fromNarrative
type: Basic
node role: treeRoot
id:
  v: fromNarrative
language:
  v: en
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Requirements fromNarrative These requirements apply to the following actors: PAS Payer PAS Client ainfo-1 SHOULD Payers SHOULD attempt to use the initial DTR invocation to gather all relevant information relevant to the prior authorization request and only use the "additional information" approach when human review or other circumstances not known at the time of the initial DTR call require additional information to be collected. ainfo-2 MAY A payer MAY request additional information from the provider to support a prior authorization request by responding to the X12 278 Request with an X12 278 Response ainfo-3 SHALL When a single LOINC code is used, the TRN at the X12 278 header or line level associated with the 102089-0 LOINC code SHALL be the DTR context ID used to retrieve the appropriate questionnaire. ainfo-4 SHALL The PAS task profile SHALL be used to convey PAS X12 278 Response information to CDex. ainfo-5 SHOULD All of the additional information request codes SHOULD be used as input to a CDex task. ainfo-6 SHALL When the LOINC code 102089-0 is present, the associated TRNs SHALL also be exchange as Task.input. ainfo-7 SHALL A separate task SHALL be created for each of the above attachment request types (PWK01, LOINC, questionnaire). conf-1 SHALL Payers SHALL have a distinct endpoint for each different supported version (which are not inter-version compatible) of the PAS specification. conf-2 SHALL If a payer supports endpoint discovery, they SHALL have at most a single endpoint for each combination of version of the specification and coverage (e.g., Medicare, Medicaid, or commercial) they provide coverage under. conf-3 SHALL If a payer does not support endpoint discovery, they SHALL expose only one PAS endpoint of each supported version capable of handling all coverages. conf-4 SHALL PA Intermediary Systems SHALL be capable of processing all data elements that are marked as Must Support on the Claim Request and Claim Inquiry. conf-5 SHALL…
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fm
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 4
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas
        l: hl7.fhir.us.davinci-pas
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: trial-use
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas
        l: hl7.fhir.us.davinci-pas
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.url
    l: extension-Requirements.url
  value: Uri
    v: http://hl7.org/fhir/us/davinci-pas/Requirements/fromNarrative
    l: fromNarrative
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.version
    l: extension-Requirements.version
  value: String
    v: 2.2.1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.name
    l: extension-Requirements.name
  value: String
    v: FromNarrative
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.title
    l: extension-Requirements.title
  value: String
    v: Narrative Conformance Statements
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.status
    l: extension-Requirements.status
  value: Code
    v: active
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.experimental
    l: extension-Requirements.experimental
  value: Boolean
    v: false
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.date
    l: extension-Requirements.date
  value: DateTime
    v: 2026-03-27T14:15:30+11:00
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.publisher
    l: extension-Requirements.publisher
  value: String
    v: HL7 International / Financial Management
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.contact
    l: extension-Requirements.contact
  value: ContactDetail
    name:
      v: HL7 International / Financial Management
    telecom:
      system:
        v: url
      value:
        v: http://hl7.org/Special/committees/fm
    telecom:
      system:
        v: email
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.contact
    l: extension-Requirements.contact
  value: ContactDetail
    name:
      v: Jean Duteau
    telecom:
      system:
        v: email
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.contact
    l: extension-Requirements.contact
  value: ContactDetail
    name:
      v: HL7 International / Financial Management
    telecom:
      system:
        v: url
      value:
        v: http://www.hl7.org/Special/committees/fm
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.description
    l: extension-Requirements.description
  value: Markdown
    v: Conformance statements found throughout the narrative of the IG consolidated into this computable resource for traceability purposes
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.jurisdiction
    l: extension-Requirements.jurisdiction
  value: CodeableConcept
    coding:
      system:
        v: urn:iso:std:iso:3166
        l: 3166
      code:
        v: US
      display:
        v: United States of America
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.actor
    l: extension-Requirements.actor
  value: Canonical
    v: http://hl7.org/fhir/us/davinci-pas/ActorDefinition/payer
    l: payer
    extension:
      url:
        v: http://hl7.org/fhir/tools/StructureDefinition/requirements-actorkey
        l: requirements-actorkey
      value: Id
        v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.actor
    l: extension-Requirements.actor
  value: Canonical
    v: http://hl7.org/fhir/us/davinci-pas/ActorDefinition/client
    l: client
    extension:
      url:
        v: http://hl7.org/fhir/tools/StructureDefinition/requirements-actorkey
        l: requirements-actorkey
      value: Id
        v: client
extension:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
      l: requirements-statementcategory
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
      l: requirements-statementactor
    value: Id
      v: payer
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
      l: extension-Requirements.statement.key
    value: Id
      v: ainfo-1
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
      l: extension-Requirements.statement.conformance
    value: Code
      v: SHOULD
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
      l: extension-Requirements.statement.requirement
    value: Markdown

v: exchange

v: exchange

Markdown
v: Payers **SHOULD** attempt to use the initial DTR invocation to gather all relevant information relevant to the prior authorization request and only use the "additional information" approach when human review or other circumstances not known at the time of the initial DTR call require additional information to be collected.

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: ainfo-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: A payer **MAY** request additional information from the provider to support a prior authorization request by responding to the X12 278 Request with an X12 278 Response
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: ainfo-3
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: When a single LOINC code is used, the TRN at the X12 278 header or line level associated with the 102089-0 LOINC code **SHALL** be the DTR context ID used to retrieve the appropriate questionnaire.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: ainfo-4
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The [PAS task profile](StructureDefinition-profile-task.html) **SHALL** be used to convey PAS X12 278 Response information to CDex.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: ainfo-5
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All of the additional information request codes **SHOULD** be used as input to a CDex task.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: ainfo-6
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: When the LOINC code 102089-0 is present, the associated TRNs **SHALL** also be exchange as Task.input.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: ainfo-7
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: A separate task **SHALL** be created for each of the above attachment request types (PWK01, LOINC, questionnaire).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Payers **SHALL** have a distinct endpoint for each different supported version (which are not inter-version compatible) of the PAS specification.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If a payer supports endpoint discovery, they **SHALL** have at most a single endpoint for each combination of version of the specification and coverage (e.g., Medicare, Medicaid, or commercial) they provide coverage under.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-3
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If a payer does not support endpoint discovery, they **SHALL** expose only one PAS endpoint of each supported version capable of handling all coverages.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-4
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PA Intermediary Systems **SHALL** be capable of processing all data elements that are marked as Must Support on the Claim Request and Claim Inquiry.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-5
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: They **SHALL NOT** generate an error or cause the application to fail due the presence of any data element marked as Must Support.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-6
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PA Intermediary Systems **SHALL** be capable of returning resource instances containing any of the data elements that are marked as Must Support on the Claim Response and the Claim Inquiry Response.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-7
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PA Client Systems **SHALL** be capable of receiving all data elements that are marked as Must Support on the Claim Response and the Claim Inquiry Response.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-8
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: They **SHALL NOT** generate an error or cause the application to fail when receiving any data element that is marked as Must Support.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-9
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD-NOT
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PA Client Systems **SHOULD NOT** send any data elements that are not marked as Must Support.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-10
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If these data elements are included in a Claim Request or Claim Inquiry, the receiving PA Intermediary System **MAY** ignore those elements.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-11
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: When processing prior auth requests and additional data submissions, PAS services **SHALL NOT** depend on or set expectations for the inclusion of resource instances not compliant with profiles defined in this guide, CRD, DTR, HRex, or US Core.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-12
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Similarly, they **SHALL NOT** depend on or set expectations for the inclusion of any data elements not marked as mandatory (min cardinality >= 1) or mustSupport in those profiles.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-13
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If the proposed change is adopted and published in the PAS continuous integration build or the CI build of one of its dependencies (e.g. US Core), implementations **MAY**, by mutual agreement, pre-adopt the use of those additional profiles and/or mustSupport data elements and not be considered in violation of #1 above.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-14
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Where cardinality and other constraints present in profiles allow data elements to be omitted, PAS compliant systems **SHALL NOT** treat the omission of those elements as a conformance error.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-15
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PAS clients and services **SHALL** use standard PAS data elements (i.e. elements found within PAS-defined or inherited profiles and marked as mandatory or mustSupport) to communicate needed data if such elements are intended to convey such information.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: conf-16
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PAS implementing organizations **SHALL NOT** publish guidance setting expectations for where certain data elements are conveyed within PAS and inherited data structures, but **MAY** submit change requests to PAS, HRex, or US Core requesting that additional guidance be provided to implementers on data structure usage to increase consistency across implementations.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: storage
      display:
        v: storage
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: metric-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each of these IGs recommends a set of metrics that **SHOULD** or **MAY** be collected by their respective implementations to facilitate the evaluation of adoption, functionality, processes, and improved outcomes.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: storage
      display:
        v: storage
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: metric-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PAS implementers **SHOULD** store information for each PAS call in a manner that would allow them to respond to measures based on this logical model.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: privacy
      display:
        v: privacy
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: priv-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Implementations **SHALL** permit provider review of data prior to transmission, but **SHALL NOT** require such review.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: privacy
      display:
        v: privacy
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: priv-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Payers who do not view the FHIR version of the transmitted information **SHOULD** be aware of the possibility of these limitations and ensure they have policies that enforce appropriate sharing constraints on data.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: privacy
      display:
        v: privacy
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: priv-3
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PAS Servers **SHOULD** support server-server OAuth and **MAY** support mutually authenticated TLS.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Timings **SHALL** have at least one of: a count, a frequency and period and periodUnit (with optional frequencyMax and periodMax), a calendarPattern, or a deliveryPattern.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Quantities **SHALL** have a value and either a unit or a code
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-3
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If a quantity code is present, it **SHALL** use the X12 quantity units.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-4
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Claim instance of the [update Bundle](specification.html#updating-authorization-requests) **SHALL** reference the updated Claim instance within the `Claim.related.claim` element. Note that the presence of this reference and the requirement that referenced instances be included in the submitted Bundle implies that the instance representing the prior version of the Claim **SHALL** be included in the update Bundle.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-5
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Claim instance of the update Bundle **SHALL** contain within the `Claim.item` element each item requested in the updated claim and any prior versions of the claim, including requested items that have been added, modified, deleted, or left unchanged during this or previous updates.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-6
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Claim instance of the update Bundle **SHALL** contain within the `Claim.supportingInfo` element each piece of supporting documentation submitted with the updated claim and any prior versions of claim, including supporting documentation that has been added, modified, deleted, or left unchanged during this or previous updates.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-7
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each `Claim.item` entry that represents an item no longer being requested, whether removed in this update or a previous one, **SHALL** be flagged using the infoCancelledFlag modifierExtension and **SHALL** have the code `3` (Cancel) in the Certification Type extension.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-8
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each `Claim.supportingInfo` entry that is no longer to be used when evaluating the request, whether removed in this update or a previous one, **SHALL** be flagged using the infoCancelledFlag modifierExtension.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-9
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each `Claim.item` and `Claim.supportingInfo` entry that has been changed as a part of this most recent update, including removal, **SHALL** be flagged using the changed extension with a value of `changed`.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-10
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each `Claim.item` and `Claim.supportingInfo` entry that has been added as a part of this most recent update, **SHALL** be flagged using the changed extension with a value of `added`.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-ben-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: X12 standard requires no dash for ZIP+4 codes and that intermediaries **SHALL** expect the dash to be present and **SHALL** remove the dash, if present, when converting the zip code to meet the X12 standard.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: prof-sub-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: X12 standard requires no dash for ZIP+4 codes and that intermediaries **SHALL** expect the dash to be present and **SHALL** remove the dash, if present, when converting the zip code to meet the X12 standard.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Along with the profiles defined in the PAS implementation guide, implementations **SHALL** also support the relevant US Core profiles for supplementary information.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: They **SHOULD** support any other profiles relevant to the types of prior authorizations they process.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-3
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Clients and Servers supporting this implementation guide **SHOULD** also comply with the Da Vinci [Coverage Requirements Discovery (CRD)](http://www.hl7.org/fhir/us/davinci-crd) and [Documentation Templates and Rules (DTR)](http://www.hl7.org/fhir/us/davinci-dtr) implementation guides.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-4
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Every system claiming conformance to this IG **SHALL** comply with the [Security and Privacy page in the Da Vinci HRex guide](http://hl7.org/fhir/us/davinci-hrex/security.html).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-5
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If a payer supports endpoint discovery, they **SHALL** have at most a single endpoint for each coverage (e.g., Medicare, Medicaid, or commercial) they provide coverage under.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-6
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If a payer does not support endpoint discovery, they **SHALL** expose only one PAS endpoint capable of handling all coverages.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-7
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All of this **SHOULD** happen synchronously with a maximum of 15 seconds between the user initiating the prior authorization request and seeing the resulting response - i.e. including network transmission time for request and response.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-8
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: A subscription-based mechanism **SHALL** be used by the client to be informed of updates to the authorization.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-9
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD-NOT
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: **NOTE**: The Claim Inquiry response does not include all of the information that can be returned in a request response, such as any request for additional information, so the inquire operation **SHOULD NOT** be used by the client while waiting for final results.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-10
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Provider and EHR Vendor organizations **MAY** leverage the [payer registry](https://www.hl7.org/fhir/us/davinci-pdex/payertopayerexchange.html#mtls-endpoint-discovery) developed by PDex (which will eventually fold into the national directory under FAST) as a means of determining which endpoints exist for which payers as candidates for configuration.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-11
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Bundle **SHALL** be encoded in JSON.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-12
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The first entry in the Bundle **SHALL** be a Claim resource complying with the [profile](StructureDefinition-profile-claim.html) defined in this IG to ensure the content is sufficient to appropriately populate an X12N/005010X217 message.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-13
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Additional Bundle entries **SHALL** be populated with any resources referenced by the Claim resource (and any resources referenced by **those** resources, fully traversing all references and complying with all identified profiles).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-14
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each unique resource instance **SHALL** only appear at most once in the Bundle.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-15
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Only one unique resource instance **SHOULD** be created to represent the same information. In other words, avoid creating multiple Practitioner instances for the same person.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-16
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Bundle.entry.fullUrl values **SHALL** be:
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-17
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All GUIDs used **SHALL** be unique, including across independent prior authorization submissions - with the exception that the same resource instance being referenced in distinct prior authorization request Bundles can have the same GUID.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-18
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Relevant resources referenced by those "supporting information" resources **SHALL** also be included (e.g. prescriber Practitioner and Medication for a MedicationRequest).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-19
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Any such resource that has a US Core profile **SHALL** comply with the relevant US Core profiles.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-20
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All "supporting information" resources included in the Bundle **SHALL** be pointed to by the Claim resource using the Claim.supportingInfo.valueReference element.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-21
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: To attach non-FHIR instance data such as PDFs, CDAs, JPGs, a DocumentReference instance **SHOULD** be used.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-22
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Claim.supportingInfo.sequence for each entry **SHALL** be unique within the Claim.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-23
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All resources **SHALL** comply with their respective profiles.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-24
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: FHIR elements not marked as 'must support' **MAY** be included in resources within the Bundle, but client systems **SHOULD** have no expectation of such elements being processed by the payer unless prior arrangements have been made.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-25
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Systems that do not process such elements **SHALL** ignore unsupported elements unless they are 'modifier' elements, in which case the system **MAY** treat the presence of the element as an error.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-26
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: In addition, the system **SHALL** make the entire PAS FHIR Bundle available to the intended payer.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-27
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The method **MAY** be based on the X12 275 or another method that trading partners have agreed to use.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-28
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If the X12 275 is used for this purpose, the 275 BDS01 Filter ID Code element **SHALL** be set to "B64" and the CAT02 Attachment Information Format Code element **SHALL** be sent to "HL".
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-29
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Translation/mapping systems **SHOULD** be aware that if the size of the attachments as part of a claims submission would exceed the size limitations of a particular recipient, the intermediary **SHOULD** split the attachments into separate 275s to remain within the overall limit.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-30
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Bundle **SHALL** start with a [ClaimResponse](StructureDefinition-profile-claimresponse-base.html) entry that contains information mapped from the 278 response.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-31
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each unique resource instance **SHALL** only appear at most once in the Bundle.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-32
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Only one unique resource instance **SHOULD** be created to represent the same information. In other words, avoid creating multiple Practitioner instances for the same person.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-33
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: When echoing back resources that are the same as were present in the prior authorization request, the system **SHALL** ensure that the same fullUrl and resource identifiers are used in the response as appeared in the request.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-34
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Each item returned on the PAS ClaimResponse **SHALL** echo the same item.sequence as that same item had on the Claim. The item.sequence element **SHALL** serve as the main tracing identifier of items throughout requests and responses.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-35
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: In the case of an error in an Operation invocation (e.g., 4XX error), the receiving system **SHALL** return a single OperationOutcome that details why the Bundle could not be processed.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-36
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: For instances where the authorized item is a modification of the requested item, the requested item details **SHALL** be returned in the ClaimResponse.item with an adjudication status of A6 - 'Modified'.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-37
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The details of what was actually item **SHALL** be returned in the ClaimResponse.addItem.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-38
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Recipients of the transactions **SHOULD** respond as indicated below and senders of the transaction **SHOULD** look for the following responses and then take appropriate actions.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-39
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All transactions in PAS are synchronous and **SHALL** require one of the following HTTP responses:
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-40
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If an OperationOutcome is received, it may have information regarding errors that **SHOULD** be addressed in the future, but did not cause the transaction to fail.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-41
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: NOTE: These errors **SHOULD** not be returned to the provider but **SHOULD** be reviewed and addressed by technical staff.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-42
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Although there are no constraints on the frequency of the query, clients **SHOULD** ensure that no repetitive inquiries do not happen so as not to stress payer systems.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-43
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Intermediaries **SHALL** interpret the 'not-applicable' code as no product or service code.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-44
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: This Claim Inquiry Response **SHALL** either reference a Claim or have a Data Absent Reason indicating why the Claim can not be referenced (eg. original claim received by fax).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-45
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The referenced Claim instance **SHOULD** be returned if there is information in the Response that needs to be present can not be returned in the Claim Response instance.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-46
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: the returned ClaimResponse **SHALL** include the current results for all submitted items, including any items changed or canceled since the original authoriation request.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-47
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: if a specific reference number (either the REF-NT or REF-BB) is submitted and is not the 'current' number (because subsequent additions/changes/cancellations have been made to the prior authorization request), the returned record **SHALL** be the current authorization response - even though it no longer has the same identifier.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-48
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: I.e. If a search is for a 'replaced' prior authorization, the search result **SHALL** include the 'current' prior authorization response for the most recent replacing prior authorization request.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-49
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: systems **MAY** withhold information about prior authorizations that are 'open' but are deemed to be not relevant to the provider (eg. prior authorization requests for sensitive care where the requesting provider is neither the ordering nor rendering provider) who is checking for the prior authorization status if not searching by a specific Claim identifier.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-50
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: In such situations the response **SHOULD** include an OperationOutcome warning that some prior authorizations have been suppressed and provide an alternative mechanism (e.g. telephone number) to provide further information if needed.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-51
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Implementers **SHALL** support subscriptions to provide the final response.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-52
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: ^payerServers **SHALL** permit access to the prior authorization response to systems other than the original submitter.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-53
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: They **SHALL** require a match on the patient member or subscriber id (identifier on the Claim.patient) plus the ordering and/or rendering provider identifier, i.e. the provider's NPI.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-54
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Implementers **SHALL** support the R4 Subscriptions referenced in the [Subscriptions for R5 Backport Implementation Guide](http://hl7.org/fhir/uv/subscriptions-backport/).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-55
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Servers supporting subscriptions **SHALL** expose this as part of their CapabilityStatement
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-56
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Servers **SHALL** only support the [rest-hook channel type](https://hl7.org/fhir/uv/subscriptions-backport/channels.html#rest-hook-1)
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-57
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: This Subscription **SHALL** conform to the [PAS Subscription profile](StructureDefinition-profile-subscription.html).
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-58
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Subscription filter criteria **SHALL** be org-identifier = [sending system identifier].
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-59
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Intermediaries **SHALL** ensure that subscriptions to monitor a particular sending system's prior authorizations are only created or modified by that sending system.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-60
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Once the [subscription](Subscription-PASSubscriptionExample.html) has been created, the Server **SHALL** send a [notification](Bundle-PASSubscriptionNotification.html) over the requested channel indicating that a prior authorization response submitted by the requesting provider organization has changed.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-61
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: This notification **SHALL** include a full PAS Response Bundle.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-62
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Due to the inquiry not supporting all of the required information needed in a PAS response, PAS Clients and Intermediaries **SHALL** only support subscriptions with content='full-resource'.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-63
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: When details of a submitted request change and a provider needs to request prior authorization of a different set of items, clients **SHOULD** submit an update to the previously submitted Claim.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-64
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Servers **MAY** reject updates and require that a new request is made by providing the appropriate X12 error code.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-65
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The Claim that is being updated **SHALL** be referenced in the Claim.related.claim element and included in the Bundle.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot
    l: requirements-statementshallnot
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-66
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: If that Claim instance is itself a Claim Update, its referenced Claim **SHALL NOT** be included.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-67
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All other referenced resources **SHALL** be included in the Bundle.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-68
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: When changing the details of the request, the Claim instance **SHALL** contain all item and supportingInfo entries from the original Claim and any previous update Claims with `sequence` values preserved, but with the current request details.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-69
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Cancelled entries: item and supportingInfo entries that have been removed from the request **SHALL** include the infoCancelled modifier extension with a valueBoolean of `true` in the Claim.item.modifierExtension or Claim.supportingInfo.modifierExtension element.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-70
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Canceled items **SHALL** additionally contain a certificationType extension with a code of 3 (Cancel) in the Claim.item.extension element.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-71
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Entries added, modified, or cancelled compared to the immediately prior version of the Claim referenced in the Claim.related.claim element **SHALL** contain a [infoChanged extension](StructureDefinition-extension-infoChanged.html) within the Claim.item or the Claim.supportingInfo element.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-72
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The [infoChanged extension](StructureDefinition-extension-infoChanged.html) for added entries **SHALL** have a valueCode of `changed` and those for modified or deleted entries SHALL have a valueCode of `changed` (newly marking an item as canceled is considered a 'change').
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: spec-73
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: PAS systems **SHALL** ensure that prior authorizations that were initially pended remain available for query for at least 6 months after the anticipated completion of the services whose authorization was requested.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: use-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The intermediary **SHALL** always exchange a FHIR bundle with the EHR (figure 2.3)
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: use-2
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The intermediary **SHALL** convert the FHIR bundle to and from an X12 278 (and optionally to an X12 275) if necessary to meet the HIPAA transaction requirements
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: use-3
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: MAY
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: The intermediary **MAY** convert the X12 278 to and from a FHIR bundle and exchange it with a payer as long as the PA request and response are in an X12 278 format at some time between the exchange with the EHR and the payer
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: use-4
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: As well, EHRs **SHOULD** annotate their orders with the decisions contained in the PAS Response.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: privacy
      display:
        v: privacy
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: use-5
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHALL
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: Prior to sending clinical data as part of the PAS exchange, the provider (or their designated agent) **SHALL** have the ability, but not an obligation, to review patient information and where appropriate amend or withhold the submission to comply with current regulations and relevant provider policies. The provider can choose to turn off the ability to review documentation. The vendor must allow them this option.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementcategory
    l: requirements-statementcategory
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
        l: PASTempCodes
      code:
        v: exchange
      display:
        v: exchange
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: client
extension:
  url:
    v: http://hl7.org/fhir/tools/StructureDefinition/requirements-statementactor
    l: requirements-statementactor
  value: Id
    v: payer
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key
    l: extension-Requirements.statement.key
  value: Id
    v: use-6
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance
    l: extension-Requirements.statement.conformance
  value: Code
    v: SHOULD
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement
    l: extension-Requirements.statement.requirement
  value: Markdown
    v: All exchanges **SHOULD** meet Federal and state regulations, including any HIPAA restrictions and restrictions on sensitive data.
url:
  v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement
  l: extension-Requirements.statement

system:
  v: urn:ietf:rfc:3986
  l: 3986
value:
  v: urn:oid:2.16.840.1.113883.4.642.40.24.36.1

coding:
  system:
    v: http://hl7.org/fhir/fhir-types
    l: fhir-types
  code:
    v: Requirements