Da Vinci - Prior Authorization Support
0.1.0 - STU Ballot
Da Vinci - Prior Authorization Support
0.1.0 - STU Ballot
This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions 
The official URL for this profile is:
http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
Summary
Mandatory: 2 elements
Must-Support: 93 elements
Fixed Value: 3 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim | 0..* | |||
  extension-institutionalEncounter | S | 0..1 | Reference() | Institutional Encounter URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-institutionalEncounter |
| identifier | S | 0..* | Identifier | |
| status | S | 1..1 | code | |
| type | S | 1..1 | CodeableConcept | |
 use | S | 1..1 | code | Fixed Value: preauthorization |
  extension-certificationType | S | 0..* | code | Preauthorization Certification Type URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType |
| patient | S | 1..1 | Reference(Patient) | |
| created | S | 1..1 | dateTime | |
 insurer | S | 0..1 | Reference(UMOOrganization) | |
| provider | S | 1..1 | Reference(RequestorPractitionerRole | RequestorOrganization) | |
| priority | S | 1..1 | CodeableConcept | |
| related | S | 0..* | BackboneElement | |
| reference | S | 0..1 | Identifier | |
| prescription | S | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | |
| extension-requestedService | S | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| facility | S | 0..1 | Reference(Location) | |
 supportingInfo | S | (Slice Definition) | Slice: Unordered, Open by pattern:category | |
 (All Slices) | Content/Rules for all slices | |||
 sequence | S | 1..1 | positiveInt | |
 category | S | 1..1 | CodeableConcept | Binding: PASSupportingInfoType (required) |
| RelatedCauses | S | 0..* | BackboneElement | |
 sequence | S | 1..1 | positiveInt | |
 category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
  coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
 system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: relatedCauses | |
| code | S | 0..1 | CodeableConcept | |
 value[x] | S | 0..1 | string | |
| CurrentHealthCondition | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: currentHealthCondition | |
| value[x] | S | 0..1 | string | |
| PatientPrognosis | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientPrognosis | |
| value[x] | S | 0..1 | string | |
| ReleaseOfInformation | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: releaseOfInformation | |
| value[x] | S | 0..1 | string | |
| DelayReason | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: delayReason | |
| value[x] | S | 0..1 | string | |
| LastMenstrualPeriod | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: lastMenstrualPeriod | |
| timing[x] | S | 0..1 | date | |
| EstimatedBirthDate | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimatedBirthDate | |
| timing[x] | S | 0..1 | date | |
| OnsetOfSymptoms | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: onsetOfSymptoms | |
 timing[x] | S | 0..1 | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| PatientEvent | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |
| timing[x] | S | 0..1 | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| AdmissionReview | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionReview | |
| timing[x] | S | 0..1 | Period | |
| AdditionalInformation | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: additionalInformation | |
| code | S | 0..1 | CodeableConcept | |
| value[x] | S | 0..1 | Reference(DocumentReference) | |
| FreeFormMessage | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: freeFormMessage | |
| value[x] | S | 0..1 | string | |
| diagnosis | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| diagnosisReference | S | 1..1 | Reference(Condition) | |
| insurance | S | 1..1 | BackboneElement | |
| sequence | S | 1..1 | positiveInt | Fixed Value: 1 |
| focal | S | 1..1 | boolean | Fixed Value: true |
| coverage | S | 1..1 | Reference(Coverage) | |
| accident | S | 0..1 | BackboneElement | |
| date | S | 1..1 | date | |
| item | S | 0..* | BackboneElement | |
| extension-requestedService | S | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| sequence | S | 1..1 | positiveInt | |
| diagnosisSequence | S | 0..* | positiveInt | |
| informationSequence | S | 0..* | positiveInt | |
| revenue | S | 0..1 | CodeableConcept | |
| category | S | 0..1 | CodeableConcept | |
| productOrService | S | 1..1 | CodeableConcept | |
| locationReference | S | 0..1 | Reference(Location) | |
| detail | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| revenue | S | 0..1 | CodeableConcept | |
| productOrService | S | 1..1 | CodeableConcept | |
| quantity | S | 0..1 | SimpleQuantity | |
| unitPrice | S | 0..1 | Money | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | I | 0..* | Claim, Pre-determination or Pre-authorization | |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
 contained | 0..* | Resource | Contained, inline Resources | |
 extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension-institutionalEncounter | SI | 0..1 | Reference() | Institutional Encounter URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-institutionalEncounter |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | S | 0..* | Identifier | Business Identifier for claim |
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible) |
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example) | |
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required) Fixed Value: preauthorization |
| id | 0..1 | string | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension-certificationType | SI | 0..* | code | Preauthorization Certification Type URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType |
| value | 0..1 | string | Primitive value for code | |
| patient | SΣ | 1..1 | Reference(Patient) | The recipient of the products and services |
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim |
| created | SΣ | 1..1 | dateTime | Resource creation date |
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |
| insurer | SΣ | 0..1 | Reference(UMOOrganization) | Target |
| provider | SΣ | 1..1 | Reference(RequestorPractitionerRole | RequestorOrganization) | Party responsible for the claim |
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example) |
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example) | |
| related | SI | 0..* | BackboneElement | Prior or corollary claims |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| claim | 0..1 | Reference(Claim) | Reference to the related claim | |
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example) | |
| reference | S | 0..1 | Identifier | File or case reference |
| prescription | S | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| extension-requestedService | S | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| url | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService" | |
| value[x] | (Slice Definition) | Value of extension Slice: Unordered, Closed by type:$this | ||
| valueReference | 0..1 | Reference(ServiceRequest) | Value of extension | |
| reference | ΣI | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | Σ | 0..1 | string | Text alternative for the resource |
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |
| payee | I | 0..1 | BackboneElement | Recipient of benefits payable |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example) | |
| party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |
| referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |
| facility | S | 0..1 | Reference(Location) | Servicing facility |
| careTeam | I | 0..* | BackboneElement | Members of the care team |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example) | |
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example) | |
| supportingInfo | SI | (Slice Definition) | Supporting information Slice: Unordered, Open by pattern:category | |
| (All Slices) | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: PASSupportingInfoType (required) |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| RelatedCauses | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: relatedCauses | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| CurrentHealthCondition | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: currentHealthCondition | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| PatientPrognosis | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientPrognosis | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| ReleaseOfInformation | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: releaseOfInformation | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| DelayReason | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: delayReason | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| LastMenstrualPeriod | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: lastMenstrualPeriod | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | date | When it occurred |
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| EstimatedBirthDate | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimatedBirthDate | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | date | When it occurred |
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| OnsetOfSymptoms | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: onsetOfSymptoms | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | When it occurred | |
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| PatientEvent | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | When it occurred | |
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| AdmissionReview | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionReview | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | Period | When it occurred |
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| AdditionalInformation | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: additionalInformation | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | Reference(DocumentReference) | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| FreeFormMessage | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: freeFormMessage | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| diagnosis | SI | 0..* | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Diagnosis instance identifier |
| diagnosis[x] | (Slice Definition) | Nature of illness or problem Slice: Unordered, Closed by type:$this | ||
| diagnosisReference | S | 1..1 | Reference(Condition) | Nature of illness or problem |
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example) | |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example) | |
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example) | |
| procedure | I | 0..* | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example) | |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example) | ||
| procedureCodeableConcept | CodeableConcept | |||
| procedureReference | Reference(http://hl7.org/fhir/R4/procedure.html) | |||
| udi | 0..* | Reference(Device) | Unique device identifier | |
| insurance | SΣI | 1..1 | BackboneElement | Patient insurance information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SΣ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | SΣ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| identifier | 0..1 | Identifier | Pre-assigned Claim number | |
| coverage | SΣ | 1..1 | Reference(Coverage) | Insurance information |
| businessArrangement | 0..1 | string | Additional provider contract number | |
| preAuthRef | 0..* | string | Prior authorization reference number | |
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |
| accident | SI | 0..1 | BackboneElement | Details of the event |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| date | S | 1..1 | date | When the incident occurred |
| type | 0..1 | CodeableConcept | The nature of the accident Binding: V3 Value SetActIncidentCode (extensible) | |
| location[x] | 0..1 | Where the event occurred | ||
| locationAddress | Address | |||
| locationReference | Reference(http://hl7.org/fhir/R4/location.html) | |||
| item | SI | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension-requestedService | SI | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Item instance identifier |
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | |
| diagnosisSequence | S | 0..* | positiveInt | Applicable diagnoses |
| procedureSequence | 0..* | positiveInt | Applicable procedures | |
| informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information |
| revenue | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | S | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example) | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) | |
| serviced[x] | 0..1 | Date or dates of service or product delivery | ||
| servicedDate | date | |||
| servicedPeriod | Period | |||
| location[x] | (Slice Definition) | Place of service or where product was supplied Slice: Unordered, Closed by type:$this | ||
| locationReference | S | 0..1 | Reference(Location) | Place of service or where product was supplied |
| quantity | 0..1 | SimpleQuantity | Count of products or services | |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example) | |
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example) | |
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |
| detail | SI | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Item instance identifier |
| revenue | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) | |
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) | |
| quantity | S | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | S | 0..1 | Money | Fee, charge or cost per item |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| subDetail | I | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) | |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) | |
| quantity | 0..1 | SimpleQuantity | Count of products or services | |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| total | 0..1 | Money | Total claim cost | |
| Documentation for this format | ||||
This structure is derived from Claim
Summary
Mandatory: 2 elements
Must-Support: 93 elements
Fixed Value: 3 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | |||
| extension-institutionalEncounter | S | 0..1 | Reference() | Institutional Encounter URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-institutionalEncounter |
| identifier | S | 0..* | Identifier | |
| status | S | 1..1 | code | |
| type | S | 1..1 | CodeableConcept | |
| use | S | 1..1 | code | Fixed Value: preauthorization |
| extension-certificationType | S | 0..* | code | Preauthorization Certification Type URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType |
| patient | S | 1..1 | Reference(Patient) | |
| created | S | 1..1 | dateTime | |
| insurer | S | 0..1 | Reference(UMOOrganization) | |
| provider | S | 1..1 | Reference(RequestorPractitionerRole | RequestorOrganization) | |
| priority | S | 1..1 | CodeableConcept | |
| related | S | 0..* | BackboneElement | |
| reference | S | 0..1 | Identifier | |
| prescription | S | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | |
| extension-requestedService | S | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| facility | S | 0..1 | Reference(Location) | |
| supportingInfo | S | (Slice Definition) | Slice: Unordered, Open by pattern:category | |
| (All Slices) | Content/Rules for all slices | |||
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Binding: PASSupportingInfoType (required) |
| RelatedCauses | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: relatedCauses | |
| code | S | 0..1 | CodeableConcept | |
| value[x] | S | 0..1 | string | |
| CurrentHealthCondition | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: currentHealthCondition | |
| value[x] | S | 0..1 | string | |
| PatientPrognosis | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientPrognosis | |
| value[x] | S | 0..1 | string | |
| ReleaseOfInformation | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: releaseOfInformation | |
| value[x] | S | 0..1 | string | |
| DelayReason | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: delayReason | |
| value[x] | S | 0..1 | string | |
| LastMenstrualPeriod | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: lastMenstrualPeriod | |
| timing[x] | S | 0..1 | date | |
| EstimatedBirthDate | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimatedBirthDate | |
| timing[x] | S | 0..1 | date | |
| OnsetOfSymptoms | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: onsetOfSymptoms | |
| timing[x] | S | 0..1 | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| PatientEvent | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |
| timing[x] | S | 0..1 | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| AdmissionReview | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionReview | |
| timing[x] | S | 0..1 | Period | |
| AdditionalInformation | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: additionalInformation | |
| code | S | 0..1 | CodeableConcept | |
| value[x] | S | 0..1 | Reference(DocumentReference) | |
| FreeFormMessage | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| category | S | 1..1 | CodeableConcept | Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: freeFormMessage | |
| value[x] | S | 0..1 | string | |
| diagnosis | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| diagnosisReference | S | 1..1 | Reference(Condition) | |
| insurance | S | 1..1 | BackboneElement | |
| sequence | S | 1..1 | positiveInt | Fixed Value: 1 |
| focal | S | 1..1 | boolean | Fixed Value: true |
| coverage | S | 1..1 | Reference(Coverage) | |
| accident | S | 0..1 | BackboneElement | |
| date | S | 1..1 | date | |
| item | S | 0..* | BackboneElement | |
| extension-requestedService | S | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| sequence | S | 1..1 | positiveInt | |
| diagnosisSequence | S | 0..* | positiveInt | |
| informationSequence | S | 0..* | positiveInt | |
| revenue | S | 0..1 | CodeableConcept | |
| category | S | 0..1 | CodeableConcept | |
| productOrService | S | 1..1 | CodeableConcept | |
| locationReference | S | 0..1 | Reference(Location) | |
| detail | S | 0..* | BackboneElement | |
| sequence | S | 1..1 | positiveInt | |
| revenue | S | 0..1 | CodeableConcept | |
| productOrService | S | 1..1 | CodeableConcept | |
| quantity | S | 0..1 | SimpleQuantity | |
| unitPrice | S | 0..1 | Money | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | I | 0..* | Claim, Pre-determination or Pre-authorization | |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension-institutionalEncounter | SI | 0..1 | Reference() | Institutional Encounter URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-institutionalEncounter |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | S | 0..* | Identifier | Business Identifier for claim |
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible) |
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example) | |
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required) Fixed Value: preauthorization |
| id | 0..1 | string | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension-certificationType | SI | 0..* | code | Preauthorization Certification Type URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType |
| value | 0..1 | string | Primitive value for code | |
| patient | SΣ | 1..1 | Reference(Patient) | The recipient of the products and services |
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim |
| created | SΣ | 1..1 | dateTime | Resource creation date |
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |
| insurer | SΣ | 0..1 | Reference(UMOOrganization) | Target |
| provider | SΣ | 1..1 | Reference(RequestorPractitionerRole | RequestorOrganization) | Party responsible for the claim |
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example) |
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example) | |
| related | SI | 0..* | BackboneElement | Prior or corollary claims |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| claim | 0..1 | Reference(Claim) | Reference to the related claim | |
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example) | |
| reference | S | 0..1 | Identifier | File or case reference |
| prescription | S | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| extension-requestedService | S | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| url | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService" | |
| value[x] | (Slice Definition) | Value of extension Slice: Unordered, Closed by type:$this | ||
| valueReference | 0..1 | Reference(ServiceRequest) | Value of extension | |
| reference | ΣI | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | Σ | 0..1 | string | Text alternative for the resource |
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |
| payee | I | 0..1 | BackboneElement | Recipient of benefits payable |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example) | |
| party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |
| referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |
| facility | S | 0..1 | Reference(Location) | Servicing facility |
| careTeam | I | 0..* | BackboneElement | Members of the care team |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example) | |
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example) | |
| supportingInfo | SI | (Slice Definition) | Supporting information Slice: Unordered, Open by pattern:category | |
| (All Slices) | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: PASSupportingInfoType (required) |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| RelatedCauses | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: relatedCauses | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| CurrentHealthCondition | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: currentHealthCondition | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| PatientPrognosis | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientPrognosis | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| ReleaseOfInformation | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: releaseOfInformation | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| DelayReason | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: delayReason | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| LastMenstrualPeriod | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: lastMenstrualPeriod | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | date | When it occurred |
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| EstimatedBirthDate | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimatedBirthDate | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | date | When it occurred |
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| OnsetOfSymptoms | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: onsetOfSymptoms | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | When it occurred | |
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| PatientEvent | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientEvent | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | When it occurred | |
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| AdmissionReview | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admissionReview | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | S | 0..1 | Period | When it occurred |
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(http://hl7.org/fhir/R4/resource.html) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| AdditionalInformation | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: additionalInformation | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | Reference(DocumentReference) | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| FreeFormMessage | SI | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Information instance identifier |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: freeFormMessage | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | S | 0..1 | string | Data to be provided |
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) | |
| diagnosis | SI | 0..* | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Diagnosis instance identifier |
| diagnosis[x] | (Slice Definition) | Nature of illness or problem Slice: Unordered, Closed by type:$this | ||
| diagnosisReference | S | 1..1 | Reference(Condition) | Nature of illness or problem |
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example) | |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example) | |
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example) | |
| procedure | I | 0..* | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example) | |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example) | ||
| procedureCodeableConcept | CodeableConcept | |||
| procedureReference | Reference(http://hl7.org/fhir/R4/procedure.html) | |||
| udi | 0..* | Reference(Device) | Unique device identifier | |
| insurance | SΣI | 1..1 | BackboneElement | Patient insurance information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SΣ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | SΣ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| identifier | 0..1 | Identifier | Pre-assigned Claim number | |
| coverage | SΣ | 1..1 | Reference(Coverage) | Insurance information |
| businessArrangement | 0..1 | string | Additional provider contract number | |
| preAuthRef | 0..* | string | Prior authorization reference number | |
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |
| accident | SI | 0..1 | BackboneElement | Details of the event |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| date | S | 1..1 | date | When the incident occurred |
| type | 0..1 | CodeableConcept | The nature of the accident Binding: V3 Value SetActIncidentCode (extensible) | |
| location[x] | 0..1 | Where the event occurred | ||
| locationAddress | Address | |||
| locationReference | Reference(http://hl7.org/fhir/R4/location.html) | |||
| item | SI | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension-requestedService | SI | 0..* | Reference() | Service Level Event URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Item instance identifier |
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | |
| diagnosisSequence | S | 0..* | positiveInt | Applicable diagnoses |
| procedureSequence | 0..* | positiveInt | Applicable procedures | |
| informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information |
| revenue | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | S | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example) | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) | |
| serviced[x] | 0..1 | Date or dates of service or product delivery | ||
| servicedDate | date | |||
| servicedPeriod | Period | |||
| location[x] | (Slice Definition) | Place of service or where product was supplied Slice: Unordered, Closed by type:$this | ||
| locationReference | S | 0..1 | Reference(Location) | Place of service or where product was supplied |
| quantity | 0..1 | SimpleQuantity | Count of products or services | |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example) | |
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example) | |
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |
| detail | SI | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | S | 1..1 | positiveInt | Item instance identifier |
| revenue | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) | |
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) | |
| quantity | S | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | S | 0..1 | Money | Fee, charge or cost per item |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| subDetail | I | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) | |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) | |
| quantity | 0..1 | SimpleQuantity | Count of products or services | |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| total | 0..1 | Money | Total claim cost | |
| Documentation for this format | ||||
Other representations of profile: Schematron
| Path | Conformance | ValueSet / Code |
| Claim.language | preferred | CommonLanguages Max Binding: AllLanguages |
| Claim.status | required | FinancialResourceStatusCodes |
| Claim.type | extensible | ClaimTypeCodes |
| Claim.subType | example | ExampleClaimSubTypeCodes |
| Claim.use | required | Fixed Value: preauthorization |
| Claim.priority | example | ProcessPriorityCodes |
| Claim.fundsReserve | example | Funds Reservation Codes |
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes |
| Claim.prescription.type | extensible | ResourceType |
| Claim.payee.type | example | Claim Payee Type Codes |
| Claim.careTeam.role | example | ClaimCareTeamRoleCodes |
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodes |
| Claim.supportingInfo.category | required | PASSupportingInfoType |
| Claim.supportingInfo.code | example | ExceptionCodes |
| Claim.supportingInfo.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:RelatedCauses.category | example | Pattern: relatedCauses |
| Claim.supportingInfo:RelatedCauses.code | example | ExceptionCodes |
| Claim.supportingInfo:RelatedCauses.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:CurrentHealthCondition.category | example | Pattern: currentHealthCondition |
| Claim.supportingInfo:CurrentHealthCondition.code | example | ExceptionCodes |
| Claim.supportingInfo:CurrentHealthCondition.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:PatientPrognosis.category | example | Pattern: patientPrognosis |
| Claim.supportingInfo:PatientPrognosis.code | example | ExceptionCodes |
| Claim.supportingInfo:PatientPrognosis.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:ReleaseOfInformation.category | example | Pattern: releaseOfInformation |
| Claim.supportingInfo:ReleaseOfInformation.code | example | ExceptionCodes |
| Claim.supportingInfo:ReleaseOfInformation.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:DelayReason.category | example | Pattern: delayReason |
| Claim.supportingInfo:DelayReason.code | example | ExceptionCodes |
| Claim.supportingInfo:DelayReason.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:LastMenstrualPeriod.category | example | Pattern: lastMenstrualPeriod |
| Claim.supportingInfo:LastMenstrualPeriod.code | example | ExceptionCodes |
| Claim.supportingInfo:LastMenstrualPeriod.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:EstimatedBirthDate.category | example | Pattern: estimatedBirthDate |
| Claim.supportingInfo:EstimatedBirthDate.code | example | ExceptionCodes |
| Claim.supportingInfo:EstimatedBirthDate.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:OnsetOfSymptoms.category | example | Pattern: onsetOfSymptoms |
| Claim.supportingInfo:OnsetOfSymptoms.code | example | ExceptionCodes |
| Claim.supportingInfo:OnsetOfSymptoms.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:PatientEvent.category | example | Pattern: patientEvent |
| Claim.supportingInfo:PatientEvent.code | example | ExceptionCodes |
| Claim.supportingInfo:PatientEvent.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:AdmissionReview.category | example | Pattern: admissionReview |
| Claim.supportingInfo:AdmissionReview.code | example | ExceptionCodes |
| Claim.supportingInfo:AdmissionReview.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:AdditionalInformation.category | example | Pattern: additionalInformation |
| Claim.supportingInfo:AdditionalInformation.code | example | ExceptionCodes |
| Claim.supportingInfo:AdditionalInformation.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:FreeFormMessage.category | example | Pattern: freeFormMessage |
| Claim.supportingInfo:FreeFormMessage.code | example | ExceptionCodes |
| Claim.supportingInfo:FreeFormMessage.reason | example | MissingToothReasonCodes |
| Claim.diagnosis.type | example | ExampleDiagnosisTypeCodes |
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodes |
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodes |
| Claim.procedure.type | example | ExampleProcedureTypeCodes |
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes |
| Claim.accident.type | extensible | v3.ActIncidentCode |
| Claim.item.revenue | example | ExampleRevenueCenterCodes |
| Claim.item.category | example | BenefitCategoryCodes |
| Claim.item.productOrService | example | USCLSCodes |
| Claim.item.modifier | example | ModifierTypeCodes |
| Claim.item.programCode | example | ExampleProgramReasonCodes |
| Claim.item.bodySite | example | OralSiteCodes |
| Claim.item.subSite | example | SurfaceCodes |
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodes |
| Claim.item.detail.category | example | BenefitCategoryCodes |
| Claim.item.detail.productOrService | example | USCLSCodes |
| Claim.item.detail.modifier | example | ModifierTypeCodes |
| Claim.item.detail.programCode | example | ExampleProgramReasonCodes |
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodes |
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodes |
| Claim.item.detail.subDetail.productOrService | example | USCLSCodes |
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodes |
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodes |
| Id | Path | Details | Requirements |
| dom-2 | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-4 | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-3 | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-6 | Claim | A resource should have narrative for robust management : text.div.exists() | |
| dom-5 | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| ele-1 | Claim.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.use.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.use.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.use.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.use.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.related | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.payee | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.accident | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.detail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
IG © 2019+ HL7 International - Financial Management Work Group. Package hl7.fhir.us.davinci-pas#0.1.0 based on FHIR 4.0.0. Generated 2019-08-05
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