Profile Comparison between http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update vs http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update

Left:PAS Claim Update (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update)
Right:PAS Claim Update (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update)

Messages

ErrorStructureDefinition.versionValues for version differ: '2.1.0' vs '2.2.0-snapshot'
InformationStructureDefinition.dateValues for date differ: '2024-12-20T21:11:16+00:00' vs '2026-01-30T23:58:09+00:00'
ErrorStructureDefinition.baseDefinitionValues for baseDefinition differ: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base' vs 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.0-snapshot'
InformationClaim.languageExample/preferred bindings differ at Claim.language using binding from PASClaimUpdate
InformationStructureDefinition.definitionValues for definition differ: 'An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.' vs 'A unique identifier assigned to this claim.'
InformationStructureDefinition.shortValues for short differ: 'active | cancelled | draft | entered-in-error' vs 'This is fixed to active even if the CertificationType is indicating that the Claim is to be cancelled as it reflects that status of this instance and not the overall Claim'
InformationStructureDefinition.shortValues for short differ: 'Category or discipline' vs 'This is used as a high-level mapping of the X12 UM03 field'
InformationStructureDefinition.shortValues for short differ: 'Item instance identifier' vs 'Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse'
InformationStructureDefinition.shortValues for short differ: 'A fixed quantity (no comparator)' vs 'Count of products or services'
InformationStructureDefinition.definitionValues for definition differ: 'The comparator is not used on a SimpleQuantity' vs 'The number of repetitions of a service or product.'

Metadata

NameValueComments
.abstractfalse
    .baseDefinitionhttp://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-basehttp://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.0-snapshot
    • Values Differ
    .copyright
      .date2024-12-20T21:11:16+00:002026-01-30T23:58:09+00:00
      • Values Differ
      .descriptionThis profile defines constraints and extensions used when update a previously submitted Claim instance. * The Claim instance of the update Bundle SHALL reference the updated Claim instance within the `Claim.related.claim` element. Note that the presence of this reference and the requirement that referenced instances be included in the submitted Bundle implies that the instance representing the prior version of the Claim SHALL be included in the update Bundle. * The Claim instance of the update Bundle SHALL contain within the `Claim.item` element each item requested in the updated claim and any prior versions of the claim, including requested items that have been added, modified, deleted, or left unchanged during this or previous updates. * The Claim instance of the update Bundle SHALL contain within the `Claim.supportingInfo` element each piece of supporting documentation submitted with the updated claim and any prior versions of claim, including supporting documentation that has been added, modified, deleted, or left unchanged during this or previous updates. * Each `Claim.item` entry that represents an item no longer being requested, whether removed in this update or a previous one, SHALL be flagged using the infoCancelledFlag modifierExtension and SHALL have the code `3` (Cancel) in the Certification Type extension. * Each `Claim.supportingInfo` entry that is no longer to be used when evaluating the request, whether removed in this update or a previous one, SHALL be flagged using the infoCancelledFlag modifierExtension. * Each `Claim.item` and `Claim.supportingInfo` entry that has been changed as a part of this most recent update, including removal, SHALL be flagged using the changed extension with a value of `changed`. * Each `Claim.item` and `Claim.supportingInfo` entry that has been added as a part of this most recent update, SHALL be flagged using the changed extension with a value of `added`.This profile defines constraints and extensions used when updating a previously submitted Claim instance.
      • Values Differ
      .experimental
        .fhirVersion4.0.1
          .jurisdiction
            ..jurisdiction[0]urn:iso:std:iso:3166#US
              .kindresource
                .namePASClaimUpdate
                  .publisherHL7 International / Financial Management
                    .purpose
                      .statusactive
                        .titlePAS Claim Update
                          .typeClaim
                            .urlhttp://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update
                              .version2.1.02.2.0-snapshot
                              • Values Differ

                              Structure

                              NameL FlagsL Card.L TypeL Description & ConstraintsR FlagsR Card.R TypeR Description & ConstraintsCommentsdoco
                              .. Claim 0..*PASClaimBasePreauthorization
                              0..*PASClaimBase(2.2.0-snapshot)Preauthorization
                                ... id Σ0..1idLogical id of this artifactΣ0..1idLogical id of this artifact
                                  ... meta Σ0..1MetaMetadata about the resourceΣ0..1MetaMetadata about the resource
                                    ... implicitRules ?!Σ0..1uriA set of rules under which this content was created?!Σ0..1uriA set of rules under which this content was created
                                      ... language 0..1codeLanguage of the resource content
                                      Binding: ?? (preferred): A human language.
                                      Additional BindingsPurpose
                                      ??Max Binding
                                      0..1codeLanguage of the resource content
                                      Binding: ?? (preferred): A human language.
                                      Additional BindingsPurpose
                                      ??Max Binding
                                      • Example/preferred bindings differ at Claim.language using binding from PASClaimUpdate
                                      ... text 0..1NarrativeText summary of the resource, for human interpretation
                                      This profile does not constrain the narrative in regard to content, language, or traceability to data elements
                                      0..1NarrativeText summary of the resource, for human interpretation
                                      This profile does not constrain the narrative in regard to content, language, or traceability to data elements
                                        ... contained 0..*ResourceContained, inline Resources
                                        0..*ResourceContained, inline Resources
                                          ... Slices for extension 0..*ExtensionExtension
                                          Slice: Unordered, Open by value:url
                                          0..*ExtensionExtension
                                          Slice: Unordered, Open by value:url
                                            ... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
                                            ?!0..*ExtensionExtensions that cannot be ignored
                                              ... identifier S1..2??Business identifier for claim
                                              S1..2??Business identifier for claim
                                                .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                  .... Slices for extension 0..*ExtensionAdditional content defined by implementations
                                                  Slice: Unordered, Open by value:url
                                                  0..*ExtensionAdditional content defined by implementations
                                                  Slice: Unordered, Open by value:url
                                                    .... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
                                                    Binding: ?? (required): Identifies the purpose for this identifier, if known .
                                                    ?!Σ0..1codeusual | official | temp | secondary | old (If known)
                                                    Binding: ?? (required): Identifies the purpose for this identifier, if known .
                                                      .... type Σ0..1CodeableConceptDescription of identifier
                                                      Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
                                                      Σ0..1CodeableConceptDescription of identifier
                                                      Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
                                                        .... system SΣ1..1uriSHOULD use a scheme of 'urn:trnorg:<TRN03>'
                                                        Example General: http://www.acme.com/identifiers/patient
                                                        SΣ1..1uriSHOULD use a scheme of 'urn:trnorg:<TRN03>'
                                                        Example General: http://www.acme.com/identifiers/patient
                                                          .... value SΣ1..1stringThe value that is unique
                                                          Example General: 123456
                                                          SΣ1..1stringThe value that is unique
                                                          Example General: 123456
                                                            .... period Σ0..1PeriodTime period when id is/was valid for useΣ0..1PeriodTime period when id is/was valid for use
                                                              .... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)Σ0..1Reference(Organization)Organization that issued id (may be just text)
                                                                ... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
                                                                Binding: ?? (required): A code specifying the state of the resource instance.
                                                                Required Pattern: active
                                                                ?!SΣ1..1codeThis is fixed to active even if the CertificationType is indicating that the Claim is to be cancelled as it reflects that status of this instance and not the overall Claim
                                                                Binding: ?? (required): A code specifying the state of the resource instance.
                                                                Required Pattern: active
                                                                  ... type Σ1..1CodeableConceptCategory or discipline
                                                                  Binding: ?? (extensible): The type or discipline-style of the claim.
                                                                  Σ1..1CodeableConceptThis is used as a high-level mapping of the X12 UM03 field
                                                                  Binding: ?? (required)
                                                                    ... subType 0..1CodeableConceptMore granular claim type
                                                                    Binding: ?? (example): A more granular claim typecode.
                                                                    0..1CodeableConceptMore granular claim type
                                                                    Binding: ?? (example): A more granular claim typecode.
                                                                      ... use SΣ1..1codeclaim | preauthorization | predetermination
                                                                      Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
                                                                      Required Pattern: preauthorization
                                                                      SΣ1..1codeclaim | preauthorization | predetermination
                                                                      Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
                                                                      Required Pattern: preauthorization
                                                                        ... patient SΣ1..1Reference(PAS Beneficiary Patient)The recipient of the products and servicesSΣ1..1Reference(PAS Beneficiary Patient(2.2.0-snapshot))The recipient of the products and services
                                                                          ... billablePeriod Σ0..1PeriodRelevant time frame for the claimΣ0..1PeriodRelevant time frame for the claim
                                                                            ... created Σ1..1dateTimeResource creation dateΣ1..1dateTimeResource creation date
                                                                              ... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim0..1Reference(Practitioner | PractitionerRole)Author of the claim
                                                                                ... insurer SΣ1..1Reference(PAS Insurer Organization)TargetSΣ1..1Reference(PAS Insurer Organization(2.2.0-snapshot))Target
                                                                                  ... provider SΣ1..1Reference(PAS Requestor Organization | PAS PractitionerRole)Party responsible for the claimSΣ1..1Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))Party responsible for the claim
                                                                                    ... priority Σ1..1CodeableConceptDesired processing ugency
                                                                                    Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
                                                                                    Σ1..1CodeableConceptDesired processing ugency
                                                                                    Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
                                                                                      ... fundsReserve 0..1CodeableConceptFor whom to reserve funds
                                                                                      Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
                                                                                      0..1CodeableConceptFor whom to reserve funds
                                                                                      Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
                                                                                        ... related S1..1BackboneElementPrior or corollary claims
                                                                                        S1..1BackboneElementPrior or corollary claims
                                                                                          .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                            .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                            0..*ExtensionAdditional content defined by implementations
                                                                                              .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                              ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                .... claim S1..1Reference(Claim)Reference to the related claimS1..1Reference(Claim)Reference to the related claim
                                                                                                  .... relationship S1..1CodeableConceptHow the reference claim is related
                                                                                                  Binding: ?? (example): Relationship of this claim to a related Claim.
                                                                                                  Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship","code":"prior"}]}
                                                                                                  S1..1CodeableConceptHow the reference claim is related
                                                                                                  Binding: ?? (example): Relationship of this claim to a related Claim.
                                                                                                  Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship","code":"prior"}]}
                                                                                                    .... reference 0..1IdentifierFile or case reference0..1IdentifierFile or case reference
                                                                                                      ... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
                                                                                                        ... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
                                                                                                          ... payee 0..1BackboneElementRecipient of benefits payable0..1BackboneElementRecipient of benefits payable
                                                                                                            .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                              .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                              0..*ExtensionAdditional content defined by implementations
                                                                                                                .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                  .... type 1..1CodeableConceptCategory of recipient
                                                                                                                  Binding: ?? (example): A code for the party to be reimbursed.
                                                                                                                  1..1CodeableConceptCategory of recipient
                                                                                                                  Binding: ?? (example): A code for the party to be reimbursed.
                                                                                                                    .... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
                                                                                                                      ... referral 0..1Reference(ServiceRequest)Treatment referral0..1Reference(ServiceRequest)Treatment referral
                                                                                                                        ... facility 0..1Reference(Location)Servicing facility0..1Reference(Location)Servicing facility
                                                                                                                          ... Slices for careTeam S0..*BackboneElementMembers of the care team
                                                                                                                          Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
                                                                                                                          S0..*BackboneElementMembers of the care team
                                                                                                                          Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
                                                                                                                            .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                              .... Slices for extension 1..*ExtensionExtension
                                                                                                                              Slice: Unordered, Open by value:url
                                                                                                                              1..*ExtensionExtension
                                                                                                                              Slice: Unordered, Open by value:url
                                                                                                                                .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                  .... sequence S1..1positiveIntOrder of care teamS1..1positiveIntOrder of care team
                                                                                                                                    .... provider S1..1Reference(PAS Organization Base Profile | PAS PractitionerRole)Practitioner or organizationS1..1Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))Practitioner or organization
                                                                                                                                      .... responsible 0..1booleanIndicator of the lead practitioner0..1booleanIndicator of the lead practitioner
                                                                                                                                        .... role S0..1CodeableConceptFunction within the team
                                                                                                                                        Binding: ?? (example): The role codes for the care team members.
                                                                                                                                        S0..1CodeableConceptFunction within the team
                                                                                                                                        Binding: ?? (example): The role codes for the care team members.
                                                                                                                                          .... qualification S0..1CodeableConceptPractitioner credential or specialization
                                                                                                                                          Binding: ?? (example): Provider professional qualifications.
                                                                                                                                          S0..1CodeableConceptPractitioner credential or specialization
                                                                                                                                          Binding: ?? (example): Provider professional qualifications.
                                                                                                                                            ... Slices for supportingInfo S0..*BackboneElementSupporting information
                                                                                                                                            Slice: Unordered, Open by value:category
                                                                                                                                            S0..*BackboneElementSupporting information
                                                                                                                                            Slice: Unordered, Open by value:category
                                                                                                                                              .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                .... Slices for extension 0..*ExtensionExtension
                                                                                                                                                Slice: Unordered, Open by value:url
                                                                                                                                                0..*ExtensionExtension
                                                                                                                                                Slice: Unordered, Open by value:url
                                                                                                                                                  .... Slices for modifierExtension ?!Σ0..*ExtensionExtension
                                                                                                                                                  Slice: Unordered, Open by value:url
                                                                                                                                                  ?!Σ0..*ExtensionExtension
                                                                                                                                                  Slice: Unordered, Open by value:url
                                                                                                                                                    .... sequence S1..1positiveIntInformation instance identifierS1..1positiveIntInformation instance identifier
                                                                                                                                                      .... category S1..1CodeableConceptClassification of the supplied information
                                                                                                                                                      Binding: ?? (extensible)
                                                                                                                                                      S1..1CodeableConceptClassification of the supplied information
                                                                                                                                                      Binding: ?? (extensible)
                                                                                                                                                        .... code 0..1CodeableConceptType of information
                                                                                                                                                        Binding: ?? (example): The valuset used for additional information codes.
                                                                                                                                                        0..1CodeableConceptType of information
                                                                                                                                                        Binding: ?? (example): The valuset used for additional information codes.
                                                                                                                                                          .... timing[x] 0..1date, PeriodWhen it occurred0..1date, PeriodWhen it occurred
                                                                                                                                                            .... value[x] 0..1boolean, string, Quantity, Attachment, Reference(Resource)Data to be provided0..1boolean, string, Quantity, Attachment, Reference(Resource)Data to be provided
                                                                                                                                                              .... reason 0..1CodeableConceptExplanation for the information
                                                                                                                                                              Binding: ?? (example): Reason codes for the missing teeth.
                                                                                                                                                              0..1CodeableConceptExplanation for the information
                                                                                                                                                              Binding: ?? (example): Reason codes for the missing teeth.
                                                                                                                                                                ... diagnosis S0..*BackboneElementPertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
                                                                                                                                                                S0..*BackboneElementPertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
                                                                                                                                                                  .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                    .... Slices for extension 0..*ExtensionExtension
                                                                                                                                                                    Slice: Unordered, Open by value:url
                                                                                                                                                                    0..*ExtensionExtension
                                                                                                                                                                    Slice: Unordered, Open by value:url
                                                                                                                                                                      .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                      ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                        .... sequence S1..1positiveIntDiagnosis instance identifierS1..1positiveIntDiagnosis instance identifier
                                                                                                                                                                          .... diagnosis[x] S1..1CodeableConceptNature of illness or problem
                                                                                                                                                                          Binding: ?? (required)
                                                                                                                                                                          S1..1CodeableConceptNature of illness or problem
                                                                                                                                                                          Binding: ?? (required)
                                                                                                                                                                            .... type S0..1CodeableConceptTiming or nature of the diagnosis
                                                                                                                                                                            Binding: ?? (required)
                                                                                                                                                                            S0..1CodeableConceptTiming or nature of the diagnosis
                                                                                                                                                                            Binding: ?? (required)
                                                                                                                                                                              .... onAdmission 0..1CodeableConceptPresent on admission
                                                                                                                                                                              Binding: ?? (example): Present on admission.
                                                                                                                                                                              0..1CodeableConceptPresent on admission
                                                                                                                                                                              Binding: ?? (example): Present on admission.
                                                                                                                                                                                .... packageCode 0..1CodeableConceptPackage billing code
                                                                                                                                                                                Binding: ?? (example): The DRG codes associated with the diagnosis.
                                                                                                                                                                                0..1CodeableConceptPackage billing code
                                                                                                                                                                                Binding: ?? (example): The DRG codes associated with the diagnosis.
                                                                                                                                                                                  ... procedure 0..*BackboneElementClinical procedures performed
                                                                                                                                                                                  0..*BackboneElementClinical procedures performed
                                                                                                                                                                                    .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                      .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                      0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                        .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                        ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                          .... sequence 1..1positiveIntProcedure instance identifier1..1positiveIntProcedure instance identifier
                                                                                                                                                                                            .... type 0..*CodeableConceptCategory of Procedure
                                                                                                                                                                                            Binding: ?? (example): Example procedure type codes.
                                                                                                                                                                                            0..*CodeableConceptCategory of Procedure
                                                                                                                                                                                            Binding: ?? (example): Example procedure type codes.
                                                                                                                                                                                              .... date 0..1dateTimeWhen the procedure was performed0..1dateTimeWhen the procedure was performed
                                                                                                                                                                                                .... procedure[x] 1..1CodeableConcept, Reference(Procedure)Specific clinical procedure
                                                                                                                                                                                                Binding: ?? (example): Example ICD10 Procedure codes.
                                                                                                                                                                                                1..1CodeableConcept, Reference(Procedure)Specific clinical procedure
                                                                                                                                                                                                Binding: ?? (example): Example ICD10 Procedure codes.
                                                                                                                                                                                                  .... udi 0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                  0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                    ... insurance SΣ1..*BackboneElementPatient insurance information
                                                                                                                                                                                                    SΣ1..*BackboneElementPatient insurance information
                                                                                                                                                                                                      .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                        .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                        0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                          .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                          ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                            .... sequence SΣ1..1positiveIntInsurance instance identifierSΣ1..1positiveIntInsurance instance identifier
                                                                                                                                                                                                              .... focal Σ1..1booleanCoverage to be used for adjudication
                                                                                                                                                                                                              Required Pattern: true
                                                                                                                                                                                                              Σ1..1booleanCoverage to be used for adjudication
                                                                                                                                                                                                              Required Pattern: true
                                                                                                                                                                                                                .... identifier 0..1IdentifierPre-assigned Claim number0..1IdentifierPre-assigned Claim number
                                                                                                                                                                                                                  .... coverage SΣ1..1Reference(PAS Coverage)Insurance informationSΣ1..1Reference(PAS Coverage(2.2.0-snapshot))Insurance information
                                                                                                                                                                                                                    .... businessArrangement 0..1stringAdditional provider contract number0..1stringAdditional provider contract number
                                                                                                                                                                                                                      .... preAuthRef 0..*stringPrior authorization reference number
                                                                                                                                                                                                                      0..*stringPrior authorization reference number
                                                                                                                                                                                                                        .... claimResponse 0..1Reference(ClaimResponse)Adjudication results0..1Reference(ClaimResponse)Adjudication results
                                                                                                                                                                                                                          ... accident S0..1BackboneElementDetails of the eventS0..1BackboneElementDetails of the event
                                                                                                                                                                                                                            .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                              .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                              0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                  .... date SC1..1dateWhen the incident occurredSC1..1dateWhen the incident occurred
                                                                                                                                                                                                                                    .... type S0..1CodeableConceptThe nature of the accident
                                                                                                                                                                                                                                    Binding: ?? (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.
                                                                                                                                                                                                                                    S0..1CodeableConceptThe nature of the accident
                                                                                                                                                                                                                                    Binding: ?? (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] S0..1AddressWhere the event occurredS0..1AddressWhere the event occurred
                                                                                                                                                                                                                                        ... item SC1..*BackboneElementProduct or service provided
                                                                                                                                                                                                                                        Constraints: ImmediateLevelOfCare
                                                                                                                                                                                                                                        SC1..*BackboneElementProduct or service provided
                                                                                                                                                                                                                                          .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                            .... Slices for extension 2..*ExtensionExtension
                                                                                                                                                                                                                                            Slice: Unordered, Open by value:url
                                                                                                                                                                                                                                            2..*ExtensionExtension
                                                                                                                                                                                                                                            Slice: Unordered, Open by value:url
                                                                                                                                                                                                                                              .... Slices for modifierExtension ?!Σ0..*ExtensionExtension
                                                                                                                                                                                                                                              Slice: Unordered, Open by value:url
                                                                                                                                                                                                                                              ?!Σ0..*ExtensionExtension
                                                                                                                                                                                                                                              Slice: Unordered, Open by value:url
                                                                                                                                                                                                                                                .... sequence S1..1positiveIntItem instance identifierS1..1positiveIntSequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
                                                                                                                                                                                                                                                  .... careTeamSequence S0..*positiveIntApplicable careTeam members
                                                                                                                                                                                                                                                  S0..*positiveIntApplicable careTeam members
                                                                                                                                                                                                                                                    .... diagnosisSequence S0..*positiveIntApplicable diagnoses
                                                                                                                                                                                                                                                    S0..*positiveIntApplicable diagnoses
                                                                                                                                                                                                                                                      .... procedureSequence 0..*positiveIntApplicable procedures
                                                                                                                                                                                                                                                      0..*positiveIntApplicable procedures
                                                                                                                                                                                                                                                        .... informationSequence S0..*positiveIntApplicable exception and supporting information
                                                                                                                                                                                                                                                        S0..*positiveIntApplicable exception and supporting information
                                                                                                                                                                                                                                                          .... revenue S0..1CodeableConceptRevenue or cost center code
                                                                                                                                                                                                                                                          Binding: ?? (required)
                                                                                                                                                                                                                                                          S0..1CodeableConceptRevenue or cost center code
                                                                                                                                                                                                                                                          Binding: ?? (required)
                                                                                                                                                                                                                                                            .... category S1..1CodeableConceptSince PAS requests only have item-level information, a category is required for conformance with the X12 278 request.
                                                                                                                                                                                                                                                            Binding: ?? (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.
                                                                                                                                                                                                                                                            S1..1CodeableConceptSince PAS requests only have item-level information, a category is required for conformance with the X12 278 request.
                                                                                                                                                                                                                                                            Binding: ?? (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 S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                              Binding: ?? (required)
                                                                                                                                                                                                                                                              S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                              Binding: ?? (required)
                                                                                                                                                                                                                                                                .... modifier S0..*CodeableConceptProduct or service billing modifiers
                                                                                                                                                                                                                                                                Binding: ?? (required)
                                                                                                                                                                                                                                                                S0..*CodeableConceptProduct or service billing modifiers
                                                                                                                                                                                                                                                                Binding: ?? (required)
                                                                                                                                                                                                                                                                  .... programCode 0..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                                                                                                                  Binding: ?? (example): Program specific reason codes.
                                                                                                                                                                                                                                                                  0..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                                                                                                                  Binding: ?? (example): Program specific reason codes.
                                                                                                                                                                                                                                                                    .... Slices for serviced[x] S0..1date, PeriodDate or dates of service or product delivery
                                                                                                                                                                                                                                                                    Slice: Unordered, Closed by type:$this
                                                                                                                                                                                                                                                                    S0..1date, PeriodDate or dates of service or product delivery
                                                                                                                                                                                                                                                                    Slice: Unordered, Closed by type:$this
                                                                                                                                                                                                                                                                      .... location[x] S1..1CodeableConceptPlace of service or where product was supplied
                                                                                                                                                                                                                                                                      Binding: ?? (required)
                                                                                                                                                                                                                                                                      S1..1CodeableConceptPlace of service or where product was supplied
                                                                                                                                                                                                                                                                      Binding: ?? (required)
                                                                                                                                                                                                                                                                        .... quantity SC0..1??A fixed quantity (no comparator)S0..1??Count of products or services
                                                                                                                                                                                                                                                                          .... unitPrice S0..1MoneyFee, charge or cost per itemS0..1MoneyFee, charge or cost per item
                                                                                                                                                                                                                                                                            .... factor 0..1decimalPrice scaling factor0..1decimalPrice scaling factor
                                                                                                                                                                                                                                                                              .... net 0..1MoneyTotal item cost0..1MoneyTotal item cost
                                                                                                                                                                                                                                                                                .... udi 0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                                                                                                0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                                                                                                  .... bodySite 0..1CodeableConceptAnatomical location
                                                                                                                                                                                                                                                                                  Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
                                                                                                                                                                                                                                                                                  0..1CodeableConceptAnatomical location
                                                                                                                                                                                                                                                                                  Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
                                                                                                                                                                                                                                                                                    .... subSite 0..*CodeableConceptAnatomical sub-location
                                                                                                                                                                                                                                                                                    Binding: ?? (example): The code for the tooth surface and surface combinations.
                                                                                                                                                                                                                                                                                    0..*CodeableConceptAnatomical sub-location
                                                                                                                                                                                                                                                                                    Binding: ?? (example): The code for the tooth surface and surface combinations.
                                                                                                                                                                                                                                                                                      .... encounter 0..*Reference(Encounter)Encounters related to this billed item
                                                                                                                                                                                                                                                                                      0..*Reference(Encounter)Encounters related to this billed item
                                                                                                                                                                                                                                                                                        .... detail 0..*BackboneElementProduct or service provided
                                                                                                                                                                                                                                                                                        0..*BackboneElementProduct or service provided
                                                                                                                                                                                                                                                                                          ..... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                            ..... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                            0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                              ..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                              ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                ..... sequence 1..1positiveIntItem instance identifier1..1positiveIntItem instance identifier
                                                                                                                                                                                                                                                                                                  ..... revenue 0..1CodeableConceptRevenue or cost center code
                                                                                                                                                                                                                                                                                                  Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
                                                                                                                                                                                                                                                                                                  0..1CodeableConceptRevenue or cost center code
                                                                                                                                                                                                                                                                                                  Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
                                                                                                                                                                                                                                                                                                    ..... category 0..1CodeableConceptBenefit classification
                                                                                                                                                                                                                                                                                                    Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
                                                                                                                                                                                                                                                                                                    0..1CodeableConceptBenefit classification
                                                                                                                                                                                                                                                                                                    Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
                                                                                                                                                                                                                                                                                                      ..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                                                                      Binding: ?? (example): Allowable service and product codes.
                                                                                                                                                                                                                                                                                                      1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                                                                      Binding: ?? (example): Allowable service and product codes.
                                                                                                                                                                                                                                                                                                        ..... modifier 0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                                                                                                                        Binding: ?? (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.
                                                                                                                                                                                                                                                                                                        0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                                                                                                                        Binding: ?? (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..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                                                                                                                                                          Binding: ?? (example): Program specific reason codes.
                                                                                                                                                                                                                                                                                                          0..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                                                                                                                                                          Binding: ?? (example): Program specific reason codes.
                                                                                                                                                                                                                                                                                                            ..... quantity 0..1??Count of products or services0..1??Count of products or services
                                                                                                                                                                                                                                                                                                              ..... unitPrice 0..1MoneyFee, charge or cost per item0..1MoneyFee, charge or cost per item
                                                                                                                                                                                                                                                                                                                ..... factor 0..1decimalPrice scaling factor0..1decimalPrice scaling factor
                                                                                                                                                                                                                                                                                                                  ..... net 0..1MoneyTotal item cost0..1MoneyTotal item cost
                                                                                                                                                                                                                                                                                                                    ..... udi 0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                                                                                                                                    0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                                                                                                                                      ..... subDetail 0..*BackboneElementProduct or service provided
                                                                                                                                                                                                                                                                                                                      0..*BackboneElementProduct or service provided
                                                                                                                                                                                                                                                                                                                        ...... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                                                          ...... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                          0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                            ...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                            ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                              ...... sequence 1..1positiveIntItem instance identifier1..1positiveIntItem instance identifier
                                                                                                                                                                                                                                                                                                                                ...... revenue 0..1CodeableConceptRevenue or cost center code
                                                                                                                                                                                                                                                                                                                                Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
                                                                                                                                                                                                                                                                                                                                0..1CodeableConceptRevenue or cost center code
                                                                                                                                                                                                                                                                                                                                Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
                                                                                                                                                                                                                                                                                                                                  ...... category 0..1CodeableConceptBenefit classification
                                                                                                                                                                                                                                                                                                                                  Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
                                                                                                                                                                                                                                                                                                                                  0..1CodeableConceptBenefit classification
                                                                                                                                                                                                                                                                                                                                  Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
                                                                                                                                                                                                                                                                                                                                    ...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                                                                                                    Binding: ?? (example): Allowable service and product codes.
                                                                                                                                                                                                                                                                                                                                    1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                                                                                                    Binding: ?? (example): Allowable service and product codes.
                                                                                                                                                                                                                                                                                                                                      ...... modifier 0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                                                                                                                                                      Binding: ?? (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.
                                                                                                                                                                                                                                                                                                                                      0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                                                                                                                                                      Binding: ?? (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..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                                                                                                                                                                                        Binding: ?? (example): Program specific reason codes.
                                                                                                                                                                                                                                                                                                                                        0..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                                                                                                                                                                                        Binding: ?? (example): Program specific reason codes.
                                                                                                                                                                                                                                                                                                                                          ...... quantity 0..1??Count of products or services0..1??Count of products or services
                                                                                                                                                                                                                                                                                                                                            ...... unitPrice 0..1MoneyFee, charge or cost per item0..1MoneyFee, charge or cost per item
                                                                                                                                                                                                                                                                                                                                              ...... factor 0..1decimalPrice scaling factor0..1decimalPrice scaling factor
                                                                                                                                                                                                                                                                                                                                                ...... net 0..1MoneyTotal item cost0..1MoneyTotal item cost
                                                                                                                                                                                                                                                                                                                                                  ...... udi 0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                                                                                                                                                                  0..*Reference(Device)Unique device identifier
                                                                                                                                                                                                                                                                                                                                                    ... total 0..1MoneyTotal claim cost0..1MoneyTotal claim cost

                                                                                                                                                                                                                                                                                                                                                      doco Documentation for this format