description: This profile defines constraints and extensions used when update a previously submitted Claim instance.\n\n* The Claim instance of the update Bundle SHALL reference the updated Claim instance within the `Claim.related.claim` element. Note that the presence of this reference and the requirement that referenced instances be included in the submitted Bundle implies that the instance representing the prior version of the Claim SHALL be included in the update Bundle.\n* The Claim instance of the update Bundle SHALL contain within the `Claim.item` element each item requested in the updated claim and any prior versions of the claim, including requested items that have been added, modified, deleted, or left unchanged during this or previous updates.\n* The Claim instance of the update Bundle SHALL contain within the `Claim.supportingInfo` element each piece of supporting documentation submitted with the updated claim and any prior versions of claim, including supporting documentation that has been added, modified, deleted, or left unchanged during this or previous updates.\n* Each `Claim.item` entry that represents an item no longer being requested, whether removed in this update or a previous one, SHALL be flagged using the infoCancelledFlag modifierExtension and SHALL have the code `3` (Cancel) in the Certification Type extension.\n* Each `Claim.supportingInfo` entry that is no longer to be used when evaluating the request, whether removed in this update or a previous one, SHALL be flagged using the infoCancelledFlag modifierExtension.\n* Each `Claim.item` and `Claim.supportingInfo` entry that has been changed as a part of this most recent update, including removal, SHALL be flagged using the changed extension with a value of `changed`.\n* Each `Claim.item` and `Claim.supportingInfo` entry that has been added as a part of this most recent update, SHALL be flagged using the changed extension with a value of `added`. 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 elements: value: choices: [valueReference] index: 2 valueReference: type: Reference choiceOf: value refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter'] index: 3 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', index: 4} min: 0 max: 1 identifier: {array: true, min: 1, max: 2, index: 5} related: mustSupport: true index: 6 elements: claim: {mustSupport: true, index: 7} relationship: mustSupport: true pattern: type: CodeableConcept value: coding: - {code: prior, system: 'http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship'} index: 8 required: [claim, relationship] supportingInfo: index: 9 extensions: infoChanged: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged', min: 0, max: 1, type: Extension, short: A code indicating how the piece of information has changed., mustSupport: true, index: 11} elements: extension: index: 10 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', index: 11} min: 0 max: 1 modifierExtension: index: 12 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', index: 13} 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: 14 elements: category: pattern: type: CodeableConcept value: coding: - {code: additionalInformation, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'} index: 15 timing: choices: [] index: 17 value: mustSupport: true choices: [valueReference] index: 19 valueReference: type: Reference mustSupport: true choiceOf: value refers: ['http://hl7.org/fhir/StructureDefinition/Resource', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse'] index: 20 required: [valueReference, value] MessageText: match: {} schema: short: Send text messages to the UMO. mustSupport: true array: true index: 21 elements: category: pattern: type: CodeableConcept value: coding: - {code: freeFormMessage, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'} index: 22 timing: choices: [] index: 24 value: mustSupport: true choices: [valueString] index: 26 valueString: {type: string, mustSupport: true, choiceOf: value, index: 27} required: [valueString, value] diagnosis: short: 'Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.' index: 28 extensions: recordedDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate', min: 0, max: 1, type: Extension, short: The date that a diagnosis was recorded. (HIxx-4), mustSupport: true, index: 30} elements: extension: index: 29 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', index: 30} 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', 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: 31 extensions: requestType: {url: null, min: 1, _required: true, index: 33} certificationType: {url: null, min: 1, _required: true, index: 34} epsdtIndicator: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator', 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: 35} nursingHomeResidentialStatus: url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus type: Extension short: A code specifying the status of a nursing home resident at the time of service. (SV209) mustSupport: true index: 36 elements: value: mustSupport: true choices: [] index: 38 nursingHomeLevelOfCare: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare', 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: 39} revenueUnitRateLimit: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit', min: 0, max: 1, type: Extension, short: The limit on the rate per unit of revenue for hospital accomodation. (SV206), mustSupport: true, index: 40} requestedService: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService', min: 0, max: 1, type: Extension, short: The details of the service being requested., mustSupport: true, index: 41} infoChanged: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged', min: 0, max: 1, type: Extension, short: A code indicating how the piece of information has changed., mustSupport: true, index: 42} elements: extension: array: true min: 2 index: 32 slicing: slices: requestType: match: {} schema: {_required: true, index: 33} min: 1 certificationType: match: {} schema: {_required: true, index: 34} 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', index: 35} 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 index: 36 elements: value: mustSupport: true choices: [] index: 38 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', index: 39} 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', index: 40} 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', index: 41} 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', index: 42} min: 0 max: 1 modifierExtension: index: 43 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', index: 44} 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: 45} location: choices: [] index: 47 unitPrice: {mustSupport: true, index: 48} required: [location, category] package_version: 2.1.0 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 elements: value: choices: [valueReference] index: 2 valueReference: type: Reference choiceOf: value refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter'] index: 3 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: 4} 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 version: 2.1.0 required: [related, identifier, item]