description: PAS constraints on Claim resource mandating support for elements relevant to the prior authorization request
package_name: hl7.fhir.us.davinci-pas
derivation: constraint
name: PASClaim
type: Claim
elements:
  patient:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary']
    index: 6
  insurance:
    mustSupport: true
    index: 59
    elements:
      sequence: {mustSupport: true, index: 60}
      focal:
        pattern: {type: Boolean, value: true}
        index: 61
      coverage: {mustSupport: true, index: 62}
  diagnosis:
    mustSupport: true
    index: 50
    extensions:
      recordedDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate', min: 0, max: 1, type: Extension, mustSupport: true, index: 52}
    elements:
      extension:
        index: 51
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            recordedDate:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate', index: 52}
              min: 0
              max: 1
      sequence: {mustSupport: true, index: 53}
      diagnosis:
        mustSupport: true
        choices: [diagnosisCodeableConcept]
        index: 55
      diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 56}
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisType'}
        mustSupport: true
        index: 58
  supportingInfo:
    mustSupport: true
    index: 14
    elements:
      sequence: {mustSupport: true, index: 15}
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType'}
        mustSupport: true
        index: 16
    slicing:
      rules: open
      description: Slice based on the different types of supporting information that can be included in a authorization request.
      discriminator:
      - {path: category, type: value}
      min: null
      slices:
        PatientEvent:
          match:
            category:
              coding:
              - {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 17
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 18
              timing:
                mustSupport: true
                choices: []
                index: 20
              value:
                choices: []
                index: 22
            required: [timing]
        AdmissionReview:
          match:
            category:
              coding:
              - {code: admissionReview, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 23
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: admissionReview, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 24
              timing:
                mustSupport: true
                choices: []
                index: 26
              value:
                choices: []
                index: 28
            required: [timing]
        AdditionalInformation:
          match:
            category:
              coding:
              - {code: additionalInformation, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 29
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: additionalInformation, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 30
              timing:
                choices: []
                index: 32
              value:
                mustSupport: true
                choices: [valueReference]
                index: 34
              valueReference:
                type: Reference
                mustSupport: true
                choiceOf: value
                refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
                index: 35
            required: [valueReference, value]
        MessageText:
          match:
            category:
              coding:
              - {code: freeFormMessage, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 36
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: freeFormMessage, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 37
              timing:
                choices: []
                index: 39
              value:
                mustSupport: true
                choices: [valueString]
                index: 41
              valueString: {type: string, mustSupport: true, choiceOf: value, index: 42}
            required: [valueString, value]
        InstitutionalEncounter:
          match:
            category:
              coding:
              - {code: institutionalEncounter, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 43
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: institutionalEncounter, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 44
              timing:
                choices: []
                index: 46
              value:
                mustSupport: true
                choices: [valueReference]
                index: 48
              valueReference:
                type: Reference
                mustSupport: true
                choiceOf: value
                refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter']
                index: 49
            required: [valueReference, value]
  use:
    pattern: {type: Code, value: preauthorization}
    index: 5
  item:
    mustSupport: true
    index: 69
    extensions:
      certificationType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', min: 0, max: 1, type: Extension, mustSupport: true, index: 75}
      nursingHomeLevelOfCare: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare', min: 0, max: 1, type: Extension, mustSupport: true, index: 80}
      productOrServiceCodeEnd: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', min: 0, max: 1, type: Extension, mustSupport: true, index: 76}
      epsdtIndicator: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator', min: 0, max: 1, type: Extension, mustSupport: true, index: 77}
      requestedService: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService', min: 0, max: 1, type: Extension, mustSupport: true, index: 82}
      authorizationNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 72}
      revenueUnitRateLimit: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit', min: 0, max: 1, type: Extension, mustSupport: true, index: 81}
      itemTraceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 71}
      administrationReferenceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 73}
      requestType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', min: 0, max: 1, type: Extension, mustSupport: true, index: 74}
      nursingHomeResidentialStatus:
        url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus
        type: Extension
        mustSupport: true
        index: 78
        elements:
          valueCodeableConcept:
            binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/SV2/1/09/00/1345'}
            index: 79
    elements:
      category:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365'}
        mustSupport: true
        index: 88
      diagnosisSequence: {mustSupport: true, index: 85}
      modifier:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 90
      revenue:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes'}
        mustSupport: true
        index: 87
      locationCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: location, index: 95}
      serviced:
        mustSupport: true
        choices: []
        index: 92
      careTeamSequence: {mustSupport: true, index: 84}
      productOrService:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 89
      extension:
        index: 70
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            certificationType:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', index: 75}
              min: 0
              max: 1
            nursingHomeLevelOfCare:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare', index: 80}
              min: 0
              max: 1
            productOrServiceCodeEnd:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', index: 76}
              min: 0
              max: 1
            epsdtIndicator:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator', index: 77}
              min: 0
              max: 1
            requestedService:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService', index: 82}
              min: 0
              max: 1
            authorizationNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', index: 72}
              min: 0
              max: 1
            revenueUnitRateLimit:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit', index: 81}
              min: 0
              max: 1
            itemTraceNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber', index: 71}
              min: 0
              max: 1
            administrationReferenceNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', index: 73}
              min: 0
              max: 1
            requestType:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', index: 74}
              min: 0
              max: 1
            nursingHomeResidentialStatus:
              match: {url: null}
              schema:
                type: Extension
                mustSupport: true
                url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus
                index: 78
                elements:
                  valueCodeableConcept:
                    binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/SV2/1/09/00/1345'}
                    index: 79
      informationSequence: {mustSupport: true, index: 86}
      sequence: {mustSupport: true, index: 83}
      quantity: {mustSupport: true, index: 97}
      location:
        mustSupport: true
        choices: [locationCodeableConcept]
        index: 94
      unitPrice: {mustSupport: true, index: 98}
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: null
      slices:
        levelOfServiceType:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', index: 1}
          min: 0
          max: 1
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer']
    index: 7
  accident:
    mustSupport: true
    index: 63
    elements:
      date: {mustSupport: true, index: 64}
      type:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362'}
        mustSupport: true
        index: 65
      location:
        choices: [locationAddress]
        index: 67
      locationAddress: {type: Address, choiceOf: location, index: 68}
  status:
    pattern: {type: Code, value: active}
    index: 4
  identifier:
    mustSupport: true
    index: 2
    extensions:
      subDepartment: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment', min: 0, max: 1, type: Extension, mustSupport: true, index: 3}
    elements:
      extension:
        type: Extension
        mustSupport: true
        url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
        index: 3
        slicing:
          slices:
            subDepartment:
              match: {}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment', index: 3}
              min: 0
              max: 1
  provider:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor']
    index: 8
  careTeam:
    mustSupport: true
    index: 9
    elements:
      sequence: {mustSupport: true, index: 10}
      provider:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization', 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner']
        index: 11
      role:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98'}
        mustSupport: true
        index: 12
      qualification:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127'}
        mustSupport: true
        index: 13
package_version: 1.0.0
extensions:
  levelOfServiceType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', min: 0, max: 1, type: Extension, mustSupport: true, index: 1}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 1.0.0
required: [identifier, item]