HL7.FHIR.US.DAVINCI-PAS\PAS Claim Update

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

StructureDefinition: PASClaimUpdate

The official URL for this profile is:

http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Text Summary
Differential Table
Snapshot Table
All

This structure is derived from PASClaim

Summary

Must-Support: 3 elements

Extensions

This structure refers to these extensions:

This structure is derived from PASClaim

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*
supportingInfo		0..*	BackboneElement
extension-infoChanged	S	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
item		0..*	BackboneElement
extension-infoChanged	S	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
ItemCancelledFlag	?!S	0..*	ItemCancelled
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	I		(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	Extension Slice: Unordered, Open by value:url
extension-infoChanged	SI	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
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	I	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
extension-infoChanged	S	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
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-infoChanged"
value[x]			(Slice Definition)	Value of extension Slice: Unordered, Closed by type:$this
valueCode		0..1	code	Value of extension Binding: PASInformationChangeMode (required)
modifierExtension	?!Σ	0..*	(Slice Definition)	Extension Slice: Unordered, Open by value:url
ItemCancelledFlag	?!SI	0..*	ItemCancelled	Item Cancelled Flag
sequence	S	1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example)
category	S	0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example)
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example)
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example)
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example)
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]			(Slice Definition)	Place of service or where product was supplied Slice: Unordered, Closed by type:$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 PASClaim

Summary

Must-Support: 3 elements

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from PASClaim

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*
supportingInfo		0..*	BackboneElement
extension-infoChanged	S	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
item		0..*	BackboneElement
extension-infoChanged	S	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
ItemCancelledFlag	?!S	0..*	ItemCancelled
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	I		(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	Extension Slice: Unordered, Open by value:url
extension-infoChanged	SI	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
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	I	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
extension-infoChanged	S	0..*	code	Changed Information Code URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged
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-infoChanged"
value[x]			(Slice Definition)	Value of extension Slice: Unordered, Closed by type:$this
valueCode		0..1	code	Value of extension Binding: PASInformationChangeMode (required)
modifierExtension	?!Σ	0..*	(Slice Definition)	Extension Slice: Unordered, Open by value:url
ItemCancelledFlag	?!SI	0..*	ItemCancelled	Item Cancelled Flag
sequence	S	1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence	S	0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence	S	0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example)
category	S	0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example)
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example)
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example)
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example)
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]			(Slice Definition)	Place of service or where product was supplied Slice: Unordered, Closed by type:$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

Terminology Bindings

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.extension:ItemChanged.value[x]:valueCode	required	PASInformationChangeMode
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

Constraints

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.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.modifierExtension	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())