## Profile Comparison between http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update vs http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update

Left: | PAS Claim Update (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update)
Right: | PAS Claim Update (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update)

### Messages

Error | StructureDefinition.version | Values for version differ: '2.1.0' vs '2.2.0-ballot'
Information | StructureDefinition.date | Values for date differ: '2024-12-20T21:11:16+00:00' vs '2026-01-30T16:26:59+00:00'
Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base' vs 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.0-ballot'
Information | Claim.language | Example/preferred bindings differ at Claim.language using binding from PASClaimUpdate
Information | StructureDefinition.definition | Values for definition differ: 'An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.' vs 'A unique identifier assigned to this claim.'
Information | StructureDefinition.short | Values for short differ: 'active | cancelled | draft | entered-in-error' vs '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'
Information | StructureDefinition.short | Values for short differ: 'Category or discipline' vs 'This is used as a high-level mapping of the X12 UM03 field'
Information | StructureDefinition.short | Values for short differ: 'Item instance identifier' vs 'Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse'
Information | StructureDefinition.short | Values for short differ: 'A fixed quantity (no comparator)' vs 'Count of products or services'
Information | StructureDefinition.definition | Values for definition differ: 'The comparator is not used on a SimpleQuantity' vs 'The number of repetitions of a service or product.'

### Metadata

Name | Value | Comments
--- | --- | ---
abstract | false |
baseDefinition | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.0-ballot | Values Differ
copyright |  |
date | 2024-12-20T21:11:16+00:00 | 2026-01-30T16:26:59+00:00 | Values Differ
description | This profile defines constraints and extensions used when update a previously submitted Claim instance. * 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. * 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. * 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. * 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. * 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. * 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`. * 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`. | This profile defines constraints and extensions used when updating a previously submitted Claim instance. * 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. * 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. * 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. * 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. * 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. * 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`. * 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`. | Values Differ
experimental |  |
fhirVersion | 4.0.1 |
jurisdiction |  |
jurisdiction[0] | urn:iso:std:iso:3166#US |
kind | resource |
name | PASClaimUpdate |
publisher | HL7 International / Financial Management |
purpose |  |
status | active |
title | PAS Claim Update |
type | Claim |
url | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update |
version | 2.1.0 | 2.2.0-ballot | Values Differ

### Structure

Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---
Claim |  | 0..* | PASClaimBase | Preauthorization |  | 0..* | PASClaimBase(2.2.0-ballot) | Preauthorization |
id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!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
|  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
| Example/preferred bindings differ at Claim.language using binding from PASClaimUpdate
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 |  | 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 |  | 0..* | Resource | Contained, inline Resources |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | S | 1..2 | ?? | Business identifier for claim | S | 1..2 | ?? | Business identifier for claim |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!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. | 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 | 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 | 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 | 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) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | ?!S Σ | 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: ?? (required): A code specifying the state of the resource instance. Required Pattern: active |
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. | Σ | 1..1 | CodeableConcept | This is used as a high-level mapping of the X12 UM03 field Binding: ?? (required) |
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |  | 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. Required Pattern: preauthorization | S Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization |
patient | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | S Σ | 1..1 | Reference(PAS Beneficiary Patient(2.2.0-ballot)) | The recipient of the products and services |
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim |
created | Σ | 1..1 | dateTime | Resource creation date | Σ | 1..1 | dateTime | Resource creation date |
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |
insurer | S Σ | 1..1 | Reference(PAS Insurer Organization) | Target | S Σ | 1..1 | Reference(PAS Insurer Organization(2.2.0-ballot)) | Target |
provider | S Σ | 1..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | Party responsible for the claim | S Σ | 1..1 | Reference(PAS Requestor Organization(2.2.0-ballot) | PAS PractitionerRole(2.2.0-ballot)) | Party responsible for the claim |
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred. | 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). |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). |
related | S | 1..1 | BackboneElement | Prior or corollary claims | S | 1..1 | BackboneElement | Prior or corollary claims |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
claim | S | 1..1 | Reference(Claim) | Reference to the related claim | S | 1..1 | Reference(Claim) | Reference to the related claim |
relationship | S | 1..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship","code":"prior"}]} | S | 1..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship","code":"prior"}]} |
reference |  | 0..1 | Identifier | File or case reference |  | 0..1 | Identifier | File or case reference |
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products |
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |
payee |  | 0..1 | BackboneElement | Recipient of benefits payable |  | 0..1 | BackboneElement | Recipient of benefits payable |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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. |  | 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 |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference |
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral |
facility |  | 0..1 | Reference(Location) | Servicing facility |  | 0..1 | Reference(Location) | Servicing facility |
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean) | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value.ofType(boolean) |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Order of care team | S | 1..1 | positiveInt | Order of care team |
provider | S | 1..1 | Reference(PAS Organization Base Profile | PAS PractitionerRole) | Practitioner or organization | S | 1..1 | Reference(PAS Organization Base Profile(2.2.0-ballot) | PAS PractitionerRole(2.2.0-ballot)) | Practitioner or organization |
responsible |  | 0..1 | boolean | Indicator of the lead practitioner |  | 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. | 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. | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. |
Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
Slices for modifierExtension | ?!Σ | 0..* | Extension | Extension Slice: Unordered, Open by value:url | ?!Σ | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
sequence | S | 1..1 | positiveInt | Information instance identifier | S | 1..1 | positiveInt | Information instance identifier |
category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | 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. |  | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. |
timing[x] |  | 0..1 | date, Period | When it occurred |  | 0..1 | date, Period | When it occurred |
value[x] |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. |
diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request. | S | 0..* | BackboneElement | Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request. |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier | S | 1..1 | positiveInt | Diagnosis instance identifier |
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: ?? (required) | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: ?? (required) |
type | S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) | S | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) |
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. |  | 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. |  | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. |
procedure |  | 0..* | BackboneElement | Clinical procedures performed |  | 0..* | BackboneElement | Clinical procedures performed |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Procedure instance identifier |  | 1..1 | positiveInt | Procedure instance identifier |
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. |  | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. |
date |  | 0..1 | dateTime | When the procedure was performed |  | 0..1 | dateTime | When the procedure was performed |
procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
insurance | S Σ | 1..* | BackboneElement | Patient insurance information | S Σ | 1..* | BackboneElement | Patient insurance information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S Σ | 1..1 | positiveInt | Insurance instance identifier | S Σ | 1..1 | positiveInt | Insurance instance identifier |
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true |
identifier |  | 0..1 | Identifier | Pre-assigned Claim number |  | 0..1 | Identifier | Pre-assigned Claim number |
coverage | S Σ | 1..1 | Reference(PAS Coverage) | Insurance information | S Σ | 1..1 | Reference(PAS Coverage(2.2.0-ballot)) | Insurance information |
businessArrangement |  | 0..1 | string | Additional provider contract number |  | 0..1 | string | Additional provider contract number |
preAuthRef |  | 0..* | string | Prior authorization reference number |  | 0..* | string | Prior authorization reference number |
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results |  | 0..1 | Reference(ClaimResponse) | Adjudication results |
accident | S | 0..1 | BackboneElement | Details of the event | S | 0..1 | BackboneElement | Details of the event |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
date | S C | 1..1 | date | When the incident occurred | S C | 1..1 | date | When the incident occurred |
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. | 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 | S | 0..1 | Address | Where the event occurred |
item | S C | 1..* | BackboneElement | Product or service provided Constraints: ImmediateLevelOfCare | S C | 1..* | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url |
Slices for modifierExtension | ?!Σ | 0..* | Extension | Extension Slice: Unordered, Open by value:url | ?!Σ | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
sequence | S | 1..1 | positiveInt | Item instance identifier | S | 1..1 | positiveInt | 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 | S | 0..* | positiveInt | Applicable careTeam members |
diagnosisSequence | S | 0..* | positiveInt | Applicable diagnoses | S | 0..* | positiveInt | Applicable diagnoses |
procedureSequence |  | 0..* | positiveInt | Applicable procedures |  | 0..* | positiveInt | Applicable procedures |
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information | S | 0..* | positiveInt | Applicable exception and supporting information |
revenue | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (required) | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (required) |
category | S | 1..1 | CodeableConcept | Since PAS requests only have item-level information, a category is required for conformance with the X12 278 request. Binding: ?? (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. | S | 1..1 | CodeableConcept | Since PAS requests only have item-level information, a category is required for conformance with the X12 278 request. 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) | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |
modifier | S | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | 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. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
Slices for serviced[x] | S | 0..1 | date, Period | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | S | 0..1 | date, Period | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this |
location[x] | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: ?? (required) | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: ?? (required) |
quantity | S C | 0..1 | ?? | A fixed quantity (no comparator) | S | 0..1 | ?? | Count of products or services |
unitPrice | S | 0..1 | Money | Fee, charge or cost per item | S | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. |  | 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. |  | 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 |  | 0..* | Reference(Encounter) | Encounters related to this billed item |
detail |  | 0..* | BackboneElement | Product or service provided |  | 0..* | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 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. |  | 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. |  | 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. |  | 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. |  | 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. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
subDetail |  | 0..* | BackboneElement | Product or service provided |  | 0..* | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 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. |  | 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. |  | 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. |  | 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. |  | 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. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
total |  | 0..1 | Money | Total claim cost |  | 0..1 | Money | Total claim cost |
Documentation for this format