description: This profile defines constraints and extensions used when updating a previously submitted Claim instance.
package_name: hl7.fhir.us.davinci-pas
derivation: constraint
name: PASClaimUpdate
type: Claim
elements:
  extension:
    type: Extension
    short: Information about a hospital claim being requested.
    mustSupport: true
    url: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
    index: 0
    slicing:
      slices:
        encounter:
          match: {}
          schema:
            type: Extension
            short: Information about a hospital claim being requested.
            mustSupport: true
            url: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
            index: 0
            extensions: {}
            elements:
              extension: {index: 1}
              value:
                choices: [valueReference]
                index: 3
              valueReference:
                type: Reference
                choiceOf: value
                refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter|2.2.1']
                index: 4
        certificationType:
          match: {}
          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|2.2.1', index: 5}
          min: 0
          max: 1
  identifier: {array: true, min: 1, max: 2, index: 6}
  related:
    mustSupport: true
    index: 7
    elements:
      claim: {mustSupport: true, index: 8}
      relationship:
        mustSupport: true
        pattern:
          type: CodeableConcept
          value:
            coding:
            - {code: prior, system: 'http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship'}
        index: 9
    required: [claim, relationship]
  supportingInfo:
    index: 10
    extensions:
      infoChanged: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged|2.2.1', min: 0, max: 1, type: Extension, short: A code indicating how the piece of information has changed., mustSupport: true, index: 12}
    elements:
      extension:
        index: 11
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            infoChanged:
              match: {url: null}
              schema: {type: Extension, short: A code indicating how the piece of information has changed., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged|2.2.1', index: 12}
              min: 0
              max: 1
      modifierExtension:
        index: 13
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            infoCancelledFlag:
              match: {url: null}
              schema: {type: Extension, short: Indicates that this piece of information is not to be used., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled|2.2.1', index: 14}
              min: 0
              max: 1
    slicing:
      slices:
        AdditionalInformation:
          match: {}
          schema:
            short: Send additional paperwork or supporting information for the request.  This can be most commonly a DocumentReference profile although any type of information is allowed.
            mustSupport: true
            array: true
            index: 15
            extensions:
              documentInformation: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation', min: 1, max: 1, type: Extension, mustSupport: true, index: 17}
            elements:
              extension:
                index: 16
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: url, type: value}
                  min: 1
                  slices:
                    documentInformation:
                      match: {url: null}
                      schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation', index: 17}
                      min: 1
                      max: 1
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: additionalInformation, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
                index: 18
              timing:
                choices: []
                index: 20
              value:
                mustSupport: true
                choices: [valueReference]
                index: 22
              valueReference:
                type: Reference
                mustSupport: true
                choiceOf: value
                refers: ['http://hl7.org/fhir/StructureDefinition/Bundle', 'http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/NutritionOrder', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-result|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-simple-observation|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs|7.0.0', 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-documentreference']
                index: 23
            required: [valueReference, extension, value]
        MessageText:
          match: {}
          schema:
            short: Send text messages to the UMO.
            mustSupport: true
            array: true
            index: 24
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: freeFormMessage, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
                index: 25
              timing:
                choices: []
                index: 27
              value:
                mustSupport: true
                choices: [valueString]
                index: 29
              valueString: {type: string, mustSupport: true, choiceOf: value, index: 30}
            required: [valueString, value]
  diagnosis:
    short: 'Pertinent diagnosis information.  NOTE: Only the first 12 diagnoses can be sent in the X12 request.'
    index: 31
    extensions:
      recordedDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate|2.2.1', min: 0, max: 1, type: Extension, short: The date that a diagnosis was recorded. (HIxx-4), mustSupport: true, index: 33}
    elements:
      extension:
        index: 32
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            recordedDate:
              match: {url: null}
              schema: {type: Extension, short: The date that a diagnosis was recorded. (HIxx-4), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate|2.2.1', index: 33}
              min: 0
              max: 1
  item:
    constraint:
      ImmediateLevelOfCare: {human: 'If Certification Type is an immediate appeal, then Level of Service Code must be present', source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update|2.2.1', severity: error, expression: 'extension.where(url=''http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType'' and value.code=''1'').exists() implies extension.where(url=''http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode'').exists()'}
    index: 34
    extensions:
      requestType: {url: null, min: 1, _required: true, index: 36}
      certificationType: {url: null, min: 1, _required: true, index: 37}
      epsdtIndicator: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator|2.2.1', min: 0, max: 1, type: Extension, short: An indicator of whether early and periodic screen for diagnosis and treatment of children is involved., mustSupport: true, index: 38}
      nursingHomeResidentialStatus:
        url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus|2.2.1
        type: Extension
        short: A code specifying the status of a nursing home resident at the time of service. (SV209)
        mustSupport: true
        index: 39
        elements:
          value:
            mustSupport: true
            choices: []
            index: 41
      nursingHomeLevelOfCare: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare|2.2.1', min: 0, max: 1, type: Extension, short: 'A code specifying the level of care provided by a nursing home facility. (SV120, SV210)', mustSupport: true, index: 42}
      revenueUnitRateLimit: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit|2.2.1', min: 0, max: 1, type: Extension, short: The limit on the rate per unit of revenue for hospital accomodation. (SV206), mustSupport: true, index: 43}
      requestedService: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService|2.2.1', min: 0, max: 1, type: Extension, short: The details of the service being requested., mustSupport: true, index: 44}
      infoChanged: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged|2.2.1', min: 0, max: 1, type: Extension, short: A code indicating how the piece of information has changed., mustSupport: true, index: 45}
    elements:
      extension:
        array: true
        min: 2
        index: 35
        slicing:
          slices:
            requestType:
              match: {}
              schema: {_required: true, index: 36}
              min: 1
            certificationType:
              match: {}
              schema: {_required: true, index: 37}
              min: 1
            epsdtIndicator:
              match: {}
              schema: {type: Extension, short: An indicator of whether early and periodic screen for diagnosis and treatment of children is involved., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator|2.2.1', index: 38}
              min: 0
              max: 1
            nursingHomeResidentialStatus:
              match: {}
              schema:
                type: Extension
                short: A code specifying the status of a nursing home resident at the time of service. (SV209)
                mustSupport: true
                url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus|2.2.1
                index: 39
                elements:
                  value:
                    mustSupport: true
                    choices: []
                    index: 41
            nursingHomeLevelOfCare:
              match: {}
              schema: {type: Extension, short: 'A code specifying the level of care provided by a nursing home facility. (SV120, SV210)', mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare|2.2.1', index: 42}
              min: 0
              max: 1
            revenueUnitRateLimit:
              match: {}
              schema: {type: Extension, short: The limit on the rate per unit of revenue for hospital accomodation. (SV206), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit|2.2.1', index: 43}
              min: 0
              max: 1
            requestedService:
              match: {}
              schema: {type: Extension, short: The details of the service being requested., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService|2.2.1', index: 44}
              min: 0
              max: 1
            infoChanged:
              match: {}
              schema: {type: Extension, short: A code indicating how the piece of information has changed., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged|2.2.1', index: 45}
              min: 0
              max: 1
      modifierExtension:
        index: 46
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            infoCancelledFlag:
              match: {url: null}
              schema: {type: Extension, short: Indicates that this piece of information is not to be used., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled|2.2.1', index: 47}
              min: 0
              max: 1
      category: {short: 'Since PAS requests only have item-level information, a category is required for conformance with the X12 278 request.', index: 48}
      location:
        choices: []
        index: 50
      unitPrice: {mustSupport: true, index: 51}
    required: [location, category]
package_version: 2.2.1
extensions:
  encounter:
    url: http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter
    type: Extension
    short: Information about a hospital claim being requested.
    mustSupport: true
    index: 0
    extensions: {}
    elements:
      extension: {index: 1}
      value:
        choices: [valueReference]
        index: 3
      valueReference:
        type: Reference
        choiceOf: value
        refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter|2.2.1']
        index: 4
  certificationType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType|2.2.1', min: 0, max: 1, type: Extension, short: A code representing the type of certification being requested (UM02), mustSupport: true, index: 5}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update
base: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.1
version: 2.2.1
required: [related, identifier, item]