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

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

Structure

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*		Preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding ele-1: All FHIR elements must have a @value or children
text		0..1	Narrative	Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	S	1..2	??, ??	Business identifier for claim ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
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. ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children
subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. ele-1: All FHIR elements must have a @value or children
patient	SΣ	1..1	Reference(PAS Beneficiary Patient | #sd-profile-beneficiary-profile-beneficiary)	The recipient of the products and services ele-1: All FHIR elements must have a @value or children
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	dateTime	Resource creation date ele-1: All FHIR elements must have a @value or children
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim ele-1: All FHIR elements must have a @value or children
insurer	SΣ	1..1	Reference(PAS Insurer Organization | #sd-profile-insurer-profile-insurer)	Target ele-1: All FHIR elements must have a @value or children
provider	SΣ	1..1	Reference(PAS Requestor Organization | PAS PractitionerRole | #sd-profile-requestor-profile-requestor)	Party responsible for the claim ele-1: All FHIR elements must have a @value or children
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred. ele-1: All FHIR elements must have a @value or children
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products ele-1: All FHIR elements must have a @value or children
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller ele-1: All FHIR elements must have a @value or children
payee		0..1	BackboneElement	Recipient of benefits payable ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Category of recipient Binding: ?? (example): A code for the party to be reimbursed. ele-1: All FHIR elements must have a @value or children
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference ele-1: All FHIR elements must have a @value or children
referral		0..1	Reference(ServiceRequest)	Treatment referral ele-1: All FHIR elements must have a @value or children
facility		0..1	Reference(Location)	Servicing facility ele-1: All FHIR elements must have a @value or children
careTeam	S	0..*	BackboneElement	Members of the care team ele-1: All FHIR elements must have a @value or children
extension		1..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	S	1..1	positiveInt	Order of care team ele-1: All FHIR elements must have a @value or children
provider	S	1..1	Reference(PAS Organization Base Profile | PAS PractitionerRole | #sd-profile-organization-profile-organization)	Practitioner or organization ele-1: All FHIR elements must have a @value or children
responsible		0..1	boolean	Indicator of the lead practitioner ele-1: All FHIR elements must have a @value or children
role	S	0..1	CodeableConcept	Function within the team Binding: ?? (example): The role codes for the care team members. ele-1: All FHIR elements must have a @value or children
qualification	S	0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children
supportingInfo	S	0..*	BackboneElement	Supporting information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	S	1..1	positiveInt	Information instance identifier ele-1: All FHIR elements must have a @value or children
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children
code		0..1	CodeableConcept	Type of information Binding: ?? (example): The valuset used for additional information codes. ele-1: All FHIR elements must have a @value or children
timing[x]		0..1		When it occurred ele-1: All FHIR elements must have a @value or children
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided ele-1: All FHIR elements must have a @value or children
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. ele-1: All FHIR elements must have a @value or children
diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request. ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	S	1..1	positiveInt	Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
type	S	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission. ele-1: All FHIR elements must have a @value or children
packageCode		0..1	CodeableConcept	Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. ele-1: All FHIR elements must have a @value or children
procedure		0..*	BackboneElement	Clinical procedures performed ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Procedure instance identifier ele-1: All FHIR elements must have a @value or children
type		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes. ele-1: All FHIR elements must have a @value or children
date		0..1	dateTime	When the procedure was performed ele-1: All FHIR elements must have a @value or children
procedure[x]		1..1		Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. ele-1: All FHIR elements must have a @value or children
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
insurance	SΣ	1..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	SΣ	1..1	positiveInt	Insurance instance identifier ele-1: All FHIR elements must have a @value or children
focal	Σ	1..1	boolean	Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children
identifier		0..1	Identifier	Pre-assigned Claim number ele-1: All FHIR elements must have a @value or children
coverage	SΣ	1..1	Reference(PAS Coverage | #sd-profile-coverage-profile-coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
businessArrangement		0..1	string	Additional provider contract number ele-1: All FHIR elements must have a @value or children
preAuthRef		0..*	string	Prior authorization reference number ele-1: All FHIR elements must have a @value or children
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results ele-1: All FHIR elements must have a @value or children
accident	S	0..1	BackboneElement	Details of the event ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
date	SC	1..1	date	When the incident occurred ele-1: All FHIR elements must have a @value or children FullDateRule: Dates need to be a full date - YYYY-MM-DD
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. ele-1: All FHIR elements must have a @value or children
location[x]	S	0..1	Address	Where the event occurred ele-1: All FHIR elements must have a @value or children
item	SC	1..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children ImmediateLevelOfCare: If Certification Type is an immediate appeal, then Level of Service Code must be present
extension		2..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	S	1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
careTeamSequence	S	0..*	positiveInt	Applicable careTeam members ele-1: All FHIR elements must have a @value or children
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses ele-1: All FHIR elements must have a @value or children
procedureSequence		0..*	positiveInt	Applicable procedures ele-1: All FHIR elements must have a @value or children
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
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. ele-1: All FHIR elements must have a @value or children
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
serviced[x]	S	0..1		Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
location[x]	S	1..1	CodeableConcept	Place of service or where product was supplied Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
quantity	S	0..1	??	left: Count of products or services; right: A fixed quantity (no comparator) ele-1: All FHIR elements must have a @value or children
unitPrice	S	0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children
encounter		0..*	Reference(Encounter)	Encounters related to this billed item ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
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. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??, ??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
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. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??, ??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
total		0..1	Money	Total claim cost ele-1: All FHIR elements must have a @value or children
Documentation for this format