description: PAS constraints on Claim resource mandating support for elements relevant to the response of a prior authorization request
package_name: hl7.fhir.us.davinci
derivation: constraint
name: PASClaimResponse
type: ClaimResponse
elements:
  patient:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary']
    index: 3
  requestor:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor']
    index: 6
  request:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim']
    index: 7
  use:
    pattern: {type: Code, value: preauthorization}
    index: 2
  item:
    mustSupport: true
    index: 10
    extensions:
      previousAuthorizationNumber: {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: 15}
      authorizedItemDetail: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail', min: 0, max: 1, type: Extension, short: The details of what has been authorized for this item if different from what was requested., mustSupport: true, index: 18}
      authorizedDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDate', min: 0, max: 1, type: Extension, short: The date/period by which the item that is pre-authorized must be completed., mustSupport: true, index: 17}
      preAuthPeriod: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod', min: 0, max: 1, type: Extension, short: The date/period when this item's preauthorization is valid., mustSupport: true, index: 14}
      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: 12}
      communicatedDiagnosis: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis', min: 0, type: Extension, short: A code representing the diagnosis that is relevant to the preauthorization., mustSupport: true, index: 20}
      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: 16}
      preAuthIssueDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate', min: 0, max: 1, type: Extension, short: The date when this item's preauthorization was issued., mustSupport: true, index: 13}
      authorizedProvider: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider', min: 0, type: Extension, short: The specific provider who has been authorized to provide this item., mustSupport: true, index: 19}
    elements:
      extension:
        index: 11
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            previousAuthorizationNumber:
              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: 15}
              min: 0
              max: 1
            authorizedItemDetail:
              match: {url: null}
              schema: {type: Extension, short: The details of what has been authorized for this item if different from what was requested., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail', index: 18}
              min: 0
              max: 1
            authorizedDate:
              match: {url: null}
              schema: {type: Extension, short: The date/period by which the item that is pre-authorized must be completed., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDate', index: 17}
              min: 0
              max: 1
            preAuthPeriod:
              match: {url: null}
              schema: {type: Extension, short: The date/period when this item's preauthorization is valid., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod', index: 14}
              min: 0
              max: 1
            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: 12}
              min: 0
            communicatedDiagnosis:
              match: {url: null}
              schema: {type: Extension, short: A code representing the diagnosis that is relevant to the preauthorization., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-communicatedDiagnosis', index: 20}
              min: 0
            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: 16}
              min: 0
              max: 1
            preAuthIssueDate:
              match: {url: null}
              schema: {type: Extension, short: The date when this item's preauthorization was issued., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate', index: 13}
              min: 0
              max: 1
            authorizedProvider:
              match: {url: null}
              schema: {type: Extension, short: The specific provider who has been authorized to provide this item., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider', index: 19}
              min: 0
      noteNumber: {mustSupport: true, index: 21}
      adjudication:
        mustSupport: true
        index: 22
        extensions:
          reviewAction: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction', min: 0, max: 1, type: Extension, short: The details of the review action that is necessary for the authorization., mustSupport: true, index: 24}
        elements:
          extension:
            index: 23
            slicing:
              rules: open
              ordered: false
              discriminator:
              - {path: url, type: value}
              min: null
              slices:
                reviewAction:
                  match: {url: null}
                  schema: {type: Extension, short: The details of the review action that is necessary for the authorization., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction', index: 24}
                  min: 0
                  max: 1
          category:
            short: This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
            pattern:
              type: CodeableConcept
              value:
                coding:
                - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
            index: 25
  created: {mustSupport: true, index: 4}
  preAuthPeriod: {mustSupport: true, index: 9}
  outcome: {mustSupport: true, index: 8}
  communicationRequest:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-communicationrequest']
    index: 26
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer']
    index: 5
  status:
    pattern: {type: Code, value: active}
    mustSupport: true
    index: 1
  identifier: {type: Identifier, mustSupport: true, index: 0}
  error:
    mustSupport: true
    index: 27
    extensions:
      followupAction: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction', min: 0, max: 1, type: Extension, short: A code representing what action must occur to resolve this error., mustSupport: true, index: 29}
      errorElement: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement', min: 0, max: 1, type: Extension, short: 'The specific loop, segment, or element that this error information is about.', mustSupport: true, index: 30}
    elements:
      extension:
        index: 28
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            followupAction:
              match: {url: null}
              schema: {type: Extension, short: A code representing what action must occur to resolve this error., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction', index: 29}
              min: 0
              max: 1
            errorElement:
              match: {url: null}
              schema: {type: Extension, short: 'The specific loop, segment, or element that this error information is about.', mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement', index: 30}
              min: 0
              max: 1
      code:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RejectReasonCodes'}
        mustSupport: true
        index: 31
package_version: pas-1.1.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 1.1.0