Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

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 2.0.1 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

Resource Profile: PAS Claim Update

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update Version: 2.0.1
Standards status: Trial-use Maturity Level: 3 Computable Name: PASClaimUpdate

PAS constraints on Claim resource when submitting an update to a previous PAS prior authorization request

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from PASClaim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* PASClaim Claim, Pre-determination or Pre-authorization
... supportingInfo 0..* BackboneElement Supporting information
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... infoChanged 0..1 code A code indicating how the piece of information has changed.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
Binding: PAS Information Change Mode Value Set (required)
.... Slices for modifierExtension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... modifierExtension:infoCancelledFlag 0..1 InfoCancelledFlag Indicates that this piece of information is not to be used.
... item
.... Slices for extension Content/Rules for all slices
..... infoChanged 0..1 code A code indicating how the piece of information has changed.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
Binding: PAS Information Change Mode Value Set (required)
.... Slices for modifierExtension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... modifierExtension:infoCancelledFlag 0..1 InfoCancelledFlag Indicates that this piece of information is not to be used.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* PASClaim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... levelOfServiceType S 0..1 CodeableConcept A code specifying the level of service being requested (UM06)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode
Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


.... conditionCode 0..* (Complex) Used to indicate condition codes for various requests for service.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
.... homeHealthCareInformation 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
.... encounter S 0..1 (Complex) Information about a hospital claim being requested.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter"
..... value[x] 1..1 Reference(PAS Encounter) Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: preauthorization
... patient Σ 1..1 Reference(PAS Beneficiary Patient) The recipient of the products and services
... created Σ 1..1 dateTime Resource creation date
... insurer SΣ 1..1 Reference(PAS Insurer Organization) Target
... provider SΣ 1..1 Reference(PAS Requestor Organization | PAS PractitionerRole) 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 as boolean
.... careTeam:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... careTeamClaimScope S 1..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Order of care team
..... provider S 1..1 Reference(PAS Organization Base Profile | PAS PractitionerRole) Practitioner or organization
..... 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 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
...... careTeamClaimScope S 1..1 (Complex) Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... careTeam:ItemClaimMember 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
...... careTeamClaimScope S 1..1 (Complex) Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... infoChanged 0..1 code A code indicating how the piece of information has changed.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
Binding: PAS Information Change Mode Value Set (required)
..... Slices for modifierExtension ?!Σ 0..* Extension Extension
Slice: Unordered, Open by value:url
...... modifierExtension:infoCancelledFlag ?! 0..1 InfoCancelledFlag Indicates that this piece of information is not to be used.
..... sequence S 1..1 positiveInt Information instance identifier
..... category S 1..1 CodeableConcept Classification of the supplied information
Binding: PAS Supporting Info Type Value Set (extensible)
.... supportingInfo:PatientEvent 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 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientEvent
..... Slices for timing[x] S 1..1 When it occurred
Slice: Unordered, Closed by type:$this
...... timingDate date
...... timingPeriod Period
...... timing[x]:timingDate C 0..1 date When it occurred
FullDateRule: Dates need to be a full date - YYYY-MM-DD
...... timing[x]:timingPeriod 0..1 Period When it occurred
.... supportingInfo:AdmissionDates 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 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admissionDates
..... Slices for timing[x] S 1..1 When it occurred
Slice: Unordered, Closed by type:$this
...... timingDate date
...... timingPeriod Period
...... timing[x]:timingDate C 0..1 date When it occurred
FullDateRule: Dates need to be a full date - YYYY-MM-DD
...... timing[x]:timingPeriod 0..1 Period When it occurred
.... supportingInfo:DischargeDates 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 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: dischargeDates
..... Slices for timing[x] S 1..1 When it occurred
Slice: Unordered, Closed by type:$this
...... timingDate date
...... timingPeriod Period
...... timing[x]:timingDate C 0..1 date When it occurred
FullDateRule: Dates need to be a full date - YYYY-MM-DD
...... timing[x]:timingPeriod 0..1 Period When it occurred
.... supportingInfo:AdditionalInformation S 0..* BackboneElement Send additional paperwork or supporting information for the request. This can be most commonly a DocumentReference profile although any type of information is allowed.
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Information instance identifier
..... category S 1..1 CodeableConcept Classification of the supplied information
Binding: PAS Supporting Info Type Value Set (extensible)
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: additionalInformation
..... value[x] S 1..1 Reference(US Core DocumentReference Profile | Resource) Data to be provided
.... supportingInfo:MessageText S 0..* BackboneElement Send text messages to the UMO.
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Information instance identifier
..... category S 1..1 CodeableConcept Classification of the supplied information
Binding: PAS Supporting Info Type Value Set (extensible)
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: freeFormMessage
..... value[x] S 1..1 string Data to be provided
... diagnosis S 0..* BackboneElement Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
.... Slices for extension Content/Rules for all slices
..... recordedDate S 0..1 date The date that a diagnosis was recorded. (HIxx-4)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: X12 278 Diagnosis Code Value Set (required)
.... type S 0..1 CodeableConcept Timing or nature of the diagnosis
Binding: X12 278 Diagnosis Type Value Set (required)
... 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) Insurance information
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 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.

... item S 1..* BackboneElement Product or service provided
.... Slices for extension Content/Rules for all slices
..... itemTraceNumber S 0..* PASIdentifier Uniquely identifies this claim item. (2000F-TRN)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
..... authorizationNumber S 0..1 string A string assigned by the UMO to an authorized review outcome associated with this service item.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
..... administrationReferenceNumber S 0..1 string A string assigned by the UMO to the original disallowed review outcome associated with this service item.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
..... requestType S 0..1 CodeableConcept A code that identifies the type of service being requested.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType
Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


..... certificationType S 0..1 CodeableConcept A code representing the type of certification being requested (UM02)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType
Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


..... productOrServiceCodeEnd 0..1 CodeableConcept Used to provide the last code in a series of codes for the service being requested.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
..... epsdtIndicator S 0..1 boolean An indicator of whether early and periodic screen for diagnosis and treatment of children is involved.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
..... nursingHomeResidentialStatus S 0..1 (Complex) A code specifying the status of a nursing home resident at the time of service. (SV209)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"
..... nursingHomeLevelOfCare S 0..1 CodeableConcept A code specifying the level of care provided by a nursing home facility. (SV120, SV210)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. 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.


..... revenueUnitRateLimit S 0..1 decimal The limit on the rate per unit of revenue for hospital accomodation. (SV206)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
..... requestedService S 0..1 Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order) The details of the service being requested.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
..... infoChanged 0..1 code A code indicating how the piece of information has changed.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
Binding: PAS Information Change Mode Value Set (required)
.... Slices for modifierExtension ?!Σ 0..* Extension Extension
Slice: Unordered, Open by value:url
..... modifierExtension:infoCancelledFlag ?! 0..1 InfoCancelledFlag Indicates that this piece of information is not to be used.
.... sequence S 1..1 positiveInt Item instance identifier
.... 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: AHA NUBC Revenue Value Set (required)
.... category S 1..1 CodeableConcept Since PAS requests only have item-level information, a category is required for conformance with the X12 278 request.
Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: X12 278 Requested Service Type (required)
.... modifier S 0..* CodeableConcept Product or service billing modifiers
Binding: X12 278 Requested Service Modifier Type (required)
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] S 0..1 CodeableConcept Place of service or where product was supplied
Binding: X12 278 Health Care Service Location Type Value Set (required)
.... quantity S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredPattern: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.userequiredPattern: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryextensiblePASSupportingInfoType
http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType
from this IG
Claim.supportingInfo:PatientEvent.categoryexamplePattern: patientEvent
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:AdmissionDates.categoryexamplePattern: admissionDates
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:DischargeDates.categoryexamplePattern: dischargeDates
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:AdditionalInformation.categoryextensiblePattern: additionalInformation
http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType
from this IG
Claim.supportingInfo:MessageText.categoryextensiblePattern: freeFormMessage
http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType
from this IG
Claim.diagnosis.diagnosis[x]requiredX12278DiagnosisCodes
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisCodes
from this IG
Claim.diagnosis.typerequiredX12278DiagnosisType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisType
from this IG
Claim.accident.typerequiredhttps://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362
https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362
Claim.item.revenuerequiredAHANUBCRevenueCodes (a valid code from https://www.nubc.org/revenue-code)
http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes
from this IG
Claim.item.categoryrequiredhttps://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365
https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365
Claim.item.productOrServicerequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG
Claim.item.modifierrequiredX12278RequestedServiceModifierType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType
from this IG
Claim.item.location[x]requiredX12278LocationType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278LocationType
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* PASClaim Claim, Pre-determination or Pre-authorization
... 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 BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... levelOfServiceType S 0..1 CodeableConcept A code specifying the level of service being requested (UM06)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode
Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/06/00/1338 (required): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


.... conditionCode 0..* (Complex) Used to indicate condition codes for various requests for service.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
.... homeHealthCareInformation 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
.... encounter S 0..1 (Complex) Information about a hospital claim being requested.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter"
..... value[x] 1..1 Reference(PAS Encounter) Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 PASIdentifier Business identifier for claim
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: preauthorization
... patient Σ 1..1 Reference(PAS Beneficiary Patient) 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) Target
... provider SΣ 1..1 Reference(PAS Requestor Organization | PAS PractitionerRole) 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 as boolean
.... careTeam:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... careTeamClaimScope S 1..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Order of care team
..... provider S 1..1 Reference(PAS Organization Base Profile | PAS PractitionerRole) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role S 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

..... qualification S 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:OverallClaimMember 0..* BackboneElement Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... careTeamClaimScope S 1..1 (Complex) Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
....... value[x] 0..1 boolean Value of extension
Fixed Value: true
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
.... careTeam:ItemClaimMember 0..* BackboneElement Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
...... careTeamClaimScope S 1..1 (Complex) Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..0
....... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
....... value[x] 0..1 boolean Value of extension
Fixed Value: false
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98 (required): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... infoChanged 0..1 code A code indicating how the piece of information has changed.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
Binding: PAS Information Change Mode Value Set (required)
..... Slices for modifierExtension ?!Σ 0..* Extension Extension
Slice: Unordered, Open by value:url
...... modifierExtension:infoCancelledFlag ?! 0..1 InfoCancelledFlag Indicates that this piece of information is not to be used.
..... sequence S 1..1 positiveInt Information instance identifier
..... category S 1..1 CodeableConcept Classification of the supplied information
Binding: PAS Supporting Info Type Value Set (extensible)
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:PatientEvent 0..1 BackboneElement Information about the dates of the event that are being requested.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientEvent
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... Slices for timing[x] S 1..1 When it occurred
Slice: Unordered, Closed by type:$this
...... timingDate date
...... timingPeriod Period
...... timing[x]:timingDate C 0..1 date When it occurred
FullDateRule: Dates need to be a full date - YYYY-MM-DD
...... timing[x]:timingPeriod 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 ΣC 0..1 dateTime Starting time with inclusive boundary
FullDateRule: Dates need to be a full date - YYYY-MM-DD
....... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
FullDateRule: Dates need to be a full date - YYYY-MM-DD
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:AdmissionDates 0..1 BackboneElement Information about the admission dates of a hospital admission being requested.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admissionDates
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... Slices for timing[x] S 1..1 When it occurred
Slice: Unordered, Closed by type:$this
...... timingDate date
...... timingPeriod Period
...... timing[x]:timingDate C 0..1 date When it occurred
FullDateRule: Dates need to be a full date - YYYY-MM-DD
...... timing[x]:timingPeriod 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 ΣC 0..1 dateTime Starting time with inclusive boundary
FullDateRule: Dates need to be a full date - YYYY-MM-DD
....... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
FullDateRule: Dates need to be a full date - YYYY-MM-DD
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:DischargeDates 0..1 BackboneElement Information about the discharge dates of a hospital admission being requested.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: dischargeDates
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... Slices for timing[x] S 1..1 When it occurred
Slice: Unordered, Closed by type:$this
...... timingDate date
...... timingPeriod Period
...... timing[x]:timingDate C 0..1 date When it occurred
FullDateRule: Dates need to be a full date - YYYY-MM-DD
...... timing[x]:timingPeriod 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 ΣC 0..1 dateTime Starting time with inclusive boundary
FullDateRule: Dates need to be a full date - YYYY-MM-DD
....... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
FullDateRule: Dates need to be a full date - YYYY-MM-DD
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:AdditionalInformation S 0..* BackboneElement Send additional paperwork or supporting information for the request. This can be most commonly a DocumentReference profile although any type of information is allowed.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Information instance identifier
..... category S 1..1 CodeableConcept Classification of the supplied information
Binding: PAS Supporting Info Type Value Set (extensible)
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: additionalInformation
....... 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.

..... value[x] S 1..1 Reference(US Core DocumentReference Profile | Resource) Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:MessageText S 0..* BackboneElement Send text messages to the UMO.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Information instance identifier
..... category S 1..1 CodeableConcept Classification of the supplied information
Binding: PAS Supporting Info Type Value Set (extensible)
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: freeFormMessage
....... 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.

..... value[x] S 1..1 string Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis S 0..* BackboneElement Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... recordedDate S 0..1 date The date that a diagnosis was recorded. (HIxx-4)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: X12 278 Diagnosis Code Value Set (required)
.... type S 0..1 CodeableConcept Timing or nature of the diagnosis
Binding: X12 278 Diagnosis Type Value Set (required)
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
Required Pattern: true
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(PAS Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 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] 0..1 Address Where the event occurred
... item S 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... itemTraceNumber S 0..* PASIdentifier Uniquely identifies this claim item. (2000F-TRN)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
..... authorizationNumber S 0..1 string A string assigned by the UMO to an authorized review outcome associated with this service item.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
..... administrationReferenceNumber S 0..1 string A string assigned by the UMO to the original disallowed review outcome associated with this service item.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
..... requestType S 0..1 CodeableConcept A code that identifies the type of service being requested.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType
Binding: https://valueset.x12.org/x217/005010/request/2000E/UM/1/01/00/1525 (required): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


..... certificationType S 0..1 CodeableConcept A code representing the type of certification being requested (UM02)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType
Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/02/00/1322 (required): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


..... productOrServiceCodeEnd 0..1 CodeableConcept Used to provide the last code in a series of codes for the service being requested.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
..... epsdtIndicator S 0..1 boolean An indicator of whether early and periodic screen for diagnosis and treatment of children is involved.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
..... nursingHomeResidentialStatus S 0..1 (Complex) A code specifying the status of a nursing home resident at the time of service. (SV209)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"
...... value[x] 0..1 CodeableConcept Value of extension
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV2/1/09/00/1345 (required): Codes specifying the status of a nursing home resident at the time 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.

..... nursingHomeLevelOfCare S 0..1 CodeableConcept A code specifying the level of care provided by a nursing home facility. (SV120, SV210)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare
Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. 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.


..... revenueUnitRateLimit S 0..1 decimal The limit on the rate per unit of revenue for hospital accomodation. (SV206)
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
..... requestedService S 0..1 Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order) The details of the service being requested.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
..... infoChanged 0..1 code A code indicating how the piece of information has changed.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
Binding: PAS Information Change Mode Value Set (required)
.... Slices for modifierExtension ?!Σ 0..* Extension Extension
Slice: Unordered, Open by value:url
..... modifierExtension:infoCancelledFlag ?! 0..1 InfoCancelledFlag Indicates that this piece of information is not to be used.
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... revenue S 0..1 CodeableConcept Revenue or cost center code
Binding: AHA NUBC Revenue Value Set (required)
.... category S 1..1 CodeableConcept Since PAS requests only have item-level information, a category is required for conformance with the X12 278 request.
Binding: https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365 (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.

.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: X12 278 Requested Service Type (required)
.... modifier S 0..* CodeableConcept Product or service billing modifiers
Binding: X12 278 Requested Service Modifier Type (required)
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] S 0..1 CodeableConcept Place of service or where product was supplied
Binding: X12 278 Health Care Service Location Type Value Set (required)
.... quantity S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1 SimpleQuantity Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
......