicedDate |
date | |||
| servicedPeriod |
Period | |||
| serviced[x]:servicedDate |
C | 0..1 | date | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| serviced[x]:servicedPeriod |
0..1 | Period | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | |
| location[x] |
S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: X12 278 Health Care Service Location Type Value Set (required) ele-1: All FHIR elements must have a @value or children |
| quantity |
SC | 0..1 | PASQuantity | A fixed quantity (no comparator) ele-1: All FHIR elements must have a @value or children qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| Claim.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | |
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typefrom the FHIR Standard | |
| Claim.use | required | Pattern: preauthorizationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1from the FHIR Standard | |
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | |
| Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrolefrom the FHIR Standard | |
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationfrom the FHIR Standard | |
| Claim.supportingInfo.category | extensible | PASSupportingInfoTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoTypefrom this IG | |
| Claim.supportingInfo:PatientEvent.category | example | Pattern: patientEventhttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.supportingInfo:AdmissionDates.category | example | Pattern: admissionDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.supportingInfo:DischargeDates.category | example | Pattern: dischargeDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.diagnosis.diagnosis[x] | required | X12278DiagnosisCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisCodesfrom this IG | |
| Claim.diagnosis.type | required | X12278DiagnosisTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisTypefrom this IG | |
| Claim.accident.type | required | https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 | |
| Claim.item.revenue | required | AHANUBCRevenueCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodesfrom this IG | |
| Claim.item.category | required | https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 | |
| Claim.item.productOrService | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG | |
| Claim.item.modifier | required | X12278RequestedServiceModifierTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierTypefrom this IG | |
| Claim.item.location[x] | required | X12278LocationTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278LocationTypefrom this IG |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim |
0..* | PASClaimBase | Query for Preauthorizations | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| levelOfServiceType |
S | 0..1 | CodeableConcept | A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| conditionCode |
S | 0..* | (Complex) | Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode | ||||
| homeHealthCareInformation |
S | 0..1 | (Complex) | Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation | ||||
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
S | 1..1 | PASIdentifier | Business identifier for claim | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| subDepartment |
S | 0..1 | string | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment | ||||
| jurisdiction |
S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: USPS Two Letter Alphabetic Codes (required) | ||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| system |
SΣ | 1..1 | uri | SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient | ||||
| value |
SΣ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| status |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| subType |
0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
| use |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization | ||||
| patient |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | ||||
| billablePeriod |
SΣ | 0..1 | Period | Relevant time frame for the claim | ||||
| created |
Σ | 1..1 | dateTime | Resource creation date | ||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
| insurer |
SΣ | 1..1 | Reference(PAS Insurer Organization) | Target | ||||
| provider |
SΣ | 1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | This is the submitter of the inquiry. | ||||
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
| fundsReserve |
0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| related |
0..* | BackboneElement | Prior or corollary claims | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| claim |
0..1 | Reference(Claim) | Reference to the related claim | |||||
| relationship |
0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
| reference |
0..1 | Identifier | File or case reference | |||||
| prescription |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
| originalPrescription |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
| payee |
0..1 | BackboneElement | Recipient of benefits payable | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| party |
0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
| referral |
0..1 | Reference(ServiceRequest) | Treatment referral | |||||
| facility |
0..1 | Reference(Location) | Servicing facility | |||||
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean) | ||||
| careTeam:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| careTeamClaimScope |
S | 1..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Order of care team | ||||
| provider |
S | 1..1 | Reference(PAS Organization Base Profile | PAS PractitionerRole) | Practitioner or organization | ||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
S | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | ||||
| qualification |
S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | ||||
| careTeam:OverallClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..0 | |||||||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |||||
| value[x] |
S | 0..1 | boolean | Value of extension Fixed Value: true | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
0..1 | CodeableConcept | Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | |||||
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required) | |||||
| careTeam:ItemClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..0 | |||||||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |||||
| value[x] |
S | 0..1 | boolean | Value of extension Fixed Value: false | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
0..1 | CodeableConcept | Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | |||||
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required) | |||||
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category | ||||
| supportingInfo:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Information instance identifier | ||||
| category |
S | 1..1 | CodeableConcept | Classification of the supplied information Binding: PAS Supporting Info Type Value Set (extensible) | ||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
 timing[x] |
0..1 | When it occurred | ||||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| value[x] |
0..1 | Data to be provided | ||||||
| valueBoolean |
boolean | |||||||
| valueString |
string | |||||||
| valueQuantity |
Quantity | |||||||
| valueAttachment |
Attachment | |||||||
| valueReference |
Reference(Resource) | |||||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:PatientEvent |
S | 0..1 | BackboneElement | Information about the dates of the event that are being requested. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this | |||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:AdmissionDates |
S | 0..1 | BackboneElement | Information about the admission dates of a hospital admission being requested. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionDates | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this | |||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:DischargeDates |
S | 0..1 | BackboneElement | Information about the discharge dates of a hospital admission being requested. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: dischargeDates | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this | |||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| diagnosis |
S | 0..* | BackboneElement | Pertinent diagnosis information | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Diagnosis instance identifier | ||||
| diagnosis[x] |
S | 1..1 | CodeableConcept | Nature of illness or problem Binding: X12 278 Diagnosis Code Value Set (required) | ||||
| type |
S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: X12 278 Diagnosis Type Value Set (required) | ||||
| onAdmission |
0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
| packageCode |
0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
| procedure |
0..* | BackboneElement | Clinical procedures performed | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Procedure instance identifier | |||||
| type |
0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
| date |
0..1 | dateTime | When the procedure was performed | |||||
| procedure[x] |
1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
| procedureCodeableConcept |
CodeableConcept | |||||||
| procedureReference |
Reference(Procedure) | |||||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| insurance |
SΣ | 1..* | BackboneElement | Patient insurance information | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
SΣ | 1..1 | positiveInt | Insurance instance identifier | ||||
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | ||||
| identifier |
0..1 | Identifier | Pre-assigned Claim number | |||||
| coverage |
SΣ | 1..1 | Reference(PAS Coverage) | Insurance information | ||||
| businessArrangement |
0..1 | string | Additional provider contract number | |||||
| preAuthRef |
0..* | string | Prior authorization reference number | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| accident |
S | 0..1 | BackboneElement | Details of the event | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| date |
SC | 1..1 | date | When the incident occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| type |
S | 0..1 | CodeableConcept | The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| location[x] |
S | 0..1 | Address | Where the event occurred | ||||
| item |
S | 0..* | BackboneElement | Product or service provided | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| itemTraceNumber |
S | 0..* | PASIdentifier | Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber | ||||
| authorizationNumber |
S | 0..1 | string | A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber | ||||
| administrationReferenceNumber |
S | 0..1 | string | A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber | ||||
| requestType |
S | 0..1 | CodeableConcept | A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| productOrServiceCodeEnd |
S | 0..1 | CodeableConcept | Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required) | ||||
| certIssueDate |
S | 0..1 | date | The specific date or period within when which item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate | ||||
| certExpirationDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization expires. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate | ||||
| certEffectiveDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization became effective. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate | ||||
| reviewActionCode |
S | 0..1 | CodeableConcept | The code describing the result of the review. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Item instance identifier | ||||
| careTeamSequence |
S | 0..* | positiveInt | Applicable careTeam members | ||||
| diagnosisSequence |
S | 0..* | positiveInt | Applicable diagnoses | ||||
| procedureSequence |
0..* | positiveInt | Applicable procedures | |||||
| informationSequence |
S | 0..* | positiveInt | Applicable exception and supporting information | ||||
| revenue |
S | 0..1 | CodeableConcept | Revenue or cost center code Binding: AHA NUBC Revenue Value Set (required) | ||||
| category |
S | 0..1 | CodeableConcept | Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| productOrService |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: X12 278 Requested Service Type (required) | ||||
| modifier |
S | 0..* | CodeableConcept | Product or service billing modifiers Binding: X12 278 Requested Service Modifier Type (required) | ||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| Slices for serviced[x] |
S | 0..1 | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |||||
| servicedDate |
date | |||||||
| servicedPeriod |
Period | |||||||
| serviced[x]:servicedDate |
C | 0..1 | date | Date or dates of service or product delivery FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| serviced[x]:servicedPeriod |
0..1 | Period | Date or dates of service or product delivery | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
ΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| location[x] |
S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: X12 278 Health Care Service Location Type Value Set (required) | ||||
| quantity |
SC | 0..1 | PASQuantity | A fixed quantity (no comparator) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| bodySite |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| encounter |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| detail |
0..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Item instance identifier | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| subDetail |
0..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Item instance identifier | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| total |
0..1 | Money | Total claim cost | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Claim.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| Claim.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | ||||
| Claim.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | ||||
| Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typefrom the FHIR Standard | ||||
| Claim.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtypefrom the FHIR Standard | ||||
| Claim.use | required | Pattern: preauthorizationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1from the FHIR Standard | ||||
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | ||||
| Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreservefrom the FHIR Standard | ||||
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationshipfrom the FHIR Standard | ||||
| Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypefrom the FHIR Standard | ||||
| Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrolefrom the FHIR Standard | ||||
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationfrom the FHIR Standard | ||||
| Claim.careTeam:OverallClaimMember.role | required | https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 | ||||
| Claim.careTeam:OverallClaimMember.qualification | required | https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 | ||||
| Claim.careTeam:ItemClaimMember.role | required | https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 | ||||
| Claim.careTeam:ItemClaimMember.qualification | required | https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 | ||||
| Claim.supportingInfo.category | extensible | PASSupportingInfoTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoTypefrom this IG | ||||
| Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.supportingInfo:PatientEvent.category | example | Pattern: patientEventhttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | ||||
| Claim.supportingInfo:PatientEvent.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo:PatientEvent.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.supportingInfo:AdmissionDates.category | example | Pattern: admissionDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | ||||
| Claim.supportingInfo:AdmissionDates.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo:AdmissionDates.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.supportingInfo:DischargeDates.category | example | Pattern: dischargeDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | ||||
| Claim.supportingInfo:DischargeDates.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo:DischargeDates.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.diagnosis.diagnosis[x] | required | X12278DiagnosisCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisCodesfrom this IG | ||||
| Claim.diagnosis.type | required | X12278DiagnosisTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisTypefrom this IG | ||||
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admissionfrom the FHIR Standard | ||||
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroupfrom the FHIR Standard | ||||
| Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-typefrom the FHIR Standard | ||||
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-proceduresfrom the FHIR Standard | ||||
| Claim.accident.type | required | https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 | ||||
| Claim.item.revenue | required | AHANUBCRevenueCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodesfrom this IG | ||||
| Claim.item.category | required | https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 | ||||
| Claim.item.productOrService | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG | ||||
| Claim.item.modifier | required | X12278RequestedServiceModifierTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierTypefrom this IG | ||||
| Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codefrom the FHIR Standard | ||||
| Claim.item.location[x] | required | X12278LocationTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278LocationTypefrom this IG | ||||
| Claim.item.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/toothfrom the FHIR Standard | ||||
| Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surfacefrom the FHIR Standard | ||||
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerfrom the FHIR Standard | ||||
| Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | ||||
| Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | ||||
| Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | ||||
| Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codefrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codefrom the FHIR Standard |
This structure is derived from PASClaimBase
Summary
Mandatory: 1 element
Must-Support: 6 elements
Extensions
This structure refers to these extensions:
Maturity: 3
Differential View
This structure is derived from PASClaimBase
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim |
0..* | PASClaimBase | Query for Preauthorizations | |
| Slices for extension |
Content/Rules for all slices | |||
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
| identifier |
1..1 | PASIdentifier | Business identifier for claim | |
| billablePeriod |
S | 0..1 | Period | Relevant time frame for the claim |
| provider |
1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | This is the submitter of the inquiry. | |
| diagnosis |
0..* | BackboneElement | Pertinent diagnosis information | |
| item |
||||
| Slices for extension |
Content/Rules for all slices | |||
| certIssueDate |
S | 0..1 | date | The specific date or period within when which item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate |
| certExpirationDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization expires. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate |
| certEffectiveDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization became effective. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate |
| reviewActionCode |
S | 0..1 | CodeableConcept | The code describing the result of the review. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
| Documentation for this format | ||||
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim |
0..* | PASClaimBase | Query for Preauthorizations dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
Content/Rules for all slices | |||
| levelOfServiceType |
S | 0..1 | CodeableConcept | A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| conditionCode |
S | 0..* | (Complex) | Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| homeHealthCareInformation |
S | 0..1 | (Complex) | Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| identifier |
S | 1..1 | PASIdentifier | Business identifier for claim ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
Content/Rules for all slices | |||
| subDepartment |
S | 0..1 | string | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| jurisdiction |
S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: USPS Two Letter Alphabetic Codes (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children |
| system |
SΣ | 1..1 | uri | SHOULD use a scheme of 'urn:trnorg:<TRN03>' ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient |
| value |
SΣ | 1..1 | string | The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 |
| status |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active |
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children |
| use |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. ele-1: All FHIR elements must have a @value or children Required Pattern: preauthorization |
| patient |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services ele-1: All FHIR elements must have a @value or children |
| billablePeriod |
SΣ | 0..1 | Period | Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children |
| created |
Σ | 1..1 | dateTime | Resource creation date ele-1: All FHIR elements must have a @value or children |
| insurer |
SΣ | 1..1 | Reference(PAS Insurer Organization) | Target ele-1: All FHIR elements must have a @value or children |
| provider |
SΣ | 1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | This is the submitter of the inquiry. ele-1: All FHIR elements must have a @value or children |
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. ele-1: All FHIR elements must have a @value or children |
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean) ele-1: All FHIR elements must have a @value or children |
| careTeam:All Slices |
Content/Rules for all slices | |||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| careTeamClaimScope |
S | 1..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children |
| provider |
S | 1..1 | Reference(PAS Organization Base Profile | PAS PractitionerRole) | Practitioner or organization ele-1: All FHIR elements must have a @value or children |
| role |
S | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. ele-1: All FHIR elements must have a @value or children |
| qualification |
S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children |
| careTeam:OverallClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request. ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| extension |
0..0 | |||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |
| value[x] |
S | 0..1 | boolean | Value of extension ele-1: All FHIR elements must have a @value or children Fixed Value: true |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization ele-1: All FHIR elements must have a @value or children | |
| careTeam:ItemClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request. ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| extension |
0..0 | |||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |
| value[x] |
S | 0..1 | boolean | Value of extension ele-1: All FHIR elements must have a @value or children Fixed Value: false |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization ele-1: All FHIR elements must have a @value or children | |
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category ele-1: All FHIR elements must have a @value or children |
| supportingInfo:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children |
| category |
S | 1..1 | CodeableConcept | Classification of the supplied information Binding: PAS Supporting Info Type Value Set (extensible) ele-1: All FHIR elements must have a @value or children |
| supportingInfo:PatientEvent |
S | 0..1 | BackboneElement | Information about the dates of the event that are being requested. ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| timingDate |
date | |||
| timingPeriod |
Period | |||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred ele-1: All FHIR elements must have a @value or children |
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| supportingInfo:AdmissionDates |
S | 0..1 | BackboneElement | Information about the admission dates of a hospital admission being requested. ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionDates | |
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| timingDate |
date | |||
| timingPeriod |
Period | |||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred ele-1: All FHIR elements must have a @value or children |
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| supportingInfo:DischargeDates |
S | 0..1 | BackboneElement | Information about the discharge dates of a hospital admission being requested. ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: dischargeDates | |
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| timingDate |
date | |||
| timingPeriod |
Period | |||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred ele-1: All FHIR elements must have a @value or children |
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| diagnosis |
S | 0..* | BackboneElement | Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children |
| diagnosis[x] |
S | 1..1 | CodeableConcept | Nature of illness or problem Binding: X12 278 Diagnosis Code Value Set (required) ele-1: All FHIR elements must have a @value or children |
| type |
S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: X12 278 Diagnosis Type Value Set (required) ele-1: All FHIR elements must have a @value or children |
| insurance |
SΣ | 1..* | BackboneElement | Patient insurance information ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
SΣ | 1..1 | positiveInt | Insurance instance identifier ele-1: All FHIR elements must have a @value or children |
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children Required Pattern: true |
| coverage |
SΣ | 1..1 | Reference(PAS Coverage) | Insurance information ele-1: All FHIR elements must have a @value or children |
| accident |
S | 0..1 | BackboneElement | Details of the event ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| date |
SC | 1..1 | date | When the incident occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| type |
S | 0..1 | CodeableConcept | The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children |
| location[x] |
S | 0..1 | Address | Where the event occurred ele-1: All FHIR elements must have a @value or children |
| item |
S | 0..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
Content/Rules for all slices | |||
| itemTraceNumber |
S | 0..* | PASIdentifier | Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| authorizationNumber |
S | 0..1 | string | A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| administrationReferenceNumber |
S | 0..1 | string | A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| requestType |
S | 0..1 | CodeableConcept | A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| productOrServiceCodeEnd |
S | 0..1 | CodeableConcept | Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certIssueDate |
S | 0..1 | date | The specific date or period within when which item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certExpirationDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization expires. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| certEffectiveDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization became effective. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| reviewActionCode |
S | 0..1 | CodeableConcept | The code describing the result of the review. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| sequence |
S | 1..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children |
| careTeamSequence |
S | 0..* | positiveInt | Applicable careTeam members ele-1: All FHIR elements must have a @value or children |
| diagnosisSequence |
S | 0..* | positiveInt | Applicable diagnoses ele-1: All FHIR elements must have a @value or children |
| informationSequence |
S | 0..* | positiveInt | Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children |
| revenue |
S | 0..1 | CodeableConcept | Revenue or cost center code Binding: AHA NUBC Revenue Value Set (required) ele-1: All FHIR elements must have a @value or children |
| category |
S | 0..1 | CodeableConcept | Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. ele-1: All FHIR elements must have a @value or children |
| productOrService |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: X12 278 Requested Service Type (required) ele-1: All FHIR elements must have a @value or children |
| modifier |
S | 0..* | CodeableConcept | Product or service billing modifiers Binding: X12 278 Requested Service Modifier Type (required) ele-1: All FHIR elements must have a @value or children |
| Slices for serviced[x] |
S | 0..1 | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children | |
| servicedDate |
date | |||
| servicedPeriod |
Period | |||
| serviced[x]:servicedDate |
C | 0..1 | date | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD |
| serviced[x]:servicedPeriod |
0..1 | Period | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | |
| location[x] |
S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: X12 278 Health Care Service Location Type Value Set (required) ele-1: All FHIR elements must have a @value or children |
| quantity |
SC | 0..1 | PASQuantity | A fixed quantity (no comparator) ele-1: All FHIR elements must have a @value or children qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| Claim.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | |
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typefrom the FHIR Standard | |
| Claim.use | required | Pattern: preauthorizationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1from the FHIR Standard | |
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | |
| Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrolefrom the FHIR Standard | |
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationfrom the FHIR Standard | |
| Claim.supportingInfo.category | extensible | PASSupportingInfoTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoTypefrom this IG | |
| Claim.supportingInfo:PatientEvent.category | example | Pattern: patientEventhttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.supportingInfo:AdmissionDates.category | example | Pattern: admissionDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.supportingInfo:DischargeDates.category | example | Pattern: dischargeDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.diagnosis.diagnosis[x] | required | X12278DiagnosisCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisCodesfrom this IG | |
| Claim.diagnosis.type | required | X12278DiagnosisTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisTypefrom this IG | |
| Claim.accident.type | required | https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 | |
| Claim.item.revenue | required | AHANUBCRevenueCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodesfrom this IG | |
| Claim.item.category | required | https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 | |
| Claim.item.productOrService | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG | |
| Claim.item.modifier | required | X12278RequestedServiceModifierTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierTypefrom this IG | |
| Claim.item.location[x] | required | X12278LocationTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278LocationTypefrom this IG |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim |
0..* | PASClaimBase | Query for Preauthorizations | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| levelOfServiceType |
S | 0..1 | CodeableConcept | A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| conditionCode |
S | 0..* | (Complex) | Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode | ||||
| homeHealthCareInformation |
S | 0..1 | (Complex) | Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation | ||||
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
S | 1..1 | PASIdentifier | Business identifier for claim | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| subDepartment |
S | 0..1 | string | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment | ||||
| jurisdiction |
S | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: USPS Two Letter Alphabetic Codes (required) | ||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| system |
SΣ | 1..1 | uri | SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient | ||||
| value |
SΣ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| status |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| subType |
0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
| use |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization | ||||
| patient |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | ||||
| billablePeriod |
SΣ | 0..1 | Period | Relevant time frame for the claim | ||||
| created |
Σ | 1..1 | dateTime | Resource creation date | ||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
| insurer |
SΣ | 1..1 | Reference(PAS Insurer Organization) | Target | ||||
| provider |
SΣ | 1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | This is the submitter of the inquiry. | ||||
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
| fundsReserve |
0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| related |
0..* | BackboneElement | Prior or corollary claims | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| claim |
0..1 | Reference(Claim) | Reference to the related claim | |||||
| relationship |
0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
| reference |
0..1 | Identifier | File or case reference | |||||
| prescription |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
| originalPrescription |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
| payee |
0..1 | BackboneElement | Recipient of benefits payable | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| party |
0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
| referral |
0..1 | Reference(ServiceRequest) | Treatment referral | |||||
| facility |
0..1 | Reference(Location) | Servicing facility | |||||
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean) | ||||
| careTeam:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| careTeamClaimScope |
S | 1..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Order of care team | ||||
| provider |
S | 1..1 | Reference(PAS Organization Base Profile | PAS PractitionerRole) | Practitioner or organization | ||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
S | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | ||||
| qualification |
S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | ||||
| careTeam:OverallClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..0 | |||||||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |||||
| value[x] |
S | 0..1 | boolean | Value of extension Fixed Value: true | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
0..1 | CodeableConcept | Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | |||||
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required) | |||||
| careTeam:ItemClaimMember |
S | 0..* | BackboneElement | Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| careTeamClaimScope |
S | 1..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..0 | |||||||
| url |
1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope" | |||||
| value[x] |
S | 0..1 | boolean | Value of extension Fixed Value: false | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
0..1 | CodeableConcept | Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | |||||
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required) | |||||
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category | ||||
| supportingInfo:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Information instance identifier | ||||
| category |
S | 1..1 | CodeableConcept | Classification of the supplied information Binding: PAS Supporting Info Type Value Set (extensible) | ||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] |
0..1 | When it occurred | ||||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| value[x] |
0..1 | Data to be provided | ||||||
| valueBoolean |
boolean | |||||||
| valueString |
string | |||||||
| valueQuantity |
Quantity | |||||||
| valueAttachment |
Attachment | |||||||
| valueReference |
Reference(Resource) | |||||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:PatientEvent |
S | 0..1 | BackboneElement | Information about the dates of the event that are being requested. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this | |||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:AdmissionDates |
S | 0..1 | BackboneElement | Information about the admission dates of a hospital admission being requested. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionDates | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this | |||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:DischargeDates |
S | 0..1 | BackboneElement | Information about the discharge dates of a hospital admission being requested. | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: dischargeDates | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| Slices for timing[x] |
S | 1..1 | When it occurred Slice: Unordered, Closed by type:$this | |||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| timing[x]:timingDate |
SC | 0..1 | date | When it occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| timing[x]:timingPeriod |
S | 0..1 | Period | When it occurred | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| diagnosis |
S | 0..* | BackboneElement | Pertinent diagnosis information | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Diagnosis instance identifier | ||||
| diagnosis[x] |
S | 1..1 | CodeableConcept | Nature of illness or problem Binding: X12 278 Diagnosis Code Value Set (required) | ||||
| type |
S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: X12 278 Diagnosis Type Value Set (required) | ||||
| onAdmission |
0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
| packageCode |
0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
| procedure |
0..* | BackboneElement | Clinical procedures performed | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Procedure instance identifier | |||||
| type |
0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
| date |
0..1 | dateTime | When the procedure was performed | |||||
| procedure[x] |
1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
| procedureCodeableConcept |
CodeableConcept | |||||||
| procedureReference |
Reference(Procedure) | |||||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| insurance |
SΣ | 1..* | BackboneElement | Patient insurance information | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
SΣ | 1..1 | positiveInt | Insurance instance identifier | ||||
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | ||||
| identifier |
0..1 | Identifier | Pre-assigned Claim number | |||||
| coverage |
SΣ | 1..1 | Reference(PAS Coverage) | Insurance information | ||||
| businessArrangement |
0..1 | string | Additional provider contract number | |||||
| preAuthRef |
0..* | string | Prior authorization reference number | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| accident |
S | 0..1 | BackboneElement | Details of the event | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| date |
SC | 1..1 | date | When the incident occurred FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| type |
S | 0..1 | CodeableConcept | The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| location[x] |
S | 0..1 | Address | Where the event occurred | ||||
| item |
S | 0..* | BackboneElement | Product or service provided | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| itemTraceNumber |
S | 0..* | PASIdentifier | Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber | ||||
| authorizationNumber |
S | 0..1 | string | A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber | ||||
| administrationReferenceNumber |
S | 0..1 | string | A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber | ||||
| requestType |
S | 0..1 | CodeableConcept | A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| certificationType |
S | 0..1 | CodeableConcept | A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| productOrServiceCodeEnd |
S | 0..1 | CodeableConcept | Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required) | ||||
| certIssueDate |
S | 0..1 | date | The specific date or period within when which item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate | ||||
| certExpirationDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization expires. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate | ||||
| certEffectiveDate |
S | 0..1 | date | The specific date or period within which this item's preauthorization became effective. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate | ||||
| reviewActionCode |
S | 0..1 | CodeableConcept | The code describing the result of the review. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
S | 1..1 | positiveInt | Item instance identifier | ||||
| careTeamSequence |
S | 0..* | positiveInt | Applicable careTeam members | ||||
| diagnosisSequence |
S | 0..* | positiveInt | Applicable diagnoses | ||||
| procedureSequence |
0..* | positiveInt | Applicable procedures | |||||
| informationSequence |
S | 0..* | positiveInt | Applicable exception and supporting information | ||||
| revenue |
S | 0..1 | CodeableConcept | Revenue or cost center code Binding: AHA NUBC Revenue Value Set (required) | ||||
| category |
S | 0..1 | CodeableConcept | Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. | ||||
| productOrService |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: X12 278 Requested Service Type (required) | ||||
| modifier |
S | 0..* | CodeableConcept | Product or service billing modifiers Binding: X12 278 Requested Service Modifier Type (required) | ||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| Slices for serviced[x] |
S | 0..1 | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |||||
| servicedDate |
date | |||||||
| servicedPeriod |
Period | |||||||
| serviced[x]:servicedDate |
C | 0..1 | date | Date or dates of service or product delivery FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| serviced[x]:servicedPeriod |
0..1 | Period | Date or dates of service or product delivery | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
ΣC | 0..1 | dateTime | Starting time with inclusive boundary FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| end |
ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||||
| location[x] |
S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: X12 278 Health Care Service Location Type Value Set (required) | ||||
| quantity |
SC | 0..1 | PASQuantity | A fixed quantity (no comparator) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| bodySite |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| encounter |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| detail |
0..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Item instance identifier | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| subDetail |
0..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Item instance identifier | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| total |
0..1 | Money | Total claim cost | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Claim.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| Claim.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | ||||
| Claim.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | ||||
| Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typefrom the FHIR Standard | ||||
| Claim.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtypefrom the FHIR Standard | ||||
| Claim.use | required | Pattern: preauthorizationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1from the FHIR Standard | ||||
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | ||||
| Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreservefrom the FHIR Standard | ||||
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationshipfrom the FHIR Standard | ||||
| Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypefrom the FHIR Standard | ||||
| Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrolefrom the FHIR Standard | ||||
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationfrom the FHIR Standard | ||||
| Claim.careTeam:OverallClaimMember.role | required | https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 | ||||
| Claim.careTeam:OverallClaimMember.qualification | required | https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 | ||||
| Claim.careTeam:ItemClaimMember.role | required | https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 | ||||
| Claim.careTeam:ItemClaimMember.qualification | required | https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 | ||||
| Claim.supportingInfo.category | extensible | PASSupportingInfoTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoTypefrom this IG | ||||
| Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.supportingInfo:PatientEvent.category | example | Pattern: patientEventhttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | ||||
| Claim.supportingInfo:PatientEvent.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo:PatientEvent.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.supportingInfo:AdmissionDates.category | example | Pattern: admissionDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | ||||
| Claim.supportingInfo:AdmissionDates.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo:AdmissionDates.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.supportingInfo:DischargeDates.category | example | Pattern: dischargeDateshttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | ||||
| Claim.supportingInfo:DischargeDates.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionfrom the FHIR Standard | ||||
| Claim.supportingInfo:DischargeDates.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonfrom the FHIR Standard | ||||
| Claim.diagnosis.diagnosis[x] | required | X12278DiagnosisCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisCodesfrom this IG | ||||
| Claim.diagnosis.type | required | X12278DiagnosisTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisTypefrom this IG | ||||
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admissionfrom the FHIR Standard | ||||
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroupfrom the FHIR Standard | ||||
| Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-typefrom the FHIR Standard | ||||
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-proceduresfrom the FHIR Standard | ||||
| Claim.accident.type | required | https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 | ||||
| Claim.item.revenue | required | AHANUBCRevenueCodeshttp://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodesfrom this IG | ||||
| Claim.item.category | required | https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 | ||||
| Claim.item.productOrService | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG | ||||
| Claim.item.modifier | required | X12278RequestedServiceModifierTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierTypefrom this IG | ||||
| Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codefrom the FHIR Standard | ||||
| Claim.item.location[x] | required | X12278LocationTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278LocationTypefrom this IG | ||||
| Claim.item.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/toothfrom the FHIR Standard | ||||
| Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surfacefrom the FHIR Standard | ||||
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerfrom the FHIR Standard | ||||
| Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | ||||
| Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | ||||
| Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | ||||
| Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codefrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codefrom the FHIR Standard |
This structure is derived from PASClaimBase
Summary
Mandatory: 1 element
Must-Support: 6 elements
Extensions
This structure refers to these extensions:
Maturity: 3
Other representations of profile: CSV, Excel, Schematron
IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pas#2.1.0 based on FHIR 4.0.1. Generated 2024-12-20
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