description: PAS constraints on Claim resource that are common to both the request and the inquiry.
package_name: hl7.fhir.us.davinci-pas
derivation: constraint
name: PASClaimBase
abstract: true
type: Claim
elements:
patient:
type: Reference
mustSupport: true
refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary']
index: 8
insurance:
mustSupport: true
index: 76
elements:
sequence: {mustSupport: true, index: 77}
focal:
pattern: {type: boolean, value: true}
type: boolean
index: 78
coverage:
type: Reference
mustSupport: true
refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage']
index: 79
diagnosis:
mustSupport: true
index: 70
elements:
sequence: {mustSupport: true, index: 71}
diagnosis:
mustSupport: true
choices: [diagnosisCodeableConcept]
index: 73
diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 74}
type:
binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisType'}
mustSupport: true
index: 75
supportingInfo:
mustSupport: true
index: 32
elements:
sequence: {mustSupport: true, index: 33}
category:
binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType'}
mustSupport: true
index: 34
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/PASTempCodes'}
schema:
short: Information about the dates of the event that are being requested.
mustSupport: true
index: 35
elements:
category:
pattern:
type: CodeableConcept
value:
coding:
- {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
type: CodeableConcept
index: 36
timing:
mustSupport: true
choices: [timingPeriod]
index: 43
slicing:
slices:
timingPeriod:
match: {}
schema:
mustSupport: true
choices: [timingPeriod]
index: 43
min: 0
max: 1
timingDate:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
type: date
mustSupport: true
choiceOf: timing
index: 41
slicing:
slices:
timingDate:
match: {}
schema:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
type: date
mustSupport: true
choiceOf: timing
index: 41
min: 0
max: 1
timingPeriod:
type: Period
mustSupport: true
choiceOf: timing
index: 44
slicing:
slices:
timingPeriod:
match: {}
schema: {type: Period, mustSupport: true, choiceOf: timing, index: 44}
min: 0
max: 1
timing[x]:
elements:
start:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
index: 45
end:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
index: 46
value:
choices: []
index: 48
required: [timing]
AdmissionDates:
match:
category:
coding:
- {code: admissionDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
schema:
short: Information about the admission dates of a hospital admission being requested.
mustSupport: true
index: 49
elements:
category:
pattern:
type: CodeableConcept
value:
coding:
- {code: admissionDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
type: CodeableConcept
index: 50
timing:
mustSupport: true
choices: [timingPeriod]
index: 57
slicing:
slices:
timingPeriod:
match: {}
schema:
mustSupport: true
choices: [timingPeriod]
index: 57
min: 0
max: 1
timingDate:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
type: date
mustSupport: true
choiceOf: timing
index: 55
slicing:
slices:
timingDate:
match: {}
schema:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
type: date
mustSupport: true
choiceOf: timing
index: 55
min: 0
max: 1
timingPeriod:
type: Period
mustSupport: true
choiceOf: timing
index: 58
slicing:
slices:
timingPeriod:
match: {}
schema: {type: Period, mustSupport: true, choiceOf: timing, index: 58}
min: 0
max: 1
timing[x]:
elements:
start:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
index: 59
end:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
index: 60
value:
choices: []
index: 62
required: [timing]
DischargeDates:
match:
category:
coding:
- {code: dischargeDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
schema:
short: Information about the discharge dates of a hospital admission being requested.
mustSupport: true
index: 63
elements:
category:
pattern:
type: CodeableConcept
value:
coding:
- {code: dischargeDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes'}
type: CodeableConcept
index: 64
timing:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
choices: [timingDate]
index: 66
timingDate:
type: date
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
choiceOf: timing
index: 67
value:
choices: []
index: 69
required: [timing, timingDate]
use:
mustSupport: true
pattern: {type: code, value: preauthorization}
type: code
index: 7
item:
mustSupport: true
index: 86
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: 88}
authorizationNumber: {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: 89}
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: 90}
requestType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', min: 0, max: 1, type: Extension, short: A code that identifies the type of service being requested., mustSupport: true, index: 91}
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: 92}
productOrServiceCodeEnd: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', min: 0, max: 1, type: Extension, short: Used to provide the last code in a series of codes for the service being requested., mustSupport: true, index: 93}
elements:
category:
binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365'}
mustSupport: true
index: 99
diagnosisSequence: {mustSupport: true, index: 96}
modifier:
binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType'}
mustSupport: true
index: 101
revenue:
binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes'}
mustSupport: true
index: 98
locationCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: location, index: 114}
serviced:
mustSupport: true
choices: [servicedPeriod]
index: 108
slicing:
slices:
servicedPeriod:
match: {}
schema:
mustSupport: true
choices: [servicedPeriod]
index: 108
min: 0
max: 1
careTeamSequence: {mustSupport: true, index: 95}
productOrService:
binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
mustSupport: true
index: 100
extension:
index: 87
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: 88}
min: 0
authorizationNumber:
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: 89}
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: 90}
min: 0
max: 1
requestType:
match: {url: null}
schema: {type: Extension, short: A code that identifies the type of service being requested., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', index: 91}
min: 0
max: 1
certificationType:
match: {url: null}
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: 92}
min: 0
max: 1
productOrServiceCodeEnd:
match: {url: null}
schema: {type: Extension, short: Used to provide the last code in a series of codes for the service being requested., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', index: 93}
min: 0
max: 1
informationSequence: {mustSupport: true, index: 97}
servicedDate:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
type: date
mustSupport: true
choiceOf: serviced
index: 106
slicing:
slices:
servicedDate:
match: {}
schema:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
type: date
mustSupport: true
choiceOf: serviced
index: 106
min: 0
max: 1
sequence: {short: 'Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse', mustSupport: true, index: 94}
serviced[x]:
elements:
start:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
index: 110
end:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
index: 111
quantity: {type: Quantity, mustSupport: true, index: 115}
location:
mustSupport: true
choices: [locationCodeableConcept]
index: 113
servicedPeriod:
type: Period
mustSupport: true
choiceOf: serviced
index: 109
slicing:
slices:
servicedPeriod:
match: {}
schema: {type: Period, mustSupport: true, choiceOf: serviced, index: 109}
min: 0
max: 1
extension:
index: 0
slicing:
rules: open
ordered: false
discriminator:
- {path: url, type: value}
min: null
slices:
levelOfServiceType:
match: {url: null}
schema: {type: Extension, short: A code specifying the level of service being requested (UM06), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', index: 1}
min: 0
max: 1
conditionCode:
match: {url: null}
schema: {type: Extension, short: Used to indicate condition codes for various requests for service., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode', index: 2}
min: 0
homeHealthCareInformation:
match: {url: null}
schema: {type: Extension, short: Used to provide required information about home health care services. (CR6), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation', index: 3}
min: 0
max: 1
insurer:
type: Reference
mustSupport: true
refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer']
index: 9
accident:
mustSupport: true
index: 80
elements:
date:
constraint:
FullDateRule: {human: Dates need to be a full date - YYYY-MM-DD, source: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base', severity: error, expression: $this.toString().length() = 10}
mustSupport: true
index: 81
type:
binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362'}
mustSupport: true
index: 82
location:
mustSupport: true
choices: [locationAddress]
index: 84
locationAddress: {type: Address, mustSupport: true, choiceOf: location, index: 85}
status:
mustSupport: true
pattern: {type: code, value: active}
type: code
index: 6
identifier:
type: Identifier
short: Business identifier for claim
mustSupport: true
index: 4
elements:
system: {short: 'SHOULD use a scheme of ''urn:trnorg:''', index: 5}
provider:
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: 10
careTeam:
mustSupport: true
index: 11
extensions:
careTeamClaimScope: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope', min: 1, max: 1, type: Extension, mustSupport: true, index: 13}
elements:
extension:
index: 12
slicing:
rules: open
ordered: false
discriminator:
- {path: url, type: value}
min: 1
slices:
careTeamClaimScope:
match: {url: null}
schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope', index: 13}
min: 1
max: 1
sequence: {mustSupport: true, index: 14}
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-practitionerrole']
index: 15
role: {mustSupport: true, index: 16}
qualification: {mustSupport: true, index: 17}
required: [extension]
slicing:
rules: open
description: Slice based on whether the care team member belongs to the overall claim or to an individual claim item.
discriminator:
- {path: 'extension(''http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'').value.ofType(boolean)', type: value}
min: null
slices:
OverallClaimMember:
match:
extension('http://hl7:
org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'):
value: {ofType(boolean): null}
schema:
short: 'Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request.'
mustSupport: true
array: true
index: 18
extensions:
careTeamClaimScope:
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
type: Extension
mustSupport: true
index: 20
elements:
value:
mustSupport: true
pattern: {type: boolean, value: true}
choices: []
type: boolean
index: 22
elements:
extension:
index: 19
slicing:
rules: open
ordered: false
discriminator:
- {path: url, type: value}
min: 1
slices:
careTeamClaimScope:
match: {url: null}
schema:
type: Extension
mustSupport: true
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
index: 20
elements:
value:
mustSupport: true
pattern: {type: boolean, value: true}
choices: []
type: boolean
index: 22
role:
binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98'}
index: 23
qualification:
binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127'}
index: 24
required: [extension]
ItemClaimMember:
match:
extension('http://hl7:
org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'):
value: {ofType(boolean): null}
schema:
short: 'Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request.'
mustSupport: true
array: true
index: 25
extensions:
careTeamClaimScope:
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
type: Extension
mustSupport: true
index: 27
elements:
value:
mustSupport: true
pattern: {type: boolean, value: false}
choices: []
type: boolean
index: 29
elements:
extension:
index: 26
slicing:
rules: open
ordered: false
discriminator:
- {path: url, type: value}
min: 1
slices:
careTeamClaimScope:
match: {url: null}
schema:
type: Extension
mustSupport: true
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
index: 27
elements:
value:
mustSupport: true
pattern: {type: boolean, value: false}
choices: []
type: boolean
index: 29
role:
binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98'}
index: 30
qualification:
binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127'}
index: 31
required: [extension]
package_version: 2.2.0-ballot
extensions:
levelOfServiceType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode', min: 0, max: 1, type: Extension, short: A code specifying the level of service being requested (UM06), mustSupport: true, index: 1}
conditionCode: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode', min: 0, type: Extension, short: Used to indicate condition codes for various requests for service., mustSupport: true, index: 2}
homeHealthCareInformation: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation', min: 0, max: 1, type: Extension, short: Used to provide required information about home health care services. (CR6), mustSupport: true, index: 3}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 2.2.0-ballot
required: [insurer]