## Intersection of http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry and http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry

This is the set of resources that conform to both PAS Claim Inquiry (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry) and PAS Claim Inquiry (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry).

### Structure

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* |  | Query for Preauthorizations
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S | 1..1 | ??, ?? | Business identifier for claim
extension |  | 0..* | Extension | Additional content defined by implementations
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system | S Σ | 1..1 | uri | SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
value | S Σ | 1..1 | string | The value that is unique Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
status | ?!S Σ | 1..1 | code | left: active | cancelled | draft | entered-in-error; right: 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: ?? (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | left: Category or discipline; right: This is used as a high-level mapping of the X12 UM03 field Binding: ?? (required): The type or discipline-style of the claim.
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode.
use | S Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(PAS Beneficiary Patient | #sd-profile-beneficiary-profile-beneficiary) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | Relevant time frame for the claim
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | S Σ | 1..1 | Reference(PAS Insurer Organization | #sd-profile-insurer-profile-insurer) | Target
provider | S Σ | 1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole | #sd-profile-requestor-profile-requestor) | This is the submitter of the inquiry.
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
related |  | 0..* | BackboneElement | Prior or corollary claims
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(Location) | Servicing facility
careTeam | S | 0..* | BackboneElement | Members of the care team
extension |  | 1..* | Extension | Extension
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Order of care team
provider | S | 1..1 | Reference(PAS Organization Base Profile | PAS PractitionerRole | #sd-profile-organization-profile-organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role | S | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members.
qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications.
supportingInfo | S | 0..* | BackboneElement | Supporting information
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Information instance identifier
category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible)
code |  | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth.
diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: ?? (required)
type | S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required)
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis.
procedure |  | 0..* | BackboneElement | Clinical procedures performed
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | S Σ | 1..* | BackboneElement | Patient insurance information
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | S Σ | 1..1 | Reference(PAS Coverage | #sd-profile-coverage-profile-coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident | S | 0..1 | BackboneElement | Details of the event
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date | S C | 1..1 | date | When the incident occurred Constraints: FullDateRule
type | S | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (required): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
location[x] | S | 0..1 | Address | Where the event occurred
item | S | 0..* | BackboneElement | Product or service provided
extension |  | 0..* | Extension | Extension
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | left: Item instance identifier; right: Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
careTeamSequence | S | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence | S | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information
revenue | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (required)
category | S | 0..1 | CodeableConcept | Benefit classification Binding: ?? (required): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required)
modifier | S | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (required)
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
serviced[x] | S | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: ?? (required)
quantity | S C | 0..1 | ??, ?? | left: A fixed quantity (no comparator); right: Count of products or services Constraints: qty-3, sqty-1
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
quantity |  | 0..1 | ??, ?? | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
quantity |  | 0..1 | ??, ?? | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total |  | 0..1 | Money | Total claim cost
Documentation for this format