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: 68
    elements:
      sequence: {mustSupport: true, index: 69}
      focal:
        pattern: {type: Boolean, value: true}
        index: 70
      coverage:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage']
        index: 71
  diagnosis:
    mustSupport: true
    index: 61
    elements:
      sequence: {mustSupport: true, index: 62}
      diagnosis:
        mustSupport: true
        choices: [diagnosisCodeableConcept]
        index: 64
      diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 65}
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278DiagnosisType'}
        mustSupport: true
        index: 67
  supportingInfo:
    mustSupport: true
    index: 28
    elements:
      sequence: {mustSupport: true, index: 29}
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/PASSupportingInfoType'}
        mustSupport: true
        index: 30
    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:
            short: Information about the dates of the event that are being requested.
            index: 31
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: patientEvent, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 32
              timing:
                mustSupport: true
                choices: []
                index: 34
              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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                index: 35
              timingPeriod:
                type: Period
                index: 36
                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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                    index: 37
                  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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                    index: 38
              value:
                choices: []
                index: 40
            required: [timing]
        AdmissionDates:
          match:
            category:
              coding:
              - {code: admissionDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            short: Information about the admission dates of a hospital admission being requested.
            index: 41
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: admissionDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 42
              timing:
                mustSupport: true
                choices: []
                index: 44
              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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                index: 45
              timingPeriod:
                type: Period
                index: 46
                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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                    index: 47
                  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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                    index: 48
              value:
                choices: []
                index: 50
            required: [timing]
        DischargeDates:
          match:
            category:
              coding:
              - {code: dischargeDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
          schema:
            short: Information about the discharge dates of a hospital admission being requested.
            index: 51
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: dischargeDates, system: 'http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType'}
                index: 52
              timing:
                mustSupport: true
                choices: []
                index: 54
              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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                index: 55
              timingPeriod:
                type: Period
                index: 56
                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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                    index: 57
                  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-inquiry', severity: error, expression: this.empty() or this.length() = 10}
                    index: 58
              value:
                choices: []
                index: 60
            required: [timing]
  use:
    pattern: {type: Code, value: preauthorization}
    index: 4
  item:
    mustSupport: true
    index: 78
    extensions:
      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: 87}
      certExpirationDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate', min: 0, max: 1, type: Extension, short: The date/period by which the item that is pre-authorized must be completed.), mustSupport: true, index: 84}
      reviewActionCode: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode', min: 0, max: 1, type: Extension, short: The code describing the result of the review., mustSupport: true, index: 88}
      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., index: 89}
      certIssueDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate', min: 0, max: 1, type: Extension, short: The date/period when this item's preauthorization was issued., mustSupport: true, index: 83}
      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: 81}
      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: 80}
      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: 82}
      requestType: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType', 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: 86}
      certEffectiveDate: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate', min: 0, max: 1, type: Extension, short: The date/period when this item's preauthorization is valid., mustSupport: true, index: 85}
    elements:
      category:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000F/UM/1/03/00/1365'}
        index: 95
      diagnosisSequence: {mustSupport: true, index: 92}
      modifier:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType'}
        mustSupport: true
        index: 97
      revenue:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/AHANUBCRevenueCodes'}
        mustSupport: true
        index: 94
      locationCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: location, index: 102}
      serviced:
        mustSupport: true
        choices: []
        index: 99
      careTeamSequence: {mustSupport: true, index: 91}
      productOrService:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType'}
        mustSupport: true
        index: 96
      extension:
        index: 79
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            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: 87}
              min: 0
              max: 1
            certExpirationDate:
              match: {url: null}
              schema: {type: Extension, short: The date/period by which the item that is pre-authorized must be completed.), mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate', index: 84}
              min: 0
              max: 1
            reviewActionCode:
              match: {url: null}
              schema: {type: Extension, short: The code describing the result of the review., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode', index: 88}
              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., url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd', index: 89}
              min: 0
              max: 1
            certIssueDate:
              match: {url: null}
              schema: {type: Extension, short: The date/period when this item's preauthorization was issued., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate', index: 83}
              min: 0
              max: 1
            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: 81}
              min: 0
              max: 1
            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: 80}
              min: 0
            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: 82}
              min: 0
              max: 1
            requestType:
              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-serviceItemRequestType', index: 86}
              min: 0
              max: 1
            certEffectiveDate:
              match: {url: null}
              schema: {type: Extension, short: The date/period when this item's preauthorization is valid., mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate', index: 85}
              min: 0
              max: 1
      informationSequence: {mustSupport: true, index: 93}
      sequence: {mustSupport: true, index: 90}
      quantity: {mustSupport: true, index: 104}
      location:
        mustSupport: true
        choices: [locationCodeableConcept]
        index: 101
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: null
      slices:
        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: 1}
          min: 0
          max: 1
        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: 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: 72
    elements:
      date: {mustSupport: true, index: 73}
      type:
        binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2000E/UM/1/05/01/1362'}
        mustSupport: true
        index: 74
      location:
        choices: [locationAddress]
        index: 76
      locationAddress: {type: Address, choiceOf: location, index: 77}
  billablePeriod: {mustSupport: true, index: 6}
  identifier: {type: Identifier, short: Business identifier for claim, 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
    extensions:
      careTeamClaimScope: {url: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope', min: 1, max: 1, type: Extension, mustSupport: true, index: 11}
    elements:
      extension:
        index: 10
        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: 11}
              min: 1
              max: 1
      sequence: {mustSupport: true, index: 12}
      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-practitioner']
        index: 13
      role: {mustSupport: true, index: 14}
      qualification: {mustSupport: true, index: 15}
    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 as boolean', type: value}
      min: null
      slices:
        OverallClaimMember:
          match:
            extension('http://hl7:
              org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'): {value as boolean: null}
          schema:
            array: true
            max: 14
            index: 16
            extensions:
              careTeamClaimScope:
                url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
                type: Extension
                mustSupport: true
                index: 18
                elements:
                  valueBoolean:
                    pattern: {type: Boolean, value: true}
                    index: 19
            elements:
              extension:
                mustSupport: true
                index: 17
                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: 18
                        elements:
                          valueBoolean:
                            pattern: {type: Boolean, value: true}
                            index: 19
              role:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010EA/NM1/1/01/00/98'}
                index: 20
              qualification:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010EA/PRV/1/03/00/127'}
                index: 21
            required: [extension]
        ItemClaimMember:
          match:
            extension('http://hl7:
              org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope'): {value as boolean: null}
          schema:
            array: true
            max: 10
            index: 22
            extensions:
              careTeamClaimScope:
                url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope
                type: Extension
                mustSupport: true
                index: 24
                elements:
                  valueBoolean:
                    pattern: {type: Boolean, value: false}
                    index: 25
            elements:
              extension:
                mustSupport: true
                index: 23
                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: 24
                        elements:
                          valueBoolean:
                            pattern: {type: Boolean, value: false}
                            index: 25
              role:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/NM1/1/01/00/98'}
                index: 26
              qualification:
                binding: {strength: required, valueSet: 'https://valueset.x12.org/x217/005010/request/2010F/PRV/1/03/00/127'}
                index: 27
            required: [extension]
package_version: 1.2.0-ballot
extensions:
  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: 1}
  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: 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: 1.2.0-ballot
required: [item]