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

Messages

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|2.2.1	Values Differ
copyright
date	2024-12-20T21:11:16+00:00	2026-10-09T18:42:41+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.	Values Differ
experimental
fhirVersion	4.0.1
jurisdiction
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	2.2.1	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(2.2.1)	Preauthorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.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
Claim.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
Claim.contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
Claim.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier	S This element must be supported.	1..2	??	Business identifier for claim	S This element must be supported.	1..2	??	Business identifier for claim
Claim.identifier.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.identifier.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
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .
Claim.identifier.type	Σ This element is included in summaries.	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 This element is included in summaries.	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.
Claim.identifier.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient	S This element must be supported. Σ This element is included in summaries.	1..1	uri	SHOULD use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	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
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim.	Σ This element is included in summaries.	1..1	CodeableConcept	This is used as a high-level mapping of the X12 UM03 field Binding: ?? (required)
Claim.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.
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Beneficiary Patient)	The recipient of the products and services	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Beneficiary Patient(2.2.1))	The recipient of the products and services
Claim.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	Σ This element is included in summaries.	1..1	dateTime	Resource creation date	Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Insurer Organization)	Target	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Insurer Organization(2.2.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Requestor Organization | PAS PractitionerRole)	Party responsible for the claim	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Requestor Organization(2.2.1) | PAS PractitionerRole(2.2.1))	Party responsible for the claim
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.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).
Claim.related	S This element must be supported.	1..1	BackboneElement	Prior or corollary claims	S This element must be supported.	1..1	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim	S This element must be supported.	1..1	Reference(Claim)	Reference to the related claim	S This element must be supported.	1..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship	S This element must be supported.	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 This element must be supported.	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"}]}
Claim.related.reference		0..1	Identifier	File or case reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.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
Claim.payee		0..1	BackboneElement	Recipient of benefits payable		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.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.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility		0..1	Reference(Location)	Servicing facility
Claim.Slices for careTeam	S This element must be supported.	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) Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	S This element must be supported.	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) Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.Slices for careTeam.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for careTeam.sequence	S This element must be supported.	1..1	positiveInt	Order of care team	S This element must be supported.	1..1	positiveInt	Order of care team
Claim.Slices for careTeam.provider	S This element must be supported.	1..1	Reference(PAS Organization Base Profile | PAS PractitionerRole)	Practitioner or organization	S This element must be supported.	1..1	Reference(PAS Organization Base Profile(2.2.1) | PAS PractitionerRole(2.2.1))	Practitioner or organization
Claim.Slices for careTeam.responsible		0..1	boolean	Indicator of the lead practitioner		0..1	boolean	Indicator of the lead practitioner
Claim.Slices for careTeam.role	S This element must be supported.	0..1	CodeableConcept	Function within the team Binding: ?? (example): The role codes for the care team members.	S This element must be supported.	0..1	CodeableConcept	Function within the team Binding: ?? (example): The role codes for the care team members.
Claim.Slices for careTeam.qualification	S This element must be supported.	0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications.	S This element must be supported.	0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications.
Claim.Slices for supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	S This element must be supported.	0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.Slices for modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.sequence	S This element must be supported.	1..1	positiveInt	Information instance identifier	S This element must be supported.	1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ?? (extensible)	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ?? (extensible)
Claim.Slices for supportingInfo.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.
Claim.Slices for supportingInfo.timing[x]		0..1	date, Period	When it occurred		0..1	date, Period	When it occurred
Claim.Slices for supportingInfo.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
Claim.Slices for supportingInfo.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.
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence	S This element must be supported.	1..1	positiveInt	Diagnosis instance identifier	S This element must be supported.	1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	Nature of illness or problem Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	Nature of illness or problem Binding: ?? (required)
Claim.diagnosis.type	S This element must be supported.	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (required)	S This element must be supported.	0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (required)
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.
Claim.diagnosis.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.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes.		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes.
Claim.procedure.date		0..1	dateTime	When the procedure was performed		0..1	dateTime	When the procedure was performed
Claim.procedure.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.
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	S This element must be supported. Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier	S This element must be supported. Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Required Pattern: true	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Required Pattern: true
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Coverage)	Insurance information	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Coverage(2.2.1))	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident	S This element must be supported.	0..1	BackboneElement	Details of the event	S This element must be supported.	0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date	S This element must be supported. C	1..1	date	When the incident occurred	S This element must be supported. C	1..1	date	When the incident occurred
Claim.accident.type	S This element must be supported.	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 This element must be supported.	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.
Claim.accident.location[x]	S This element must be supported.	0..1	Address	Where the event occurred	S This element must be supported.	0..1	Address	Where the event occurred
Claim.item	S This element must be supported. C	1..*	BackboneElement	Product or service provided Constraints: ImmediateLevelOfCare	S This element must be supported. C	1..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		2..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.sequence	S This element must be supported.	1..1	positiveInt	Item instance identifier	S This element must be supported.	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
Claim.item.careTeamSequence	S This element must be supported.	0..*	positiveInt	Applicable careTeam members	S This element must be supported.	0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence	S This element must be supported.	0..*	positiveInt	Applicable diagnoses	S This element must be supported.	0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence	S This element must be supported.	0..*	positiveInt	Applicable exception and supporting information	S This element must be supported.	0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue	S This element must be supported.	0..1	CodeableConcept	Revenue or cost center code Binding: ?? (required)	S This element must be supported.	0..1	CodeableConcept	Revenue or cost center code Binding: ?? (required)
Claim.item.category	S This element must be supported.	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 This element must be supported.	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.
Claim.item.productOrService	S This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)
Claim.item.modifier	S This element must be supported.	0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (required)	S This element must be supported.	0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (required)
Claim.item.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.
Claim.item.Slices for serviced[x]	S This element must be supported.	0..1	date, Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	S This element must be supported.	0..1	date, Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.location[x]	S This element must be supported.	1..1	CodeableConcept	Place of service or where product was supplied Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	Place of service or where product was supplied Binding: ?? (required)
Claim.item.quantity	S This element must be supported. C	0..1	??	A fixed quantity (no comparator)	S This element must be supported. C	0..1	??	Count of products or services
Claim.item.unitPrice	S This element must be supported.	0..1	Money	Fee, charge or cost per item	S This element must be supported.	0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.item.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.
Claim.item.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.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier		1..1	positiveInt	Item instance identifier
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.total		0..1	Money	Total claim cost		0..1	Money	Total claim cost
Documentation for this format