Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-snapshot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

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Resource Profile: PAS Claim Base ( Abstract )

PAS constraints on Claim resource that are common to both the request and the inquiry.

Usages:

• Derived from this Profile: PAS Claim Inquiry, PAS Claim Update, PAS Claim, PAS Claim Inquiry... Show 2 more, PAS Claim Update and PAS Claim

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	This is an abstract profile. Child profiles: PASClaimInquiry, PASClaimUpdate, PASClaim, PASClaimInquiry, PASClaimUpdate, PASClaim Preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:transmissionIdentifiers	S	0..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
extension:levelOfServiceType	S	0..1	CodeableConcept	A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:conditionCode	S	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
extension:homeHealthCareInformation	S	0..1	(Complex)	Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation
extension:authorizationNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	PASIdentifier(2.2.0-snapshot)	Business identifier for claim
Slices for extension				Content/Rules for all slices
extension:subDepartment	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
extension:jurisdiction	S	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: UspsTwoLetterAlphabeticCodes (7.0.0) (required)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	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 Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
patient	SΣ	1..1	Reference(PAS Beneficiary Patient(2.2.0-snapshot))	The recipient of the products and services
created	Σ	1..1	dateTime	Resource creation date
insurer	SΣ	1..1	Reference(PAS Insurer Organization(2.2.0-snapshot))	Target
provider	SΣ	1..1	Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
careTeam:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
careTeam:OverallClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
careTeam:ItemClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: false
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Slices for supportingInfo	S	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible)
supportingInfo:PatientEvent	S	0..1	BackboneElement	Information about the dates of the event that are being requested.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
supportingInfo:AdmissionDates	S	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
supportingInfo:DischargeDates	S	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
timing[x]	SC	1..1	date	When it occurred Constraints: FullDateRule
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.0-snapshot) (required)
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.0-snapshot) (required)
insurance	SΣ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	SΣ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
coverage	SΣ	1..1	Reference(PAS Coverage(2.2.0-snapshot))	Insurance information
accident	S	0..1	BackboneElement	Details of the event
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date	SC	1..1	date	When the incident occurred Constraints: FullDateRule
type	S	0..1	CodeableConcept	The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x]	S	0..1	Address	Where the event occurred
item	S	0..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:itemTraceNumber	S	0..*	PASIdentifier(2.2.0-snapshot)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
extension:authorizationNumber	S	0..1	string	A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
extension:requestType	S	0..1	CodeableConcept	A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:certificationType	S	0..1	CodeableConcept	A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:productOrServiceCodeEnd	S	0..1	CodeableConcept	Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
category	S	0..1	CodeableConcept	Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
Slices for serviced[x]	S	0..1		Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	SC	0..1	date	Date or dates of service or product delivery Constraints: FullDateRule
serviced[x]:servicedPeriod	S	0..1	Period	Date or dates of service or product delivery
start	ΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
location[x]	S	0..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.0-snapshot) (required)
quantity	S	0..1	PASQuantity(2.2.0-snapshot)	Count of products or services
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	required	Claim Types	📦2.2.0-snapshot	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.careTeam:OverallClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:OverallClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127	Not State	Unknown
Claim.careTeam:ItemClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:ItemClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127	Not State	Unknown
Claim.supportingInfo.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:PatientEvent.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:AdmissionDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:DischargeDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.0-snapshot	This IG
Claim.accident.type	Base	required	https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.0-snapshot	This IG
Claim.item.category	Base	required	https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365	Not State	Unknown
Claim.item.productOrService	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.0-snapshot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
FullDateRule	error	Claim.supportingInfo:PatientEvent.timing[x]:timingDate, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.start, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.end, Claim.supportingInfo:AdmissionDates.timing[x]:timingDate, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.start, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.end, Claim.supportingInfo:DischargeDates.timing[x], Claim.accident.date, Claim.item.serviced[x]:servicedDate, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	Dates need to be a full date - YYYY-MM-DD	$this.toString().length() = 10
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	This is an abstract profile. Child profiles: PASClaimInquiry, PASClaimUpdate, PASClaim, PASClaimInquiry, PASClaimUpdate, PASClaim Preauthorization
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:transmissionIdentifiers	S	0..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
extension:levelOfServiceType	S	0..1	CodeableConcept	A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:conditionCode	S	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
extension:homeHealthCareInformation	S	0..1	(Complex)	Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation
extension:authorizationNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
identifier	S	0..*	PASIdentifier(2.2.0-snapshot)	Business identifier for claim
system		1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>'
status	S	1..1	code	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 Required Pattern: active
type		1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
use	S	1..1	code	claim | preauthorization | predetermination Required Pattern: preauthorization
patient	S	1..1	Reference(PAS Beneficiary Patient(2.2.0-snapshot))	The recipient of the products and services
insurer	S	1..1	Reference(PAS Insurer Organization(2.2.0-snapshot))	Target
provider	S	1..1	Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Party responsible for the claim
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
careTeam:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization
careTeam:OverallClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
value[x]	S	0..1	boolean	Value of extension Fixed Value: true
role		0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
careTeam:ItemClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
value[x]	S	0..1	boolean	Value of extension Fixed Value: false
role		0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Slices for supportingInfo	S	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible)
supportingInfo:PatientEvent	S	0..1	BackboneElement	Information about the dates of the event that are being requested.
category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
Slices for timing[x]	S	1..1	date, Period	When it occurred Slice: Unordered, Open by type:$this
timing[x]:timingDate	SC	0..1	date	When it occurred
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SC	0..1	dateTime	Starting time with inclusive boundary
end	SC	0..1	dateTime	End time with inclusive boundary, if not ongoing
value[x]		0..0		Data to be provided
supportingInfo:AdmissionDates	S	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
Slices for timing[x]	S	1..1	date, Period	When it occurred Slice: Unordered, Open by type:$this
timing[x]:timingDate	SC	0..1	date	When it occurred
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SC	0..1	dateTime	Starting time with inclusive boundary
end	SC	0..1	dateTime	End time with inclusive boundary, if not ongoing
value[x]		0..0		Data to be provided
supportingInfo:DischargeDates	S	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
timing[x]	SC	1..1	date	When it occurred
value[x]		0..0		Data to be provided
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information
sequence	S	1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.0-snapshot) (required)
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.0-snapshot) (required)
insurance	S	1..*	BackboneElement	Patient insurance information
sequence	S	1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication Required Pattern: true
coverage	S	1..1	Reference(PAS Coverage(2.2.0-snapshot))	Insurance information
accident	S	0..1	BackboneElement	Details of the event
date	SC	1..1	date	When the incident occurred
type	S	0..1	CodeableConcept	The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x]	S	0..1	Address	Where the event occurred
item	S	0..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:itemTraceNumber	S	0..*	PASIdentifier(2.2.0-snapshot)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
extension:authorizationNumber	S	0..1	string	A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
extension:requestType	S	0..1	CodeableConcept	A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:certificationType	S	0..1	CodeableConcept	A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:productOrServiceCodeEnd	S	0..1	CodeableConcept	Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
sequence	S	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
category	S	0..1	CodeableConcept	Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
Slices for serviced[x]	S	0..1	date, Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	SC	0..1	date	Date or dates of service or product delivery
serviced[x]:servicedPeriod	S	0..1	Period	Date or dates of service or product delivery
start	C	0..1	dateTime	Starting time with inclusive boundary
end	C	0..1	dateTime	End time with inclusive boundary, if not ongoing
location[x]	S	0..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.0-snapshot) (required)
quantity	S	0..1	PASQuantity(2.2.0-snapshot)	Count of products or services
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.type	Base	required	Claim Types	📦2.2.0-snapshot	This IG
Claim.careTeam:OverallClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:OverallClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127	Not State	Unknown
Claim.careTeam:ItemClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:ItemClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127	Not State	Unknown
Claim.supportingInfo.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.0-snapshot	This IG
Claim.accident.type	Base	required	https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.0-snapshot	This IG
Claim.item.category	Base	required	https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365	Not State	Unknown
Claim.item.productOrService	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.0-snapshot	This IG

Constraints

Id

Grade

Path(s)

Description

Expression

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	This is an abstract profile. Child profiles: PASClaimInquiry, PASClaimUpdate, PASClaim, PASClaimInquiry, PASClaimUpdate, PASClaim Preauthorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text 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..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:transmissionIdentifiers	S	0..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
extension:levelOfServiceType	S	0..1	CodeableConcept	A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:conditionCode	S	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
extension:homeHealthCareInformation	S	0..1	(Complex)	Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation
extension:authorizationNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	PASIdentifier(2.2.0-snapshot)	Business identifier for claim
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:subDepartment	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
extension:jurisdiction	S	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: UspsTwoLetterAlphabeticCodes (7.0.0) (required)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	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 Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
patient	SΣ	1..1	Reference(PAS Beneficiary Patient(2.2.0-snapshot))	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	SΣ	1..1	Reference(PAS Insurer Organization(2.2.0-snapshot))	Target
provider	SΣ	1..1	Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment referral
facility		0..1	Reference(Location)	Servicing facility
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
careTeam:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
careTeam:OverallClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
careTeam:ItemClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: false
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Slices for supportingInfo	S	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible)
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:PatientEvent	S	0..1	BackboneElement	Information about the dates of the event that are being requested.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:AdmissionDates	S	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:DischargeDates	S	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]	SC	1..1	date	When it occurred Constraints: FullDateRule
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.0-snapshot) (required)
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.0-snapshot) (required)
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
insurance	SΣ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	SΣ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	SΣ	1..1	Reference(PAS Coverage(2.2.0-snapshot))	Insurance information
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident	S	0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date	SC	1..1	date	When the incident occurred Constraints: FullDateRule
type	S	0..1	CodeableConcept	The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x]	S	0..1	Address	Where the event occurred
item	S	0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:itemTraceNumber	S	0..*	PASIdentifier(2.2.0-snapshot)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
extension:authorizationNumber	S	0..1	string	A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
extension:requestType	S	0..1	CodeableConcept	A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:certificationType	S	0..1	CodeableConcept	A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:productOrServiceCodeEnd	S	0..1	CodeableConcept	Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
category	S	0..1	CodeableConcept	Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Slices for serviced[x]	S	0..1		Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	SC	0..1	date	Date or dates of service or product delivery Constraints: FullDateRule
serviced[x]:servicedPeriod	S	0..1	Period	Date or dates of service or product delivery
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
location[x]	S	0..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.0-snapshot) (required)
quantity	S	0..1	PASQuantity(2.2.0-snapshot)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
subDetail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	required	Claim Types	📦2.2.0-snapshot	This IG
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.careTeam:OverallClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:OverallClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127	Not State	Unknown
Claim.careTeam:ItemClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:ItemClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127	Not State	Unknown
Claim.supportingInfo.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:PatientEvent.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:PatientEvent.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:PatientEvent.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdmissionDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:AdmissionDates.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdmissionDates.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:DischargeDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:DischargeDates.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:DischargeDates.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	required	https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.0-snapshot	This IG
Claim.item.category	Base	required	https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365	Not State	Unknown
Claim.item.productOrService	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.0-snapshot	This IG
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
FullDateRule	error	Claim.supportingInfo:PatientEvent.timing[x]:timingDate, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.start, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.end, Claim.supportingInfo:AdmissionDates.timing[x]:timingDate, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.start, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.end, Claim.supportingInfo:DischargeDates.timing[x], Claim.accident.date, Claim.item.serviced[x]:servicedDate, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	Dates need to be a full date - YYYY-MM-DD	$this.toString().length() = 10
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Summary

Mandatory: 1 element(9 nested mandatory elements)
Must-Support: 72 elements
Fixed: 2 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

• PAS Identifier (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-identifier|2.2.0-snapshot)
• PAS Beneficiary Patient (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary|2.2.0-snapshot)
• PAS Insurer Organization (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer|2.2.0-snapshot)
• PAS Requestor Organization (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor|2.2.0-snapshot)
• PAS PractitionerRole (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole|2.2.0-snapshot)
• PAS Organization Base Profile (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-organization|2.2.0-snapshot)
• PAS Coverage (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage|2.2.0-snapshot)
• PAS Quantity (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-quantity|2.2.0-snapshot)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd|2.2.0-snapshot

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.careTeam
• The element 1 is sliced based on the value of Claim.supportingInfo
• The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]
• The element 1 is sliced based on the value of Claim.item.serviced[x]

Maturity: 4

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	This is an abstract profile. Child profiles: PASClaimInquiry, PASClaimUpdate, PASClaim, PASClaimInquiry, PASClaimUpdate, PASClaim Preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:transmissionIdentifiers	S	0..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
extension:levelOfServiceType	S	0..1	CodeableConcept	A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:conditionCode	S	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
extension:homeHealthCareInformation	S	0..1	(Complex)	Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation
extension:authorizationNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	PASIdentifier(2.2.0-snapshot)	Business identifier for claim
Slices for extension				Content/Rules for all slices
extension:subDepartment	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
extension:jurisdiction	S	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: UspsTwoLetterAlphabeticCodes (7.0.0) (required)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	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 Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
patient	SΣ	1..1	Reference(PAS Beneficiary Patient(2.2.0-snapshot))	The recipient of the products and services
created	Σ	1..1	dateTime	Resource creation date
insurer	SΣ	1..1	Reference(PAS Insurer Organization(2.2.0-snapshot))	Target
provider	SΣ	1..1	Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
careTeam:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
careTeam:OverallClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
careTeam:ItemClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: false
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Slices for supportingInfo	S	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible)
supportingInfo:PatientEvent	S	0..1	BackboneElement	Information about the dates of the event that are being requested.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
supportingInfo:AdmissionDates	S	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
supportingInfo:DischargeDates	S	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
timing[x]	SC	1..1	date	When it occurred Constraints: FullDateRule
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.0-snapshot) (required)
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.0-snapshot) (required)
insurance	SΣ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	SΣ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
coverage	SΣ	1..1	Reference(PAS Coverage(2.2.0-snapshot))	Insurance information
accident	S	0..1	BackboneElement	Details of the event
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date	SC	1..1	date	When the incident occurred Constraints: FullDateRule
type	S	0..1	CodeableConcept	The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x]	S	0..1	Address	Where the event occurred
item	S	0..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:itemTraceNumber	S	0..*	PASIdentifier(2.2.0-snapshot)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
extension:authorizationNumber	S	0..1	string	A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
extension:requestType	S	0..1	CodeableConcept	A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:certificationType	S	0..1	CodeableConcept	A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:productOrServiceCodeEnd	S	0..1	CodeableConcept	Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
category	S	0..1	CodeableConcept	Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
Slices for serviced[x]	S	0..1		Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	SC	0..1	date	Date or dates of service or product delivery Constraints: FullDateRule
serviced[x]:servicedPeriod	S	0..1	Period	Date or dates of service or product delivery
start	ΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
location[x]	S	0..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.0-snapshot) (required)
quantity	S	0..1	PASQuantity(2.2.0-snapshot)	Count of products or services
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	required	Claim Types	📦2.2.0-snapshot	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.careTeam:OverallClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:OverallClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127	Not State	Unknown
Claim.careTeam:ItemClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:ItemClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127	Not State	Unknown
Claim.supportingInfo.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:PatientEvent.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:AdmissionDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:DischargeDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.0-snapshot	This IG
Claim.accident.type	Base	required	https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.0-snapshot	This IG
Claim.item.category	Base	required	https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365	Not State	Unknown
Claim.item.productOrService	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.0-snapshot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
FullDateRule	error	Claim.supportingInfo:PatientEvent.timing[x]:timingDate, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.start, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.end, Claim.supportingInfo:AdmissionDates.timing[x]:timingDate, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.start, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.end, Claim.supportingInfo:DischargeDates.timing[x], Claim.accident.date, Claim.item.serviced[x]:servicedDate, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	Dates need to be a full date - YYYY-MM-DD	$this.toString().length() = 10
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	This is an abstract profile. Child profiles: PASClaimInquiry, PASClaimUpdate, PASClaim, PASClaimInquiry, PASClaimUpdate, PASClaim Preauthorization
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:transmissionIdentifiers	S	0..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
extension:levelOfServiceType	S	0..1	CodeableConcept	A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:conditionCode	S	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
extension:homeHealthCareInformation	S	0..1	(Complex)	Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation
extension:authorizationNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
identifier	S	0..*	PASIdentifier(2.2.0-snapshot)	Business identifier for claim
system		1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>'
status	S	1..1	code	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 Required Pattern: active
type		1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
use	S	1..1	code	claim | preauthorization | predetermination Required Pattern: preauthorization
patient	S	1..1	Reference(PAS Beneficiary Patient(2.2.0-snapshot))	The recipient of the products and services
insurer	S	1..1	Reference(PAS Insurer Organization(2.2.0-snapshot))	Target
provider	S	1..1	Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Party responsible for the claim
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
careTeam:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
role	S	0..1	CodeableConcept	Function within the team
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization
careTeam:OverallClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
value[x]	S	0..1	boolean	Value of extension Fixed Value: true
role		0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
careTeam:ItemClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
value[x]	S	0..1	boolean	Value of extension Fixed Value: false
role		0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Slices for supportingInfo	S	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible)
supportingInfo:PatientEvent	S	0..1	BackboneElement	Information about the dates of the event that are being requested.
category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
Slices for timing[x]	S	1..1	date, Period	When it occurred Slice: Unordered, Open by type:$this
timing[x]:timingDate	SC	0..1	date	When it occurred
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SC	0..1	dateTime	Starting time with inclusive boundary
end	SC	0..1	dateTime	End time with inclusive boundary, if not ongoing
value[x]		0..0		Data to be provided
supportingInfo:AdmissionDates	S	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
Slices for timing[x]	S	1..1	date, Period	When it occurred Slice: Unordered, Open by type:$this
timing[x]:timingDate	SC	0..1	date	When it occurred
timing[x]:timingPeriod	S	0..1	Period	When it occurred
start	SC	0..1	dateTime	Starting time with inclusive boundary
end	SC	0..1	dateTime	End time with inclusive boundary, if not ongoing
value[x]		0..0		Data to be provided
supportingInfo:DischargeDates	S	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
timing[x]	SC	1..1	date	When it occurred
value[x]		0..0		Data to be provided
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information
sequence	S	1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.0-snapshot) (required)
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.0-snapshot) (required)
insurance	S	1..*	BackboneElement	Patient insurance information
sequence	S	1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication Required Pattern: true
coverage	S	1..1	Reference(PAS Coverage(2.2.0-snapshot))	Insurance information
accident	S	0..1	BackboneElement	Details of the event
date	SC	1..1	date	When the incident occurred
type	S	0..1	CodeableConcept	The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x]	S	0..1	Address	Where the event occurred
item	S	0..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:itemTraceNumber	S	0..*	PASIdentifier(2.2.0-snapshot)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
extension:authorizationNumber	S	0..1	string	A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
extension:requestType	S	0..1	CodeableConcept	A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:certificationType	S	0..1	CodeableConcept	A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:productOrServiceCodeEnd	S	0..1	CodeableConcept	Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
sequence	S	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
category	S	0..1	CodeableConcept	Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
Slices for serviced[x]	S	0..1	date, Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	SC	0..1	date	Date or dates of service or product delivery
serviced[x]:servicedPeriod	S	0..1	Period	Date or dates of service or product delivery
start	C	0..1	dateTime	Starting time with inclusive boundary
end	C	0..1	dateTime	End time with inclusive boundary, if not ongoing
location[x]	S	0..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.0-snapshot) (required)
quantity	S	0..1	PASQuantity(2.2.0-snapshot)	Count of products or services
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.type	Base	required	Claim Types	📦2.2.0-snapshot	This IG
Claim.careTeam:OverallClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:OverallClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127	Not State	Unknown
Claim.careTeam:ItemClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:ItemClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127	Not State	Unknown
Claim.supportingInfo.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.0-snapshot	This IG
Claim.accident.type	Base	required	https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.0-snapshot	This IG
Claim.item.category	Base	required	https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365	Not State	Unknown
Claim.item.productOrService	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.0-snapshot	This IG

Constraints

Id

Grade

Path(s)

Description

Expression

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	This is an abstract profile. Child profiles: PASClaimInquiry, PASClaimUpdate, PASClaim, PASClaimInquiry, PASClaimUpdate, PASClaim Preauthorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text 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..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:transmissionIdentifiers	S	0..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
extension:levelOfServiceType	S	0..1	CodeableConcept	A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:conditionCode	S	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
extension:homeHealthCareInformation	S	0..1	(Complex)	Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation
extension:authorizationNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	PASIdentifier(2.2.0-snapshot)	Business identifier for claim
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:subDepartment	S	0..1	string	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
extension:jurisdiction	S	0..1	CodeableConcept	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: UspsTwoLetterAlphabeticCodes (7.0.0) (required)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	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 Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
patient	SΣ	1..1	Reference(PAS Beneficiary Patient(2.2.0-snapshot))	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	SΣ	1..1	Reference(PAS Insurer Organization(2.2.0-snapshot))	Target
provider	SΣ	1..1	Reference(PAS Requestor Organization(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment referral
facility		0..1	Reference(Location)	Servicing facility
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean)
careTeam:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	boolean	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
careTeam:OverallClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: true
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
careTeam:ItemClaimMember	S	0..*	BackboneElement	Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:careTeamClaimScope	S	1..1	(Complex)	Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
value[x]	S	0..1	boolean	Value of extension Fixed Value: false
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Order of care team
provider	S	1..1	Reference(PAS Organization Base Profile(2.2.0-snapshot) | PAS PractitionerRole(2.2.0-snapshot))	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	0..1	CodeableConcept	Function within the team Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Slices for supportingInfo	S	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible)
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:PatientEvent	S	0..1	BackboneElement	Information about the dates of the event that are being requested.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:AdmissionDates	S	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Slices for timing[x]	S	1..1		When it occurred Slice: Unordered, Closed by type:$this
timingDate			date
timingPeriod			Period
timing[x]:timingDate	SC	0..1	date	When it occurred Constraints: FullDateRule
timing[x]:timingPeriod	S	0..1	Period	When it occurred
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:DischargeDates	S	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.0-snapshot) (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]	SC	1..1	date	When it occurred Constraints: FullDateRule
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.0-snapshot) (required)
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.0-snapshot) (required)
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
insurance	SΣ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	SΣ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	SΣ	1..1	Reference(PAS Coverage(2.2.0-snapshot))	Insurance information
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident	S	0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date	SC	1..1	date	When the incident occurred Constraints: FullDateRule
type	S	0..1	CodeableConcept	The nature of the accident Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362 (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x]	S	0..1	Address	Where the event occurred
item	S	0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:itemTraceNumber	S	0..*	PASIdentifier(2.2.0-snapshot)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
extension:authorizationNumber	S	0..1	string	A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
extension:administrationReferenceNumber	S	0..1	string	A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
extension:requestType	S	0..1	CodeableConcept	A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:certificationType	S	0..1	CodeableConcept	A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:productOrServiceCodeEnd	S	0..1	CodeableConcept	Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.0-snapshot) (required)
category	S	0..1	CodeableConcept	Benefit classification Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.0-snapshot) (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.0-snapshot) (required)
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Slices for serviced[x]	S	0..1		Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	SC	0..1	date	Date or dates of service or product delivery Constraints: FullDateRule
serviced[x]:servicedPeriod	S	0..1	Period	Date or dates of service or product delivery
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
location[x]	S	0..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.0-snapshot) (required)
quantity	S	0..1	PASQuantity(2.2.0-snapshot)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
subDetail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	required	Claim Types	📦2.2.0-snapshot	This IG
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.careTeam:OverallClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:OverallClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127	Not State	Unknown
Claim.careTeam:ItemClaimMember.​role	Base	required	https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98	Not State	Unknown
Claim.careTeam:ItemClaimMember.​qualification	Base	required	https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127	Not State	Unknown
Claim.supportingInfo.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:PatientEvent.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:PatientEvent.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:PatientEvent.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdmissionDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:AdmissionDates.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdmissionDates.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:DischargeDates.​category	Base	extensible	PAS Supporting Info Type Value Set	📍2.2.0-snapshot	This IG
Claim.supportingInfo:DischargeDates.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:DischargeDates.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.0-snapshot	This IG
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	required	https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.0-snapshot	This IG
Claim.item.category	Base	required	https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365	Not State	Unknown
Claim.item.productOrService	Base	required	X12 278 Requested Service Type	📍2.2.0-snapshot	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.0-snapshot	This IG
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.0-snapshot	This IG
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
FullDateRule	error	Claim.supportingInfo:PatientEvent.timing[x]:timingDate, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.start, Claim.supportingInfo:PatientEvent.timing[x]:timingPeriod.end, Claim.supportingInfo:AdmissionDates.timing[x]:timingDate, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.start, Claim.supportingInfo:AdmissionDates.timing[x]:timingPeriod.end, Claim.supportingInfo:DischargeDates.timing[x], Claim.accident.date, Claim.item.serviced[x]:servicedDate, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	Dates need to be a full date - YYYY-MM-DD	$this.toString().length() = 10
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Summary

Mandatory: 1 element(9 nested mandatory elements)
Must-Support: 72 elements
Fixed: 2 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

• PAS Identifier (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-identifier|2.2.0-snapshot)
• PAS Beneficiary Patient (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary|2.2.0-snapshot)
• PAS Insurer Organization (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer|2.2.0-snapshot)
• PAS Requestor Organization (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor|2.2.0-snapshot)
• PAS PractitionerRole (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole|2.2.0-snapshot)
• PAS Organization Base Profile (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-organization|2.2.0-snapshot)
• PAS Coverage (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage|2.2.0-snapshot)
• PAS Quantity (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-quantity|2.2.0-snapshot)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType|2.2.0-snapshot
• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd|2.2.0-snapshot

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.careTeam
• The element 1 is sliced based on the value of Claim.supportingInfo
• The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]
• The element 1 is sliced based on the value of Claim.item.serviced[x]

Maturity: 4