# PAS Coverage - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Resource Profile: PAS Coverage 

 
PAS constraints on Coverage resource mandating support for insurance elements relevant to the prior authorization request 

**Usages:**

* Refer to this Profile: [PAS Claim Base](StructureDefinition-profile-claim-base.md) and [PAS Claim Base](http://hl7.org/fhir/us/davinci-pas/STU2.1/StructureDefinition-profile-claim-base.html)
* Examples for this Profile: [Coverage/InsuranceExample](Coverage-InsuranceExample.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.davinci-pas|current/StructureDefinition/profile-coverage)

### Formal Views of Profile Content

 [Description Differentials, Snapshots, and other representations](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](../StructureDefinition-profile-coverage.csv), [Excel](../StructureDefinition-profile-coverage.xlsx), [Schematron](../StructureDefinition-profile-coverage.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "profile-coverage",
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-compliesWithProfile",
      "valueCanonical" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|6.1.0"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 3,
      "_valueInteger" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.24.42.54"
    }
  ],
  "version" : "2.2.0-ballot",
  "name" : "PASCoverage",
  "title" : "PAS Coverage",
  "status" : "active",
  "date" : "2026-01-30T16:26:59+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [
    {
      "name" : "HL7 International / Financial Management",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://hl7.org/Special/committees/fm"
        },
        {
          "system" : "email",
          "value" : "fmlists@lists.hl7.org"
        }
      ]
    },
    {
      "name" : "Jean Duteau",
      "telecom" : [
        {
          "system" : "email",
          "value" : "mailto:jean@duteaudesign.com"
        }
      ]
    },
    {
      "name" : "HL7 International / Financial Management",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "PAS constraints on Coverage resource mandating support for insurance elements relevant to the prior authorization request",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "fhirVersion" : "4.0.1",
  "mapping" : [
    {
      "identity" : "workflow",
      "uri" : "http://hl7.org/fhir/workflow",
      "name" : "Workflow Pattern"
    },
    {
      "identity" : "rim",
      "uri" : "http://hl7.org/v3",
      "name" : "RIM Mapping"
    },
    {
      "identity" : "w5",
      "uri" : "http://hl7.org/fhir/fivews",
      "name" : "FiveWs Pattern Mapping"
    },
    {
      "identity" : "cdanetv4",
      "uri" : "http://www.cda-adc.ca/en/services/cdanet/",
      "name" : "Canadian Dental Association eclaims standard"
    },
    {
      "identity" : "v2",
      "uri" : "http://hl7.org/v2",
      "name" : "HL7 v2 Mapping"
    },
    {
      "identity" : "cpha3pharm",
      "uri" : "http://www.pharmacists.ca/",
      "name" : "Canadian Pharmacy Associaiton eclaims standard"
    }
  ],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Coverage",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0",
  "derivation" : "constraint",
  "differential" : {
    "element" : [
      {
        "id" : "Coverage",
        "path" : "Coverage",
        "constraint" : [
          {
            "key" : "self-beneficiary",
            "severity" : "error",
            "human" : "If relationship does not equal 'self', then subscriber SHALL be present.",
            "expression" : "$this.relationship.coding.where(code='18').count() = 0 implies $this.subscriber.exists()",
            "source" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage|2.2.0-ballot"
          }
        ]
      },
      {
        "id" : "Coverage.status",
        "path" : "Coverage.status",
        "patternCode" : "active"
      },
      {
        "id" : "Coverage.subscriber",
        "path" : "Coverage.subscriber",
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber|2.2.0-ballot"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Coverage.beneficiary",
        "path" : "Coverage.beneficiary",
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary|2.2.0-ballot"
            ]
          }
        ]
      },
      {
        "id" : "Coverage.relationship.coding",
        "path" : "Coverage.relationship.coding",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "value",
              "path" : "$this"
            }
          ],
          "description" : "Send an X12 code along with the FHIR code.",
          "rules" : "open"
        }
      },
      {
        "id" : "Coverage.relationship.coding:X12Code",
        "path" : "Coverage.relationship.coding",
        "sliceName" : "X12Code",
        "min" : 0,
        "max" : "1",
        "mustSupport" : true,
        "binding" : {
          "strength" : "required",
          "description" : "Codes indicating the relationship between two individuals or entities. 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.",
          "valueSet" : "https://valueset.x12.org/x217/005010/request/2000D/INS/1/02/00/1069"
        }
      },
      {
        "id" : "Coverage.payor",
        "path" : "Coverage.payor",
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer|2.2.0-ballot"
            ]
          }
        ]
      }
    ]
  }
}

```
