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

## Resource Profile: PAS Claim Inquiry 

 
PAS constraints on Claim resource when submitting an inquiry for existing authorizations. 

**Usages:**

* Use this Profile: [PAS Inquiry Request Bundle](StructureDefinition-profile-pas-inquiry-request-bundle.md) and [PAS Inquiry Request Bundle](http://hl7.org/fhir/us/davinci-pas/STU2.1/StructureDefinition-profile-pas-inquiry-request-bundle.html)
* Examples for this Profile: [Claim/PASClaimInquiryExample](Claim-PASClaimInquiryExample.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-claim-inquiry)

### 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-claim-inquiry.csv), [Excel](../StructureDefinition-profile-claim-inquiry.xlsx), [Schematron](../StructureDefinition-profile-claim-inquiry.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "profile-claim-inquiry",
  "extension" : [
    {
      "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-claim-inquiry",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.24.42.47"
    }
  ],
  "version" : "2.2.0-ballot",
  "name" : "PASClaimInquiry",
  "title" : "PAS Claim Inquiry",
  "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 Claim resource when submitting an inquiry for existing authorizations.",
  "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" : "w5",
      "uri" : "http://hl7.org/fhir/fivews",
      "name" : "FiveWs Pattern Mapping"
    },
    {
      "identity" : "rim",
      "uri" : "http://hl7.org/v3",
      "name" : "RIM Mapping"
    }
  ],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Claim",
  "baseDefinition" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.0-ballot",
  "derivation" : "constraint",
  "differential" : {
    "element" : [
      {
        "id" : "Claim",
        "path" : "Claim",
        "short" : "Query for Preauthorizations"
      },
      {
        "id" : "Claim.extension:certificationType",
        "path" : "Claim.extension",
        "sliceName" : "certificationType",
        "short" : "A code representing the type of certification being requested (UM02)",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType|2.2.0-ballot"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Claim.identifier",
        "path" : "Claim.identifier",
        "min" : 1,
        "max" : "1"
      },
      {
        "id" : "Claim.billablePeriod",
        "path" : "Claim.billablePeriod",
        "mustSupport" : true
      },
      {
        "id" : "Claim.provider",
        "path" : "Claim.provider",
        "short" : "This is the submitter of the inquiry."
      },
      {
        "id" : "Claim.diagnosis",
        "path" : "Claim.diagnosis",
        "comment" : "When multiple diagnoses are sent, the intermediary will need to convert the single inquiry into multiple X12 278 inquiries - one for each diagnosis code - and then make the union of the returned Prior Authorization responses."
      },
      {
        "id" : "Claim.item.extension:certIssueDate",
        "path" : "Claim.item.extension",
        "sliceName" : "certIssueDate",
        "short" : "The specific date or period within when which item's preauthorization was issued.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate|2.2.0-ballot"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Claim.item.extension:certExpirationDate",
        "path" : "Claim.item.extension",
        "sliceName" : "certExpirationDate",
        "short" : "The specific date or period within which this item's preauthorization expires.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate|2.2.0-ballot"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Claim.item.extension:certEffectiveDate",
        "path" : "Claim.item.extension",
        "sliceName" : "certEffectiveDate",
        "short" : "The specific date or period within which this item's preauthorization became effective.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate|2.2.0-ballot"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Claim.item.extension:reviewActionCode",
        "path" : "Claim.item.extension",
        "sliceName" : "reviewActionCode",
        "short" : "The code describing the result of the review.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode|2.2.0-ballot"
            ]
          }
        ],
        "mustSupport" : true
      }
    ]
  }
}

```
