description: PAS constraints on Claim resource when submitting an inquiry for existing authorizations.
package_name: hl7.fhir.us.davinci-pas
derivation: constraint
name: PASClaimInquiry
type: Claim
elements:
  patient:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary']
    index: 5
  insurance:
    mustSupport: true
    index: 36
    elements:
      sequence: {mustSupport: true, index: 37}
      focal:
        pattern: {type: Boolean, value: true}
        index: 38
      coverage: {mustSupport: true, index: 39}
  diagnosis:
    mustSupport: true
    index: 29
    elements:
      sequence: {mustSupport: true, index: 30}
      diagnosis:
        mustSupport: true
        choices: [diagnosisCodeableConcept]
        index: 32
      diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 33}
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisType'}
        mustSupport: true
        index: 35
  supportingInfo:
    mustSupport: true
    index: 14
    elements:
      sequence: {mustSupport: true, index: 15}
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType'}
        mustSupport: true
        index: 16
    slicing:
      rules: open
      description: Slice based on the different types of supporting information that can be included in a authorization request.
      discriminator:
      - {path: category, type: value}
      min: null
      slices:
        PatientEvent:
          match:
            category:
              coding:
              - {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 17
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 18
              timing:
                mustSupport: true
                choices: []
                index: 20
              value:
                choices: []
                index: 22
            required: [timing]
        AdmissionReview:
          match:
            category:
              coding:
              - {code: admissionReview, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            index: 23
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: admissionReview, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 24
              timing:
                mustSupport: true
                choices: []
                index: 26
              value:
                choices: []
                index: 28
            required: [timing]
  use:
    pattern: {type: Code, value: preauthorization}
    index: 4
  item:
    mustSupport: true
    index: 46
    extensions:
      certificationType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', min: 0, max: 1, type: Extension, mustSupport: true, index: 54}
      reviewActionCode: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode', min: 0, max: 1, type: Extension, mustSupport: true, index: 55}
      productOrServiceCodeEnd: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', min: 0, max: 1, type: Extension, index: 56}
      preAuthPeriod: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod', min: 0, max: 1, type: Extension, mustSupport: true, index: 52}
      authorizationNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 49}
      itemTraceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 48}
      administrationReferenceNumber: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', min: 0, max: 1, type: Extension, mustSupport: true, index: 50}
      requestType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', min: 0, max: 1, type: Extension, mustSupport: true, index: 53}
      preAuthIssueDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate', min: 0, max: 1, type: Extension, mustSupport: true, index: 51}
    elements:
      category:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365'}
        index: 62
      diagnosisSequence: {mustSupport: true, index: 59}
      modifier:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 64
      revenue:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes'}
        mustSupport: true
        index: 61
      locationCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: location, index: 69}
      serviced:
        mustSupport: true
        choices: []
        index: 66
      careTeamSequence: {mustSupport: true, index: 58}
      productOrService:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 63
      extension:
        index: 47
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            certificationType:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', index: 54}
              min: 0
              max: 1
            reviewActionCode:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode', index: 55}
              min: 0
              max: 1
            productOrServiceCodeEnd:
              match: {url: null}
              schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', index: 56}
              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: 52}
              min: 0
              max: 1
            authorizationNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber', index: 49}
              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: 48}
              min: 0
              max: 1
            administrationReferenceNumber:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber', index: 50}
              min: 0
              max: 1
            requestType:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', index: 53}
              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: 51}
              min: 0
              max: 1
      informationSequence: {mustSupport: true, index: 60}
      sequence: {mustSupport: true, index: 57}
      quantity: {mustSupport: true, index: 71}
      location:
        mustSupport: true
        choices: [locationCodeableConcept]
        index: 68
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: null
      slices:
        certificationType:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', index: 1}
          min: 0
          max: 1
        levelOfServiceType:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', index: 2}
          min: 0
          max: 1
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer']
    index: 7
  accident:
    mustSupport: true
    index: 40
    elements:
      date: {mustSupport: true, index: 41}
      type:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362'}
        mustSupport: true
        index: 42
      location:
        choices: [locationAddress]
        index: 44
      locationAddress: {type: Address, choiceOf: location, index: 45}
  billablePeriod: {mustSupport: true, index: 6}
  identifier: {mustSupport: true, index: 3}
  provider:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor']
    index: 8
  careTeam:
    mustSupport: true
    index: 9
    elements:
      sequence: {mustSupport: true, index: 10}
      provider:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization', 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner']
        index: 11
      role:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98'}
        mustSupport: true
        index: 12
      qualification:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127'}
        mustSupport: true
        index: 13
package_version: 1.0.0
extensions:
  certificationType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType', min: 0, max: 1, type: Extension, mustSupport: true, index: 1}
  levelOfServiceType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', min: 0, max: 1, type: Extension, mustSupport: true, index: 2}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 1.0.0
required: [identifier, item]