This profile defines constraints and extensions used when updating a previously submitted Claim instance.

Conformance Requirements

• The Claim instance of the update Bundle SHALL reference the updated Claim instance within the Claim.related.claim element. Note that the presence of this reference and the requirement that referenced instances be included in the submitted Bundle implies that the instance representing the prior version of the Claim SHALL be included in the update Bundle.^§prof-4
• The Claim instance of the update Bundle SHALL contain within the Claim.item element each item requested in the updated claim and any prior versions of the claim, including requested items that have been added, modified, deleted, or left unchanged during this or previous updates.^§prof-5
• The Claim instance of the update Bundle SHALL contain within the Claim.supportingInfo element each piece of supporting documentation submitted with the updated claim and any prior versions of claim, including supporting documentation that has been added, modified, deleted, or left unchanged during this or previous updates.^§prof-6
• Each Claim.item entry that represents an item no longer being requested, whether removed in this update or a previous one, SHALL be flagged using the infoCancelledFlag modifierExtension and SHALL have the code 3 (Cancel) in the Certification Type extension.^§prof-7
• Each Claim.supportingInfo entry that is no longer to be used when evaluating the request, whether removed in this update or a previous one, SHALL be flagged using the infoCancelledFlag modifierExtension.^§prof-8
• Each Claim.item and Claim.supportingInfo entry that has been changed as a part of this most recent update, including removal, SHALL be flagged using the changed extension with a value of changed.^§prof-9
• Each Claim.item and Claim.supportingInfo entry that has been added as a part of this most recent update, SHALL be flagged using the changed extension with a value of added.^§prof-10

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	PASClaimBase(2.2.1)	Preauthorization
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.Slices for extension				Content/Rules for all slices
Claim.Slices for extension.extension:transmissionIdentifiers	S This element must be supported.	0..1	(Complex)	Transmission Identifiers URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
Claim.Slices for extension.extension:levelOfServiceType	S This element must be supported.	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.
Claim.Slices for extension.extension:conditionCode	S This element must be supported.	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
Claim.Slices for extension.extension:homeHealthCareInformation	S This element must be supported.	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
Claim.Slices for extension.extension:authorizationNumber	S This element must be supported.	0..1	string	Authorization Number URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
Claim.Slices for extension.extension:administrationReferenceNumber	S This element must be supported.	0..1	string	Administration Reference Number URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
Claim.Slices for extension.extension:encounter	S This element must be supported.	0..1	(Complex)	Information about a hospital claim being requested. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
Claim.Slices for extension.extension:encounter.extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:encounter.url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter"
Claim.Slices for extension.extension:encounter.value[x]		0..1	Reference(PAS Encounter(2.2.1))	Encounters associated with the listed treatments
Claim.Slices for extension.extension:certificationType	S This element must be supported.	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.
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier	S This element must be supported.	1..2	PASIdentifier(2.2.1)	Business identifier for claim
Claim.identifier.Slices for extension				Content/Rules for all slices
Claim.identifier.Slices for extension.extension:subDepartment	S This element must be supported.	0..1	string	Identifier Sub-Department URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
Claim.identifier.Slices for extension.extension:jurisdiction	S This element must be supported.	0..1	CodeableConcept	Identifier Jurisdiction URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: UspsTwoLetterAlphabeticCodes (7.0.0) (required)
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.identifier.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	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
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Beneficiary Patient(2.2.1))	The recipient of the products and services
Claim.created	Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Insurer Organization(2.2.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Requestor Organization(2.2.1) | PAS PractitionerRole(2.2.1))	Party responsible for the claim
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.related	S This element must be supported.	1..1	BackboneElement	Prior or corollary claims
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim	S This element must be supported.	1..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship	S This element must be supported.	1..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. Required Pattern: At least the following
Claim.related.relationship.id		0..1	string	Unique id for inter-element referencing
Claim.related.relationship.extension		0..*	Extension	Additional content defined by implementations
Claim.related.relationship.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.related.relationship.coding.id		0..1	string	Unique id for inter-element referencing
Claim.related.relationship.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.related.relationship.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship
Claim.related.relationship.coding.version		0..1	string	Version of the system - if relevant
Claim.related.relationship.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: prior
Claim.related.relationship.coding.display		0..1	string	Representation defined by the system
Claim.related.relationship.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.related.relationship.text		0..1	string	Plain text representation of the concept
Claim.Slices for careTeam	S This element must be supported.	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) Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:All Slices				Content/Rules for all slices
Claim.Slices for careTeam.careTeam:All Slices.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:All Slices.Slices for extension.extension:careTeamClaimScope	S This element must be supported.	1..1	boolean	Care Team Claim Scope URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
Claim.Slices for careTeam.careTeam:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.careTeam:All Slices.sequence	S This element must be supported.	1..1	positiveInt	Order of care team
Claim.Slices for careTeam.careTeam:All Slices.provider	S This element must be supported.	1..1	Reference(PAS Organization Base Profile(2.2.1) | PAS PractitionerRole(2.2.1))	Practitioner or organization
Claim.Slices for careTeam.careTeam:All Slices.role	S This element must be supported.	0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.Slices for careTeam.careTeam:All Slices.qualification	S This element must be supported.	0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.Slices for careTeam.careTeam:OverallClaimMember	S This element must be supported.	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.
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension				Content/Rules for all slices
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope	S This element must be supported.	1..1	(Complex)	Care Team Claim Scope URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.value[x]	S This element must be supported.	0..1	boolean	Value of extension Fixed Value: true
Claim.Slices for careTeam.careTeam:OverallClaimMember.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.careTeam:OverallClaimMember.sequence		1..1	positiveInt	Order of care team
Claim.Slices for careTeam.careTeam:OverallClaimMember.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.Slices for careTeam.careTeam:OverallClaimMember.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.
Claim.Slices for careTeam.careTeam:OverallClaimMember.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
Claim.Slices for careTeam.careTeam:ItemClaimMember	S This element must be supported.	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.
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension				Content/Rules for all slices
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope	S This element must be supported.	1..1	(Complex)	Care Team Claim Scope URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.value[x]	S This element must be supported.	0..1	boolean	Value of extension Fixed Value: false
Claim.Slices for careTeam.careTeam:ItemClaimMember.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.careTeam:ItemClaimMember.sequence		1..1	positiveInt	Order of care team
Claim.Slices for careTeam.careTeam:ItemClaimMember.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.Slices for careTeam.careTeam:ItemClaimMember.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.
Claim.Slices for careTeam.careTeam:ItemClaimMember.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Claim.Slices for supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for extension.extension:infoChanged	S This element must be supported.	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: PASInformationChangeMode (2.2.1) (required)
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for modifierExtension.modifierExtension:infoCancelledFlag	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	0..1	boolean	Indicates that this piece of information is not to be used. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence	S This element must be supported.	1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.1) (extensible)
Claim.Slices for supportingInfo.supportingInfo:PatientEvent	S This element must be supported.	0..1	BackboneElement	Information about the dates of the event that are being requested.
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.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
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x]	S This element must be supported.	1..1		When it occurred Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x]				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingDate	S This element must be supported. C	0..1	date	When it occurred Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod	S This element must be supported.	0..1	Period	When it occurred
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates	S This element must be supported.	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.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
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x]	S This element must be supported.	1..1		When it occurred Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x]				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingDate	S This element must be supported. C	0..1	date	When it occurred Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod	S This element must be supported.	0..1	Period	When it occurred
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:DischargeDates	S This element must be supported.	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.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
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.timing[x]	S This element must be supported. C	1..1	date	When it occurred Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation	S This element must be supported.	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.
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension.extension:documentInformation	S This element must be supported.	1..1	(Complex)	Document Information URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.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
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: additionalInformation
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.value[x]	S This element must be supported.	1..1	Reference(PAS Document Reference | US Core QuestionnaireResponse Profile(7.0.0) | US Core AllergyIntolerance Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core DiagnosticReport Profile for Laboratory Results Reporting(7.0.0) | US Core Immunization Profile(7.0.0) | US Core MedicationRequest Profile(7.0.0) | US Core Procedure Profile(7.0.0) | US Core ServiceRequest Profile(7.0.0) | US Core Observation Clinical Result Profile(7.0.0) | US Core Simple Observation Profile(7.0.0) | US Core Vital Signs Profile(7.0.0) | NutritionOrder | DeviceRequest | Bundle)	Data to be provided
Claim.Slices for supportingInfo.supportingInfo:MessageText	S This element must be supported.	0..*	BackboneElement	Send text messages to the UMO.
Claim.Slices for supportingInfo.supportingInfo:MessageText.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:MessageText.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:MessageText.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
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: freeFormMessage
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:MessageText.value[x]	S This element must be supported.	1..1	string	Data to be provided
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..1	date	The date that a diagnosis was recorded. (HIxx-4) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence	S This element must be supported.	1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.1) (required)
Claim.diagnosis.type	S This element must be supported.	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.1) (required)
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	S This element must be supported. Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Coverage(2.2.1))	Insurance information
Claim.accident	S This element must be supported.	0..1	BackboneElement	Details of the event
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date	S This element must be supported. C	1..1	date	When the incident occurred Constraints: FullDateRule
Claim.accident.type	S This element must be supported.	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.
Claim.accident.location[x]	S This element must be supported.	0..1	Address	Where the event occurred
Claim.item	S This element must be supported. C	1..*	BackboneElement	Product or service provided Constraints: ImmediateLevelOfCare
Claim.item.Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:itemTraceNumber	S This element must be supported.	0..*	PASIdentifier(2.2.1)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
Claim.item.Slices for extension.extension:authorizationNumber	S This element must be supported.	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
Claim.item.Slices for extension.extension:administrationReferenceNumber	S This element must be supported.	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
Claim.item.Slices for extension.extension:requestType	S This element must be supported.	1..1	CodeableConcept	Service Item Request Type 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.
Claim.item.Slices for extension.extension:certificationType	S This element must be supported.	1..1	CodeableConcept	Certification Type 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.
Claim.item.Slices for extension.extension:productOrServiceCodeEnd	S This element must be supported.	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 (2.2.1) (required)
Claim.item.Slices for extension.extension:epsdtIndicator	S This element must be supported.	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
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus	S This element must be supported.	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
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.value[x]	S This element must be supported.	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.
Claim.item.Slices for extension.extension:nursingHomeLevelOfCare	S This element must be supported.	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.
Claim.item.Slices for extension.extension:revenueUnitRateLimit	S This element must be supported.	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
Claim.item.Slices for extension.extension:requestedService	S This element must be supported.	0..1	Reference(PAS Medication Request(2.2.1) | PAS Service Request(2.2.1) | PAS Device Request(2.2.1) | PAS Nutrition Order(2.2.1))	The details of the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
Claim.item.Slices for extension.extension:infoChanged	S This element must be supported.	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: PASInformationChangeMode (2.2.1) (required)
Claim.item.Slices for modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for modifierExtension.modifierExtension:infoCancelledFlag	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	0..1	boolean	Indicates that this piece of information is not to be used. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled
Claim.item.sequence	S This element must be supported.	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
Claim.item.careTeamSequence	S This element must be supported.	0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence	S This element must be supported.	0..*	positiveInt	Applicable diagnoses
Claim.item.informationSequence	S This element must be supported.	0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue	S This element must be supported.	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.1) (required)
Claim.item.category	S This element must be supported.	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.
Claim.item.productOrService	S This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.1) (required)
Claim.item.modifier	S This element must be supported.	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.1) (required)
Claim.item.Slices for serviced[x]	S This element must be supported.	0..1		Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].servicedDate			date
Claim.item.Slices for serviced[x].servicedPeriod			Period
Claim.item.Slices for serviced[x].serviced[x]:servicedDate	S This element must be supported. C	0..1	date	Date or dates of service or product delivery Constraints: FullDateRule
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod	S This element must be supported.	0..1	Period	Date or dates of service or product delivery
Claim.item.location[x]	S This element must be supported.	1..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.1) (required)
Claim.item.quantity	S This element must be supported. C	0..1	PASQuantity(2.2.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice	S This element must be supported.	0..1	Money	Fee, charge or cost per item
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	📦2.2.1	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.related.relationship	Base	example	Example Related Claim Relationship 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	📍2.2.1	This IG
Claim.supportingInfo:PatientEvent.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdmissionDates.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:DischargeDates.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdditionalInformation.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:MessageText.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.1	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.1	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.extension:nursingHomeResidentialStatus.​value[x]	Base	required	https://valueset.x12.org/x217/005010/request/2000F/SV2/1/09/00/1345	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.1	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	📍2.2.1	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.1	This IG
Claim.item.location[x]	Base	required	X12 278 Health Care Service Location Type Value Set	📍2.2.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
ImmediateLevelOfCare	error	Claim.item	If Certification Type is an immediate appeal, then Level of Service Code must be present	extension.where(url='http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType' and value.code='1').exists() implies extension.where(url='http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode').exists()

This structure is derived from PASClaimBase

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	PASClaimBase(2.2.1)	Preauthorization
Claim.Slices for extension				Content/Rules for all slices
Claim.Slices for extension.extension:encounter	S This element must be supported.	0..1	(Complex)	Information about a hospital claim being requested. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
Claim.Slices for extension.extension:encounter.extension		0..0		Extension
Claim.Slices for extension.extension:encounter.value[x]		0..1	Reference(PAS Encounter(2.2.1))	Encounters associated with the listed treatments
Claim.Slices for extension.extension:certificationType	S This element must be supported.	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.
Claim.identifier		1..2	PASIdentifier(2.2.1)	Business identifier for claim
Claim.related	S This element must be supported.	1..1	BackboneElement	Prior or corollary claims
Claim.related.claim	S This element must be supported.	1..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship	S This element must be supported.	1..1	CodeableConcept	How the reference claim is related Required Pattern: At least the following
Claim.related.relationship.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.related.relationship.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship
Claim.related.relationship.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: prior
Claim.supportingInfo		0..*	BackboneElement	Supporting information
Claim.supportingInfo.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.supportingInfo.Slices for extension.extension:infoChanged	S This element must be supported.	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: PASInformationChangeMode (2.2.1) (required)
Claim.supportingInfo.Slices for modifierExtension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.supportingInfo.Slices for modifierExtension.modifierExtension:infoCancelledFlag	S This element must be supported.	0..1	boolean	Indicates that this piece of information is not to be used. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled
Claim.Slices for supportingInfo				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation	S This element must be supported.	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.
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension.extension:documentInformation	S This element must be supported.	1..1	(Complex)	Document Information URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: additionalInformation
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.timing[x]		0..0		When it occurred
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.value[x]	S This element must be supported.	1..1	Reference(PAS Document Reference | US Core QuestionnaireResponse Profile(7.0.0) | US Core AllergyIntolerance Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core DiagnosticReport Profile for Laboratory Results Reporting(7.0.0) | US Core Immunization Profile(7.0.0) | US Core MedicationRequest Profile(7.0.0) | US Core Procedure Profile(7.0.0) | US Core ServiceRequest Profile(7.0.0) | US Core Observation Clinical Result Profile(7.0.0) | US Core Simple Observation Profile(7.0.0) | US Core Vital Signs Profile(7.0.0) | NutritionOrder | DeviceRequest | Bundle)	Data to be provided
Claim.Slices for supportingInfo.supportingInfo:MessageText	S This element must be supported.	0..*	BackboneElement	Send text messages to the UMO.
Claim.Slices for supportingInfo.supportingInfo:MessageText.category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: At least the following
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: freeFormMessage
Claim.Slices for supportingInfo.supportingInfo:MessageText.timing[x]		0..0		When it occurred
Claim.Slices for supportingInfo.supportingInfo:MessageText.value[x]	S This element must be supported.	1..1	string	Data to be provided
Claim.diagnosis		0..*	BackboneElement	Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..1	date	The date that a diagnosis was recorded. (HIxx-4) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.item	C	1..*	BackboneElement	Product or service provided
Claim.item.extension		2..*	Extension	Extension
Claim.item.Slices for extension				Content/Rules for all slices
Claim.item.Slices for extension.extension:requestType		1..1	ServiceItemRequestType(2.2.1)	Service Item Request Type
Claim.item.Slices for extension.extension:certificationType		1..1	CertificationType(2.2.1)	Certification Type
Claim.item.Slices for extension.extension:epsdtIndicator	S This element must be supported.	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
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus	S This element must be supported.	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
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.value[x]	S This element must be supported.	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.
Claim.item.Slices for extension.extension:nursingHomeLevelOfCare	S This element must be supported.	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.
Claim.item.Slices for extension.extension:revenueUnitRateLimit	S This element must be supported.	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
Claim.item.Slices for extension.extension:requestedService	S This element must be supported.	0..1	Reference(PAS Medication Request(2.2.1) | PAS Service Request(2.2.1) | PAS Device Request(2.2.1) | PAS Nutrition Order(2.2.1))	The details of the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
Claim.item.Slices for extension.extension:infoChanged	S This element must be supported.	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: PASInformationChangeMode (2.2.1) (required)
Claim.item.Slices for modifierExtension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for modifierExtension.modifierExtension:infoCancelledFlag	S This element must be supported.	0..1	boolean	Indicates that this piece of information is not to be used. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled
Claim.item.category		1..1	CodeableConcept	Since PAS requests only have item-level information, a category is required for conformance with the X12 278 request.
Claim.item.location[x]		1..1	CodeableConcept	Place of service or where product was supplied
Claim.item.unitPrice	S This element must be supported.	0..1	Money	Fee, charge or cost per item
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.item.extension:nursingHomeResidentialStatus.​value[x]	Base	required	https://valueset.x12.org/x217/005010/request/2000F/SV2/1/09/00/1345	Not State	Unknown

Constraints

Id	Grade	Path(s)	Description	Expression
ImmediateLevelOfCare	error	Claim.item	If Certification Type is an immediate appeal, then Level of Service Code must be present	extension.where(url='http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType' and value.code='1').exists() implies extension.where(url='http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode').exists()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	PASClaimBase(2.2.1)	Preauthorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.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
Claim.contained		0..*	Resource	Contained, inline Resources
Claim.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:transmissionIdentifiers	S This element must be supported.	0..1	(Complex)	Transmission Identifiers URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers
Claim.Slices for extension.extension:levelOfServiceType	S This element must be supported.	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.
Claim.Slices for extension.extension:conditionCode	S This element must be supported.	0..*	(Complex)	Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode
Claim.Slices for extension.extension:homeHealthCareInformation	S This element must be supported.	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
Claim.Slices for extension.extension:authorizationNumber	S This element must be supported.	0..1	string	Authorization Number URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber
Claim.Slices for extension.extension:administrationReferenceNumber	S This element must be supported.	0..1	string	Administration Reference Number URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber
Claim.Slices for extension.extension:encounter	S This element must be supported.	0..1	(Complex)	Information about a hospital claim being requested. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
Claim.Slices for extension.extension:encounter.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for extension.extension:encounter.extension		0..0		Extension Slice: Unordered, Open by value:url Constraints: ext-1 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:encounter.url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter"
Claim.Slices for extension.extension:encounter.value[x]		0..1	Reference(PAS Encounter(2.2.1))	Encounters associated with the listed treatments
Claim.Slices for extension.extension:certificationType	S This element must be supported.	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.
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier	S This element must be supported.	1..2	PASIdentifier(2.2.1)	Business identifier for claim
Claim.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.identifier.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.identifier.Slices for extension.extension:subDepartment	S This element must be supported.	0..1	string	Identifier Sub-Department URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
Claim.identifier.Slices for extension.extension:jurisdiction	S This element must be supported.	0..1	CodeableConcept	Identifier Jurisdiction URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction Binding: UspsTwoLetterAlphabeticCodes (7.0.0) (required)
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.identifier.type	Σ This element is included in summaries.	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.
Claim.identifier.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	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
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: Claim Types (required)
Claim.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Beneficiary Patient(2.2.1))	The recipient of the products and services
Claim.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Insurer Organization(2.2.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Requestor Organization(2.2.1) | PAS PractitionerRole(2.2.1))	Party responsible for the claim
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related	S This element must be supported.	1..1	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim	S This element must be supported.	1..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship	S This element must be supported.	1..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. Required Pattern: At least the following
Claim.related.relationship.id		0..1	string	Unique id for inter-element referencing
Claim.related.relationship.extension		0..*	Extension	Additional content defined by implementations
Claim.related.relationship.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.related.relationship.coding.id		0..1	string	Unique id for inter-element referencing
Claim.related.relationship.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.related.relationship.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship
Claim.related.relationship.coding.version		0..1	string	Version of the system - if relevant
Claim.related.relationship.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: prior
Claim.related.relationship.coding.display		0..1	string	Representation defined by the system
Claim.related.relationship.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.related.relationship.text		0..1	string	Plain text representation of the concept
Claim.related.reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
Claim.payee		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.Slices for careTeam	S This element must be supported.	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) Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:All Slices				Content/Rules for all slices
Claim.Slices for careTeam.careTeam:All Slices.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for careTeam.careTeam:All Slices.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:All Slices.Slices for extension.extension:careTeamClaimScope	S This element must be supported.	1..1	boolean	Care Team Claim Scope URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
Claim.Slices for careTeam.careTeam:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.careTeam:All Slices.sequence	S This element must be supported.	1..1	positiveInt	Order of care team
Claim.Slices for careTeam.careTeam:All Slices.provider	S This element must be supported.	1..1	Reference(PAS Organization Base Profile(2.2.1) | PAS PractitionerRole(2.2.1))	Practitioner or organization
Claim.Slices for careTeam.careTeam:All Slices.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.Slices for careTeam.careTeam:All Slices.role	S This element must be supported.	0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.Slices for careTeam.careTeam:All Slices.qualification	S This element must be supported.	0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.Slices for careTeam.careTeam:OverallClaimMember	S This element must be supported.	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.
Claim.Slices for careTeam.careTeam:OverallClaimMember.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension				Content/Rules for all slices
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope	S This element must be supported.	1..1	(Complex)	Care Team Claim Scope URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
Claim.Slices for careTeam.careTeam:OverallClaimMember.Slices for extension.extension:careTeamClaimScope.value[x]	S This element must be supported.	0..1	boolean	Value of extension Fixed Value: true
Claim.Slices for careTeam.careTeam:OverallClaimMember.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.careTeam:OverallClaimMember.sequence		1..1	positiveInt	Order of care team
Claim.Slices for careTeam.careTeam:OverallClaimMember.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.Slices for careTeam.careTeam:OverallClaimMember.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.Slices for careTeam.careTeam:OverallClaimMember.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.
Claim.Slices for careTeam.careTeam:OverallClaimMember.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127 (required)
Claim.Slices for careTeam.careTeam:ItemClaimMember	S This element must be supported.	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.
Claim.Slices for careTeam.careTeam:ItemClaimMember.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension				Content/Rules for all slices
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope	S This element must be supported.	1..1	(Complex)	Care Team Claim Scope URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"
Claim.Slices for careTeam.careTeam:ItemClaimMember.Slices for extension.extension:careTeamClaimScope.value[x]	S This element must be supported.	0..1	boolean	Value of extension Fixed Value: false
Claim.Slices for careTeam.careTeam:ItemClaimMember.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.careTeam:ItemClaimMember.sequence		1..1	positiveInt	Order of care team
Claim.Slices for careTeam.careTeam:ItemClaimMember.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.Slices for careTeam.careTeam:ItemClaimMember.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.Slices for careTeam.careTeam:ItemClaimMember.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.
Claim.Slices for careTeam.careTeam:ItemClaimMember.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127 (required)
Claim.Slices for supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for extension.extension:infoChanged	S This element must be supported.	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: PASInformationChangeMode (2.2.1) (required)
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices.Slices for modifierExtension.modifierExtension:infoCancelledFlag	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	0..1	boolean	Indicates that this piece of information is not to be used. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence	S This element must be supported.	1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: PASSupportingInfoType (2.2.1) (extensible)
Claim.Slices for supportingInfo.supportingInfo:All Slices.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x]		0..1		When it occurred
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x]		0..1		Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean			boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString			string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity			Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment			Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference			Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:All Slices.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:PatientEvent	S This element must be supported.	0..1	BackboneElement	Information about the dates of the event that are being requested.
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.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
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientEvent
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x]	S This element must be supported.	1..1		When it occurred Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x]				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingDate	S This element must be supported. C	0..1	date	When it occurred Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod	S This element must be supported.	0..1	Period	When it occurred
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.Slices for timing[x].timing[x]:timingPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:PatientEvent.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates	S This element must be supported.	0..1	BackboneElement	Information about the admission dates of a hospital admission being requested.
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.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
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionDates
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x]	S This element must be supported.	1..1		When it occurred Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x]				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingDate	S This element must be supported. C	0..1	date	When it occurred Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod	S This element must be supported.	0..1	Period	When it occurred
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.Slices for timing[x].timing[x]:timingPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:AdmissionDates.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:DischargeDates	S This element must be supported.	0..1	BackboneElement	Information about the discharge dates of a hospital admission being requested.
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.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
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: dischargeDates
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.timing[x]	S This element must be supported. C	1..1	date	When it occurred Constraints: FullDateRule
Claim.Slices for supportingInfo.supportingInfo:DischargeDates.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation	S This element must be supported.	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.
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.Slices for extension.extension:documentInformation	S This element must be supported.	1..1	(Complex)	Document Information URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.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
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: additionalInformation
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.value[x]	S This element must be supported.	1..1	Reference(PAS Document Reference | US Core QuestionnaireResponse Profile(7.0.0) | US Core AllergyIntolerance Profile(7.0.0) | US Core Condition Encounter Diagnosis Profile(7.0.0) | US Core Condition Problems and Health Concerns Profile(7.0.0) | US Core DiagnosticReport Profile for Laboratory Results Reporting(7.0.0) | US Core Immunization Profile(7.0.0) | US Core MedicationRequest Profile(7.0.0) | US Core Procedure Profile(7.0.0) | US Core ServiceRequest Profile(7.0.0) | US Core Observation Clinical Result Profile(7.0.0) | US Core Simple Observation Profile(7.0.0) | US Core Vital Signs Profile(7.0.0) | NutritionOrder | DeviceRequest | Bundle)	Data to be provided
Claim.Slices for supportingInfo.supportingInfo:AdditionalInformation.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:MessageText	S This element must be supported.	0..*	BackboneElement	Send text messages to the UMO.
Claim.Slices for supportingInfo.supportingInfo:MessageText.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:MessageText.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:MessageText.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:MessageText.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:MessageText.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
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.version		0..1	string	Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: freeFormMessage
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.display		0..1	string	Representation defined by the system
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:MessageText.category.text		0..1	string	Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:MessageText.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:MessageText.value[x]	S This element must be supported.	1..1	string	Data to be provided
Claim.Slices for supportingInfo.supportingInfo:MessageText.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..1	date	The date that a diagnosis was recorded. (HIxx-4) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence	S This element must be supported.	1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	Nature of illness or problem Binding: X12278DiagnosisCodes (2.2.1) (required)
Claim.diagnosis.type	S This element must be supported.	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: X12278DiagnosisType (2.2.1) (required)
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date		0..1	dateTime	When the procedure was performed
Claim.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	S This element must be supported. Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Coverage(2.2.1))	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident	S This element must be supported.	0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date	S This element must be supported. C	1..1	date	When the incident occurred Constraints: FullDateRule
Claim.accident.type	S This element must be supported.	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.
Claim.accident.location[x]	S This element must be supported.	0..1	Address	Where the event occurred
Claim.item	S This element must be supported. C	1..*	BackboneElement	Product or service provided Constraints: ImmediateLevelOfCare
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:itemTraceNumber	S This element must be supported.	0..*	PASIdentifier(2.2.1)	Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
Claim.item.Slices for extension.extension:authorizationNumber	S This element must be supported.	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
Claim.item.Slices for extension.extension:administrationReferenceNumber	S This element must be supported.	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
Claim.item.Slices for extension.extension:requestType	S This element must be supported.	1..1	CodeableConcept	Service Item Request Type 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.
Claim.item.Slices for extension.extension:certificationType	S This element must be supported.	1..1	CodeableConcept	Certification Type 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.
Claim.item.Slices for extension.extension:productOrServiceCodeEnd	S This element must be supported.	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 (2.2.1) (required)
Claim.item.Slices for extension.extension:epsdtIndicator	S This element must be supported.	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
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus	S This element must be supported.	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
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"
Claim.item.Slices for extension.extension:nursingHomeResidentialStatus.value[x]	S This element must be supported.	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.
Claim.item.Slices for extension.extension:nursingHomeLevelOfCare	S This element must be supported.	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.
Claim.item.Slices for extension.extension:revenueUnitRateLimit	S This element must be supported.	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
Claim.item.Slices for extension.extension:requestedService	S This element must be supported.	0..1	Reference(PAS Medication Request(2.2.1) | PAS Service Request(2.2.1) | PAS Device Request(2.2.1) | PAS Nutrition Order(2.2.1))	The details of the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
Claim.item.Slices for extension.extension:infoChanged	S This element must be supported.	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: PASInformationChangeMode (2.2.1) (required)
Claim.item.Slices for modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for modifierExtension.modifierExtension:infoCancelledFlag	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	0..1	boolean	Indicates that this piece of information is not to be used. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled
Claim.item.sequence	S This element must be supported.	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
Claim.item.careTeamSequence	S This element must be supported.	0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence	S This element must be supported.	0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence	S This element must be supported.	0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue	S This element must be supported.	0..1	CodeableConcept	Revenue or cost center code Binding: AHANUBCRevenueCodes (2.2.1) (required)
Claim.item.category	S This element must be supported.	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.
Claim.item.productOrService	S This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: X12278RequestedServiceType (2.2.1) (required)
Claim.item.modifier	S This element must be supported.	0..*	CodeableConcept	Product or service billing modifiers Binding: X12278RequestedServiceModifierType (2.2.1) (required)
Claim.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.Slices for serviced[x]	S This element must be supported.	0..1		Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].servicedDate			date
Claim.item.Slices for serviced[x].servicedPeriod			Period
Claim.item.Slices for serviced[x].serviced[x]:servicedDate	S This element must be supported. C	0..1	date	Date or dates of service or product delivery Constraints: FullDateRule
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod	S This element must be supported.	0..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	Σ This element is included in summaries. C	0..1	dateTime	Starting time with inclusive boundary Constraints: FullDateRule
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	Σ This element is included in summaries. C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: FullDateRule
Claim.item.location[x]	S This element must be supported.	1..1	CodeableConcept	Place of service or where product was supplied Binding: X12278LocationType (2.2.1) (required)
Claim.item.quantity	S This element must be supported. C	0..1	PASQuantity(2.2.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice	S This element must be supported.	0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.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.
Claim.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.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.
Claim.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.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	📦2.2.1	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	📍2.2.1	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	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
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	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
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	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
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.supportingInfo:AdditionalInformation.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdditionalInformation.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:AdditionalInformation.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:MessageText.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:MessageText.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:MessageText.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	required	X12 278 Diagnosis Code Value Set	📍2.2.1	This IG
Claim.diagnosis.type	Base	required	X12 278 Diagnosis Type Value Set	📍2.2.1	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.extension:nursingHomeResidentialStatus.​value[x]	Base	required	https://valueset.x12.org/x217/005010/request/2000F/SV2/1/09/00/1345	Not State	Unknown
Claim.item.revenue	Base	required	AHA NUBC Revenue Value Set	📍2.2.1	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	📍2.2.1	This IG
Claim.item.modifier	Base	required	X12 278 Requested Service Modifier Type	📍2.2.1	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	📍2.2.1	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
ImmediateLevelOfCare	error	Claim.item	If Certification Type is an immediate appeal, then Level of Service Code must be present	extension.where(url='http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType' and value.code='1').exists() implies extension.where(url='http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode').exists()