description: PAS constraints on Claim resource mandating support for elements relevant to the prior authorization request package_name: hl7.fhir.us.davinci-pas derivation: constraint name: PASClaim 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|2.2.0'] index: 4 identifier: {array: true, min: 1, max: 2, index: 5} related: {index: 6} supportingInfo: 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: 7 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: 7 extensions: documentInformation: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation', min: 1, max: 1, type: Extension, mustSupport: true, index: 9} elements: extension: index: 8 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: 9} min: 1 max: 1 category: pattern: type: CodeableConcept value: coding: - {code: additionalInformation, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'} index: 10 timing: choices: [] index: 12 value: mustSupport: true choices: [valueReference] index: 14 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: 15 required: [valueReference, extension, value] MessageText: match: {} schema: short: Send text messages to the UMO. mustSupport: true array: true index: 16 elements: category: pattern: type: CodeableConcept value: coding: - {code: freeFormMessage, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'} index: 17 timing: choices: [] index: 19 value: mustSupport: true choices: [valueString] index: 21 valueString: {type: string, mustSupport: true, choiceOf: value, index: 22} required: [valueString, value] diagnosis: short: 'Pertinent diagnosis information. NOTE: Only the first 12 diagnoses can be sent in the X12 request.' index: 23 extensions: recordedDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate|2.2.0', min: 0, max: 1, type: Extension, short: The date that a diagnosis was recorded. (HIxx-4), mustSupport: true, index: 25} elements: extension: index: 24 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|2.2.0', index: 25} 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|2.2.0', 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: 26 extensions: requestType: {url: null, min: 1, _required: true, index: 28} certificationType: {url: null, min: 1, _required: true, index: 29} epsdtIndicator: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator|2.2.0', 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: 30} nursingHomeResidentialStatus: url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus|2.2.0 type: Extension short: A code specifying the status of a nursing home resident at the time of service. (SV209) mustSupport: true index: 31 elements: value: mustSupport: true choices: [] index: 33 nursingHomeLevelOfCare: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare|2.2.0', 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: 34} revenueUnitRateLimit: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit|2.2.0', min: 0, max: 1, type: Extension, short: The limit on the rate per unit of revenue for hospital accomodation. (SV206), mustSupport: true, index: 35} requestedService: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService|2.2.0', min: 0, max: 1, type: Extension, short: The details of the service being requested., mustSupport: true, index: 36} elements: extension: array: true min: 2 index: 27 slicing: slices: requestType: match: {} schema: {_required: true, index: 28} min: 1 certificationType: match: {} schema: {_required: true, index: 29} 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|2.2.0', index: 30} 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|2.2.0 index: 31 elements: value: mustSupport: true choices: [] index: 33 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|2.2.0', index: 34} 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|2.2.0', index: 35} 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|2.2.0', index: 36} 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: 37} location: choices: [] index: 39 unitPrice: {mustSupport: true, index: 40} required: [location, category] package_version: 2.2.0 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 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|2.2.0'] index: 4 class: profile kind: resource url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim base: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base|2.2.0 version: 2.2.0 required: [identifier, item]