| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
Claim
|
Claim | This is an abstract profile. Child profiles: Claim , Claim | ||
Slices for extension
|
Slice: Unordered, Open by value:url | |||
levelOfServiceType
|
S | 0..1 | CodeableConcept |
A code specifying the level of service being requested (UM06) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode Binding: todo ( required ): Codes specifying the level of service rendered. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
|
conditionCode
|
0..* | (Complex) |
Used to indicate condition codes for various requests for service. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode |
|
|
homeHealthCareInformation
|
0..1 | (Complex) |
Used to provide required information about home health care services. (CR6) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation |
|
identifier
|
S | ..1 | Identifier | Business identifier for claim |
status
|
Required Pattern: active | |||
|
use
|
Required Pattern: preauthorization | |||
patient
|
Reference (PAS Beneficiary Patient) | |||
|
insurer
|
S | 1.. | Reference (PAS Insurer Organization) | |
|
provider
|
S | Reference (PAS Requestor Organization | PAS PractitionerRole) | ||
Slices for careTeam
|
S | Slice: Unordered, Open by value:extension('http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope').value as boolean | ||
careTeam:All Slices
|
Content/Rules for all slices | |||
Slices for extension
|
1.. | Slice: Unordered, Open by value:url | ||
|
careTeamClaimScope
|
S | 1..1 | boolean |
Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope |
|
sequence
|
S | |||
|
provider
|
S | Reference (PAS Organization Base Profile | PAS PractitionerRole) | ||
|
role
|
S | |||
qualification
|
S | |||
|
careTeam:OverallClaimMember
|
0..* |
Care Team Providers that are applicable to all services being requested. NOTE: Only the first 14 can be sent in the X12 Request. |
||
Slices for extension
|
1.. | Slice: Unordered, Open by value:url | ||
|
careTeamClaimScope
|
S | 1..1 | boolean |
Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope |
value[x]
|
Fixed Value: true | |||
|
role
|
Binding:
todo
( required
): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
|||
|
qualification
|
Binding: todo ( required ) | |||
|
careTeam:ItemClaimMember
|
0..* |
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. |
||
Slices for extension
|
1.. | Slice: Unordered, Open by value:url | ||
|
careTeamClaimScope
|
S | 1..1 | boolean |
Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope |
|
value[x]
|
Fixed Value: false | |||
|
role
|
Binding:
todo
( required
): Codes identifying a provider specialty. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
|||
|
qualification
|
Binding: todo ( required ) | |||
|
Slices for supportingInfo
|
S | Slice: Unordered, Open by value:category | ||
|
supportingInfo:All Slices
|
Content/Rules for all slices | |||
|
sequence
|
S | |||
|
category
|
S | Binding: PAS Supporting Info Type Value Set ( extensible ) | ||
|
supportingInfo:PatientEvent
|
0..1 | Information about the dates of the event that are being requested. | ||
|
category
|
Required Pattern: At least the following | |||
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: patientEvent |
|
|
Slices for timing[x]
|
S | 1 .. | Slice: Unordered, Open by type:$this | |
|
timing[x]:timingDate
|
C | 0..1 | date | FullDateRule: Dates need to be a full date - YYYY-MM-DD |
|
timing[x]:timingPeriod
|
0..1 | Period | ||
|
start
|
C | FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||
|
end
|
C | FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||
|
value[x]
|
.. 0 | |||
|
supportingInfo:AdmissionDates
|
0..1 | Information about the admission dates of a hospital admission being requested. | ||
|
category
|
Required Pattern: At least the following | |||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: admissionDates |
|
|
Slices for timing[x]
|
S | 1 .. | Slice: Unordered, Open by type:$this | |
|
timing[x]:timingDate
|
C | 0..1 | date | FullDateRule: Dates need to be a full date - YYYY-MM-DD |
|
timing[x]:timingPeriod
|
0..1 | Period | ||
|
start
|
C | FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||
|
end
|
C | FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||
|
value[x]
|
.. 0 | |||
|
supportingInfo:DischargeDates
|
0..1 | Information about the discharge dates of a hospital admission being requested. | ||
|
category
|
Required Pattern: At least the following | |||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: dischargeDates |
|
|
Slices for timing[x]
|
S | 1 .. | Slice: Unordered, Open by type:$this | |
|
timing[x]:timingDate
|
C | 0..1 | date | FullDateRule: Dates need to be a full date - YYYY-MM-DD |
|
timing[x]:timingPeriod
|
0..1 | Period | ||
|
start
|
C | FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||
|
end
|
C | FullDateRule: Dates need to be a full date - YYYY-MM-DD | ||
|
value[x]
|
.. 0 | |||
|
diagnosis
|
S | |||
|
sequence
|
S | |||
|
diagnosis[x]
|
S | CodeableConcept | Binding: X12 278 Diagnosis Code Value Set ( required ) | |
|
type
|
S | ..1 | Binding: X12 278 Diagnosis Type Value Set ( required ) | |
|
insurance
|
S | |||
|
sequence
|
S | |||
|
focal
|
Required Pattern: true | |||
|
coverage
|
S | Reference (PAS Coverage) | ||
|
accident
|
S | |||
|
date
|
S | |||
|
type
|
S |
Binding:
todo
( required
): Codes identifying an accompanying cause of an illness, injury or an accident. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
||
|
location[x]
|
Address | |||
|
item
|
S | 1.. | ||
|
Slices for extension
|
Slice: Unordered, Open by value:url | |||
|
itemTraceNumber
|
S | 0..* | Identifier |
Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber |
|
authorizationNumber
|
S | 0..1 | string |
A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber |
|
administrationReferenceNumber
|
S | 0..1 | string |
A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber |
|
requestType
|
S | 0..1 | CodeableConcept |
A code that identifies the type of service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType Binding: todo ( required ): Codes indicating a type of request. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
|
certificationType
|
S | 0..1 | CodeableConcept |
A code representing the type of certification being requested (UM02) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType Binding: todo ( required ): Codes indicating the type of certification. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
|
productOrServiceCodeEnd
|
0..1 | CodeableConcept |
Used to provide the last code in a series of codes for the service being requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type ( required ) |
|
|
sequence
|
S | |||
|
careTeamSequence
|
S | |||
|
diagnosisSequence
|
S | |||
|
informationSequence
|
S | |||
|
revenue
|
S | Binding: AHA NUBC Revenue Value Set ( required ) | ||
|
category
|
Binding:
todo
( required
): Codes identifying the classification of service. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions. |
|||
|
productOrService
|
S | Binding: X12 278 Requested Service Type ( required ) | ||
|
modifier
|
S | Binding: X12 278 Requested Service Modifier Type ( required ) | ||
|
serviced[x]
|
S | |||
|
location[x]
|
S | CodeableConcept | Binding: X12 278 Health Care Service Location Type Value Set ( required ) | |
|
quantity
|
S | |||
|
Documentation for this format
|
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