{
  "resourceType": "StructureDefinition",
  "id": "ext-ClaimResponse-AllowedModifier",
  "url": "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier",
  "name": "ClaimResponseAllowedModifier",
  "title": "ClaimResponse Allowed Modifier Code",
  "status": "active",
  "experimental": false,
  "description": "Indicates a code that can be sent as a 'modifier' on the Claim item in a subsequent adjudication call that would override the adjudication reason being extended.",
  "fhirVersion": "5.0.0",
  "mapping": [
    {
      "identity": "BPCS",
      "name": "Internal BPCS API"
    }
  ],
  "kind": "complex-type",
  "abstract": false,
  "context": [
    {
      "type": "element",
      "expression": "ClaimResponse.item.reviewOutcome.reason"
    }
  ],
  "type": "Extension",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation": "constraint",
  "snapshot": {
    "element": [
      {
        "id": "Extension",
        "path": "Extension",
        "short": "Allowed modifier",
        "definition": "Indicates a code that can be sent as a 'modifier' on the Claim item in a subsequent adjudication call that would override the adjudication reason being extended.",
        "comment": "In some cases 'allowed modifiers' may be listed that, on claim submission turn out to be disallowed.  In this situation, the modifier will be dropped from the list of allowed modifiers after the initial adjudication.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Extension",
          "min": 0,
          "max": "*"
        },
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Extension.id",
        "path": "Extension.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Extension.extension",
        "path": "Extension.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Extension.url",
        "path": "Extension.url",
        "representation": [
          "xmlAttr"
        ],
        "short": "identifies the meaning of the extension",
        "definition": "Source of the definition for the extension code - a logical name or a URL.",
        "comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Extension.url",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "uri"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "fixedUri": "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier",
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Extension.value[x]",
        "path": "Extension.value[x]",
        "short": "A reference to a code defined by a terminology system",
        "definition": "A reference to a code defined by a terminology system.",
        "comment": "Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Extension.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Coding",
            "profile": [
              "https://bpcs.exchange/fhir/StructureDefinition/profile-Coding-simple"
            ]
          }
        ],
        "condition": [
          "ext-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "cod-1",
            "severity": "warning",
            "human": "A Coding SHOULD NOT have a display unless a code is also present.  Computation on Coding.display alone is generally unsafe.  Consider using CodeableConcept.text",
            "expression": "code.exists().not() implies display.exists().not()",
            "source": "http://hl7.org/fhir/StructureDefinition/Coding"
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse-AllowedModifier"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6"
          },
          {
            "identity": "rim",
            "map": "CV"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding rdfs:subClassOf dt:CDCoding"
          },
          {
            "identity": "BPCS",
            "map": "AssessmentFlag.reasnUseCd, other override codes populated by intermediary based on what overrides are permitted for a given response code or EFlag"
          }
        ]
      }
    ]
  },
  "differential": {
    "element": [
      {
        "id": "Extension",
        "path": "Extension",
        "short": "Allowed modifier",
        "definition": "Indicates a code that can be sent as a 'modifier' on the Claim item in a subsequent adjudication call that would override the adjudication reason being extended.",
        "comment": "In some cases 'allowed modifiers' may be listed that, on claim submission turn out to be disallowed.  In this situation, the modifier will be dropped from the list of allowed modifiers after the initial adjudication."
      },
      {
        "id": "Extension.url",
        "path": "Extension.url",
        "fixedUri": "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier"
      },
      {
        "id": "Extension.value[x]",
        "path": "Extension.value[x]",
        "type": [
          {
            "code": "Coding",
            "profile": [
              "https://bpcs.exchange/fhir/StructureDefinition/profile-Coding-simple"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse-AllowedModifier"
        },
        "mapping": [
          {
            "identity": "BPCS",
            "map": "AssessmentFlag.reasnUseCd, other override codes populated by intermediary based on what overrides are permitted for a given response code or EFlag"
          }
        ]
      }
    ]
  }
}