PASClaimResponseBase
PAS Claim Response Base
activeDa Vinci PAS2.2.1resourceAbstract66 key elements
PAS constraints on ClaimResponse 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-claimresponse-base
- ID
- profile-claimresponse-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 | |
| :claimResponseReviewer | 0..1 | Extension | S | The responsible practitioner who reviewed to the request |
| :authorizedProvider | 0..* | Extension | S | |
| identifier | Identifier | S | ||
| status | S | |||
| patient | Reference | S | ||
| created | S | |||
| insurer | Reference | S | ||
| requestor | Reference | S | ||
| request | Reference | S1+ | ||
| :DataAbsentReason | 0..1 | Extension | S | |
| outcome | S | complete | error | partial | ||
| preAuthPeriod | S | |||
| item | S | |||
| :itemTraceNumber | 0..* | Extension | S | Uniquely identifies this claim item. (2000F-TRN) |
| :preAuthIssueDate | 0..1 | Extension | S | The date when this item's preauthorization was issued. |
| :preAuthPeriod | 0..1 | Extension | S | The date/period when this item's preauthorization is valid. |
| :previousAuthorizationNumber | 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. |
| :requestedServiceDate | 0..1 | Extension | S | The original date/period that was requested by the submitter for this item. |
| :authorizedProvider | 0..* | Extension | S | The specific provider who has been authorized to provide this item. |
| :authorizedItemDetail | 0..1 | Extension | S | The details of what has been authorized for this item. |
| :admissionDates | 0..1 | Extension | S | The authorized admission dates for this item. |
| :dischargeDate | 0..1 | Extension | S | The authorized discharge date for this item. |
| item.itemSequence | S | Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse | ||
| item.noteNumber | S | |||
| item.adjudication | S | |||
| :reviewAction | 0..1 | Extension | S | The details of the review action that is necessary for the authorization. |
| addItem | S | |||
| :itemTraceNumber | 0..* | Extension | S | |
| :preAuthIssueDate | 0..1 | Extension | S | |
| :preAuthPeriod | 0..1 | Extension | S | |
| :previousAuthorizationNumber | 0..1 | Extension | S | |
| :administrationReferenceNumber | 0..1 | Extension | S | |
| :epsdtIndicator | 0..1 | Extension | S | |
| :nursingHomeResidentialStatus | 0..1 | Extension | S | |
| :nursingHomeLevelOfCare | 0..1 | Extension | S | |
| :productOrServiceCodeEnd | 0..1 | Extension | S | |
| :revenue | 0..1 | Extension | S | |
| :revenueUnitRateLimit | 0..1 | Extension | S | |
| :requestedService | 0..1 | Extension | S | |
| :requestType | 0..1 | Extension | S | |
| :certificationType | 0..1 | Extension | S | |
| :admissionDates | 0..1 | Extension | S | |
| :dischargeDate | 0..1 | Extension | S | |
| addItem.itemSequence | 1..1 | S1+ | ||
| addItem.provider | Reference | S | ||
| :providerType | 0..1 | Extension | S | |
| addItem.productOrService | S | |||
| addItem.modifier | S | |||
| addItem.serviced[x] | S | |||
| addItem.location[x] | S | |||
| addItem.quantity | Quantity | S | ||
| addItem.unitPrice | S | |||
| addItem.adjudication | BackboneElement | S | ||
| :reviewAction | 0..1 | Extension | S | The details of the review action that is necessary for the authorization. |
| adjudication | BackboneElement | S | ||
| :reviewAction | 0..1 | Extension | S | The details of the review action that is necessary for the authorization. |
| processNote | S | |||
| processNote.number | S1+ | |||
| processNote.text | S | |||
| error | S | |||
| :followupAction | 0..1 | Extension | S | A code representing what action must occur to resolve this error. |
| :errorElement | 0..1 | Extension | S | The specific X12 loop, segment, or element that this error information is about. |
| :errorPath | 0..1 | Extension | S | The FHIRPath expression that indicates which FHIR element that this error information is about. |
| error.code | S |