PASClaimBase
PAS Claim Base
activeDa Vinci PAS2.2.1resourceAbstract75 key elements
PAS constraints on Claim resource that are common to both the request and the inquiry.
Metadata
hl7.org/fhir- Canonical URL
- http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-base
- ID
- profile-claim-base
- Type
- Base Definition
- Derivation
- constraint
Mandatory and Must-Support Elements
Elements with cardinality > 0 or marked as Must Support (S)
| Path | Card. | Type | Flags | Description |
|---|---|---|---|---|
| :transmissionIdentifiers | 0..1 | Extension | S | |
| :levelOfServiceType | 0..1 | Extension | S | A code specifying the level of service being requested (UM06) |
| :conditionCode | 0..* | Extension | S | Used to indicate condition codes for various requests for service. |
| :homeHealthCareInformation | 0..1 | Extension | S | Used to provide required information about home health care services. (CR6) |
| :authorizationNumber | 0..1 | Extension | S | |
| :administrationReferenceNumber | 0..1 | Extension | S | |
| identifier | Identifier | S | Business identifier for claim | |
| status | S | This is fixed to active even if the CertificationType is indicating that the Claim is to be cancelled as it reflects that status of this instance and not the overall Claim | ||
| use | S | |||
| patient | Reference | S | ||
| insurer | Reference | S1+ | ||
| provider | Reference | S | ||
| careTeam | S | |||
| careTeam.extension | 1+ | |||
| :careTeamClaimScope | 1..1 | Extension | S1+ | |
| careTeam.sequence | S | |||
| careTeam.provider | Reference | S | ||
| careTeam.role | S | |||
| careTeam.qualification | S | |||
| :OverallClaimMember | 0..* | S | Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request. | |
| careTeam.extension | 1+ | |||
| :careTeamClaimScope | 1..1 | Extension | S1+ | |
| careTeam.extension.value[x] | S | |||
| :ItemClaimMember | 0..* | S | Care Team Providers that are applicable to a specific item (as referenced by that item). NOTE: Only the first 10 can be sent in the X12 Request. | |
| careTeam.extension | 1+ | |||
| :careTeamClaimScope | 1..1 | Extension | S1+ | |
| careTeam.extension.value[x] | S | |||
| supportingInfo | S | |||
| supportingInfo.sequence | S | |||
| supportingInfo.category | S | |||
| :PatientEvent | 0..1 | S | Information about the dates of the event that are being requested. | |
| supportingInfo.timing[x] | S1+ | |||
| :timingDate | 0..1 | date | S | |
| :timingPeriod | 0..1 | Period | S | |
| supportingInfo.timing[x].start | S | |||
| supportingInfo.timing[x].end | S | |||
| :AdmissionDates | 0..1 | S | Information about the admission dates of a hospital admission being requested. | |
| supportingInfo.timing[x] | S1+ | |||
| :timingDate | 0..1 | date | S | |
| :timingPeriod | 0..1 | Period | S | |
| supportingInfo.timing[x].start | S | |||
| supportingInfo.timing[x].end | S | |||
| :DischargeDates | 0..1 | S | Information about the discharge dates of a hospital admission being requested. | |
| supportingInfo.timing[x] | date | S1+ | ||
| diagnosis | S | |||
| diagnosis.sequence | S | |||
| diagnosis.diagnosis[x] | CodeableConcept | S | ||
| diagnosis.type | S | |||
| insurance | S | |||
| insurance.sequence | S | |||
| insurance.coverage | Reference | S | ||
| accident | S | |||
| accident.date | S | |||
| accident.type | S | |||
| accident.location[x] | Address | S | ||
| item | S | |||
| :itemTraceNumber | 0..* | Extension | S | Uniquely identifies this claim item. (2000F-TRN) |
| :authorizationNumber | 0..1 | Extension | S | A string assigned by the UMO to an authorized review outcome associated with this service item. |
| :administrationReferenceNumber | 0..1 | Extension | S | A string assigned by the UMO to the original disallowed review outcome associated with this service item. |
| :requestType | 0..1 | Extension | S | A code that identifies the type of service being requested. |
| :certificationType | 0..1 | Extension | S | A code representing the type of certification being requested (UM02) |
| :productOrServiceCodeEnd | 0..1 | Extension | S | Used to provide the last code in a series of codes for the service being requested. |
| item.sequence | S | Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse | ||
| item.careTeamSequence | S | |||
| item.diagnosisSequence | S | |||
| item.informationSequence | S | |||
| item.revenue | S | |||
| item.category | S | |||
| item.productOrService | S | |||
| item.modifier | S | |||
| item.serviced[x] | S | |||
| :servicedDate | 0..1 | date | S | |
| :servicedPeriod | 0..1 | Period | S | |
| item.location[x] | CodeableConcept | S | ||
| item.quantity | Quantity | S |