description: PAS constraints on ClaimResponse resource that are common to both the request and the inquiry.
package_name: hl7.fhir.us.davinci-pas
derivation: constraint
name: PASClaimResponseBase
abstract: true
type: ClaimResponse
elements:
  patient:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary']
    index: 4
  requestor:
    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: 7
  request:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim']
    index: 8
    extensions:
      DataAbsentReason: {url: 'http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0', min: 0, max: 1, type: Extension, mustSupport: true, index: 9}
    elements:
      extension:
        type: Extension
        mustSupport: true
        url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
        index: 9
        slicing:
          slices:
            DataAbsentReason:
              match: {}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0', index: 9}
              min: 0
              max: 1
  processNote:
    mustSupport: true
    index: 61
    elements:
      number: {mustSupport: true, index: 62}
      text: {mustSupport: true, index: 63}
    required: [number]
  adjudication:
    type: BackboneElement
    mustSupport: true
    index: 57
    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: 59}
    elements:
      extension:
        index: 58
        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: 59}
              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'}
        type: CodeableConcept
        index: 60
  use:
    pattern: {type: code, value: preauthorization}
    type: code
    index: 3
  item:
    mustSupport: true
    index: 12
    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: 14}
      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: 15}
      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: 16}
      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: 17}
      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: 18}
      requestedServiceDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate', min: 0, max: 1, type: Extension, short: The original date/period that was requested by the submitter for this item., mustSupport: true, index: 19}
      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: 20}
      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., mustSupport: true, index: 21}
    elements:
      extension:
        index: 13
        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: 14}
              min: 0
            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: 15}
              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: 16}
              min: 0
              max: 1
            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: 17}
              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: 18}
              min: 0
              max: 1
            requestedServiceDate:
              match: {url: null}
              schema: {type: Extension, short: The original date/period that was requested by the submitter for this item., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate', index: 19}
              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: 20}
              min: 0
            authorizedItemDetail:
              match: {url: null}
              schema: {type: Extension, short: The details of what has been authorized for this item., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail', index: 21}
              min: 0
              max: 1
      itemSequence: {short: 'Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse', mustSupport: true, index: 22}
      noteNumber: {mustSupport: true, index: 23}
      adjudication:
        mustSupport: true
        index: 24
        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: 26}
        elements:
          extension:
            index: 25
            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: 26}
                  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'}
            type: CodeableConcept
            index: 27
  created: {mustSupport: true, index: 5}
  preAuthPeriod: {mustSupport: true, index: 11}
  outcome: {mustSupport: true, index: 10}
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer']
    index: 6
  status:
    mustSupport: true
    pattern: {type: code, value: active}
    type: code
    index: 2
  identifier:
    type: Identifier
    mustSupport: true
    index: 0
    elements:
      system: {short: 'Should use a scheme of ''urn:trnorg:''', index: 1}
  error:
    mustSupport: true
    index: 64
    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: 66}
      errorElement: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement', min: 0, max: 1, type: Extension, short: 'The specific X12 loop, segment, or element that this error information is about.', mustSupport: true, index: 67}
      errorPath: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath', min: 0, max: 1, type: Extension, short: The FHIRPath expression that indicates which FHIR element that this error information is about., mustSupport: true, index: 68}
    elements:
      extension:
        index: 65
        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: 66}
              min: 0
              max: 1
            errorElement:
              match: {url: null}
              schema: {type: Extension, short: 'The specific X12 loop, segment, or element that this error information is about.', mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement', index: 67}
              min: 0
              max: 1
            errorPath:
              match: {url: null}
              schema: {type: Extension, short: The FHIRPath expression that indicates which FHIR element that this error information is about., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath', index: 68}
              min: 0
              max: 1
      code:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RejectReasonCodes'}
        mustSupport: true
        index: 69
  addItem:
    mustSupport: true
    index: 28
    extensions:
      previousAuthorizationNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 33}
      revenue: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode', min: 0, max: 1, type: Extension, mustSupport: true, index: 39}
      nursingHomeLevelOfCare: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare', min: 0, max: 1, type: Extension, mustSupport: true, index: 37}
      productOrServiceCodeEnd: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', min: 0, max: 1, type: Extension, mustSupport: true, index: 38}
      preAuthPeriod: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod', min: 0, max: 1, type: Extension, mustSupport: true, index: 32}
      epsdtIndicator: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator', min: 0, max: 1, type: Extension, mustSupport: true, index: 35}
      requestedService: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService', min: 0, max: 1, type: Extension, mustSupport: true, index: 41}
      revenueUnitRateLimit: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit', min: 0, max: 1, type: Extension, mustSupport: true, index: 40}
      itemTraceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber', min: 0, type: Extension, mustSupport: true, index: 30}
      administrationReferenceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 34}
      nursingHomeResidentialStatus: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus', min: 0, max: 1, type: Extension, mustSupport: true, index: 36}
      preAuthIssueDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate', min: 0, max: 1, type: Extension, mustSupport: true, index: 31}
    elements:
      modifier:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType'}
        mustSupport: true
        index: 46
      adjudication:
        type: BackboneElement
        mustSupport: true
        index: 53
        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: 55}
        elements:
          extension:
            index: 54
            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: 55}
                  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'}
            type: CodeableConcept
            index: 56
      itemSequence: {mustSupport: true, index: 42}
      serviced:
        mustSupport: true
        choices: []
        index: 48
      productOrService:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 45
      extension:
        index: 29
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            previousAuthorizationNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', index: 33}
              min: 0
              max: 1
            revenue:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode', index: 39}
              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: 37}
              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: 38}
              min: 0
              max: 1
            preAuthPeriod:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod', index: 32}
              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: 35}
              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: 41}
              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: 40}
              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: 30}
              min: 0
            administrationReferenceNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', index: 34}
              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: 36}
              min: 0
              max: 1
            preAuthIssueDate:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate', index: 31}
              min: 0
              max: 1
      quantity: {type: Quantity, mustSupport: true, index: 51}
      location:
        mustSupport: true
        choices: []
        index: 50
      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-practitioner']
        index: 43
        extensions:
          providerType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType', min: 0, max: 1, type: Extension, mustSupport: true, index: 44}
        elements:
          extension:
            type: Extension
            mustSupport: true
            url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType
            index: 44
            slicing:
              slices:
                providerType:
                  match: {}
                  schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizedProviderType', index: 44}
                  min: 0
                  max: 1
      unitPrice: {mustSupport: true, index: 52}
    required: [itemSequence]
package_version: 2.2.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 2.2.0-ballot
required: [request]