description: PAS constraints on Claim resource that are common to both the request and the inquiry.
package_name: hl7.fhir.us.davinci
derivation: constraint
name: PASClaimBase
abstract: true
type: Claim
elements:
  patient:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary']
    index: 7
  insurance:
    mustSupport: true
    index: 82
    elements:
      sequence: {mustSupport: true, index: 83}
      focal:
        pattern: {type: Boolean, value: true}
        index: 84
      coverage:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage']
        index: 85
  diagnosis:
    mustSupport: true
    index: 76
    elements:
      sequence: {mustSupport: true, index: 77}
      diagnosis:
        mustSupport: true
        choices: [diagnosisCodeableConcept]
        index: 79
      diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 80}
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisType'}
        mustSupport: true
        index: 81
  supportingInfo:
    mustSupport: true
    index: 31
    elements:
      sequence: {mustSupport: true, index: 32}
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType'}
        mustSupport: true
        index: 33
    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/PASTempCodes'}
          schema:
            short: Information about the dates of the event that are being requested.
            index: 34
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
                index: 35
              timing:
                choices: [timingPeriod]
                index: 42
                slicing:
                  slices:
                    timingPeriod:
                      match: {}
                      schema:
                        choices: [timingPeriod]
                        index: 42
                      min: 0
                      max: 1
              timingDate:
                type: date
                constraint:
                  FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                choiceOf: timing
                index: 40
                slicing:
                  slices:
                    timingDate:
                      match: {}
                      schema:
                        type: date
                        constraint:
                          FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                        choiceOf: timing
                        index: 40
                      min: 0
                      max: 1
              timingPeriod:
                type: Period
                choiceOf: timing
                index: 43
                slicing:
                  slices:
                    timingPeriod:
                      match: {}
                      schema: {type: Period, choiceOf: timing, index: 43}
                      min: 0
                      max: 1
              timing[x]:
                elements:
                  start:
                    constraint:
                      FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                    index: 44
                  end:
                    constraint:
                      FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                    index: 45
              value:
                choices: []
                index: 47
            required: [timing]
        AdmissionDates:
          match:
            category:
              coding:
              - {code: admissionDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
          schema:
            short: Information about the admission dates of a hospital admission being requested.
            index: 48
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: admissionDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
                index: 49
              timing:
                choices: [timingPeriod]
                index: 56
                slicing:
                  slices:
                    timingPeriod:
                      match: {}
                      schema:
                        choices: [timingPeriod]
                        index: 56
                      min: 0
                      max: 1
              timingDate:
                type: date
                constraint:
                  FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                choiceOf: timing
                index: 54
                slicing:
                  slices:
                    timingDate:
                      match: {}
                      schema:
                        type: date
                        constraint:
                          FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                        choiceOf: timing
                        index: 54
                      min: 0
                      max: 1
              timingPeriod:
                type: Period
                choiceOf: timing
                index: 57
                slicing:
                  slices:
                    timingPeriod:
                      match: {}
                      schema: {type: Period, choiceOf: timing, index: 57}
                      min: 0
                      max: 1
              timing[x]:
                elements:
                  start:
                    constraint:
                      FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                    index: 58
                  end:
                    constraint:
                      FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                    index: 59
              value:
                choices: []
                index: 61
            required: [timing]
        DischargeDates:
          match:
            category:
              coding:
              - {code: dischargeDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
          schema:
            short: Information about the discharge dates of a hospital admission being requested.
            index: 62
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: dischargeDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
                index: 63
              timing:
                choices: [timingPeriod]
                index: 70
                slicing:
                  slices:
                    timingPeriod:
                      match: {}
                      schema:
                        choices: [timingPeriod]
                        index: 70
                      min: 0
                      max: 1
              timingDate:
                type: date
                constraint:
                  FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                choiceOf: timing
                index: 68
                slicing:
                  slices:
                    timingDate:
                      match: {}
                      schema:
                        type: date
                        constraint:
                          FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                        choiceOf: timing
                        index: 68
                      min: 0
                      max: 1
              timingPeriod:
                type: Period
                choiceOf: timing
                index: 71
                slicing:
                  slices:
                    timingPeriod:
                      match: {}
                      schema: {type: Period, choiceOf: timing, index: 71}
                      min: 0
                      max: 1
              timing[x]:
                elements:
                  start:
                    constraint:
                      FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                    index: 72
                  end:
                    constraint:
                      FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
                    index: 73
              value:
                choices: []
                index: 75
            required: [timing]
  use:
    pattern: {type: Code, value: preauthorization}
    index: 6
  item:
    mustSupport: true
    index: 92
    extensions:
      itemTraceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber', min: 0, type: Extension, short: Uniquely identifies this claim item. (2000F-TRN), mustSupport: true, index: 94}
      authorizationNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', min: 0, max: 1, type: Extension, short: A string assigned by the UMO to an authorized review outcome associated with this service item., mustSupport: true, index: 95}
      administrationReferenceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', min: 0, max: 1, type: Extension, short: A string assigned by the UMO to the original disallowed review outcome associated with this service item., mustSupport: true, index: 96}
      requestType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', min: 0, max: 1, type: Extension, short: A code that identifies the type of service being requested., mustSupport: true, index: 97}
      certificationType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', min: 0, max: 1, type: Extension, short: A code representing the type of certification being requested (UM02), mustSupport: true, index: 98}
      productOrServiceCodeEnd: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', min: 0, max: 1, type: Extension, short: Used to provide the last code in a series of codes for the service being requested., index: 99}
    elements:
      category:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365'}
        index: 105
      diagnosisSequence: {mustSupport: true, index: 102}
      modifier:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType'}
        mustSupport: true
        index: 107
      revenue:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes'}
        mustSupport: true
        index: 104
      locationCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: location, index: 112}
      serviced:
        mustSupport: true
        choices: []
        index: 109
      careTeamSequence: {mustSupport: true, index: 101}
      productOrService:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 106
      extension:
        index: 93
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            itemTraceNumber:
              match: {url: null}
              schema: {type: Extension, short: Uniquely identifies this claim item. (2000F-TRN), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber', index: 94}
              min: 0
            authorizationNumber:
              match: {url: null}
              schema: {type: Extension, short: A string assigned by the UMO to an authorized review outcome associated with this service item., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', index: 95}
              min: 0
              max: 1
            administrationReferenceNumber:
              match: {url: null}
              schema: {type: Extension, short: A string assigned by the UMO to the original disallowed review outcome associated with this service item., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', index: 96}
              min: 0
              max: 1
            requestType:
              match: {url: null}
              schema: {type: Extension, short: A code that identifies the type of service being requested., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', index: 97}
              min: 0
              max: 1
            certificationType:
              match: {url: null}
              schema: {type: Extension, short: A code representing the type of certification being requested (UM02), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', index: 98}
              min: 0
              max: 1
            productOrServiceCodeEnd:
              match: {url: null}
              schema: {type: Extension, short: Used to provide the last code in a series of codes for the service being requested., url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', index: 99}
              min: 0
              max: 1
      informationSequence: {mustSupport: true, index: 103}
      sequence: {mustSupport: true, index: 100}
      quantity: {mustSupport: true, index: 113}
      location:
        mustSupport: true
        choices: [locationCodeableConcept]
        index: 111
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: null
      slices:
        levelOfServiceType:
          match: {url: null}
          schema: {type: Extension, short: A code specifying the level of service being requested (UM06), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', index: 1}
          min: 0
          max: 1
        conditionCode:
          match: {url: null}
          schema: {type: Extension, short: Used to indicate condition codes for various requests for service., url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode', index: 2}
          min: 0
        homeHealthCareInformation:
          match: {url: null}
          schema: {type: Extension, short: Used to provide required information about home health care services. (CR6), url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation', index: 3}
          min: 0
          max: 1
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer']
    index: 8
  accident:
    mustSupport: true
    index: 86
    elements:
      date: {mustSupport: true, index: 87}
      type:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362'}
        mustSupport: true
        index: 88
      location:
        choices: [locationAddress]
        index: 90
      locationAddress: {type: Address, choiceOf: location, index: 91}
  status:
    pattern: {type: Code, value: active}
    index: 5
  identifier: {type: Identifier, short: Business identifier for claim, mustSupport: true, index: 4}
  provider:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole', 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor']
    index: 9
  careTeam:
    mustSupport: true
    index: 10
    extensions:
      careTeamClaimScope: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope', min: 1, max: 1, type: Extension, mustSupport: true, index: 12}
    elements:
      extension:
        index: 11
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: 1
          slices:
            careTeamClaimScope:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope', index: 12}
              min: 1
              max: 1
      sequence: {mustSupport: true, index: 13}
      provider:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-organization', 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole']
        index: 14
      role: {mustSupport: true, index: 15}
      qualification: {mustSupport: true, index: 16}
    required: [extension]
    slicing:
      rules: open
      description: Slice based on whether the care team member belongs to the overall claim or to an individual claim item.
      discriminator:
      - {path: 'extension(''http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'').value as boolean', type: value}
      min: null
      slices:
        OverallClaimMember:
          match:
            extension('http://hl7:
              org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'): {value as boolean: null}
          schema:
            short: 'Care Team Providers that are applicable to all services being requested.  NOTE: Only the first 14 can be sent in the X12 Request.'
            array: true
            index: 17
            extensions:
              careTeamClaimScope:
                url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
                type: Extension
                mustSupport: true
                index: 19
                elements:
                  value:
                    pattern: {type: Boolean, value: true}
                    choices: []
                    index: 21
            elements:
              extension:
                index: 18
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: url, type: value}
                  min: 1
                  slices:
                    careTeamClaimScope:
                      match: {url: null}
                      schema:
                        type: Extension
                        mustSupport: true
                        url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
                        index: 19
                        elements:
                          value:
                            pattern: {type: Boolean, value: true}
                            choices: []
                            index: 21
              role:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98'}
                index: 22
              qualification:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127'}
                index: 23
            required: [extension]
        ItemClaimMember:
          match:
            extension('http://hl7:
              org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'): {value as boolean: null}
          schema:
            short: 'Care Team Providers that are applicable to a specific item (as referenced by that item).  NOTE: Only the first 10 can be sent in the X12 Request.'
            array: true
            index: 24
            extensions:
              careTeamClaimScope:
                url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
                type: Extension
                mustSupport: true
                index: 26
                elements:
                  value:
                    pattern: {type: Boolean, value: false}
                    choices: []
                    index: 28
            elements:
              extension:
                index: 25
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: url, type: value}
                  min: 1
                  slices:
                    careTeamClaimScope:
                      match: {url: null}
                      schema:
                        type: Extension
                        mustSupport: true
                        url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
                        index: 26
                        elements:
                          value:
                            pattern: {type: Boolean, value: false}
                            choices: []
                            index: 28
              role:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98'}
                index: 29
              qualification:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127'}
                index: 30
            required: [extension]
package_version: pas-2.0.1
extensions:
  levelOfServiceType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', min: 0, max: 1, type: Extension, short: A code specifying the level of service being requested (UM06), mustSupport: true, index: 1}
  conditionCode: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode', min: 0, type: Extension, short: Used to indicate condition codes for various requests for service., index: 2}
  homeHealthCareInformation: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation', min: 0, max: 1, type: Extension, short: Used to provide required information about home health care services. (CR6), index: 3}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 2.0.1
required: [insurer, item]