臺灣長期照顧實作指引(TW LTC IG)
1.1.0 - STU 1.1.0

臺灣長期照顧實作指引(TW LTC IG) - Local Development build (v1.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: 長照支付審查－分案審核明細

Official URL: http://ltc-ig.fhir.tw/StructureDefinition/LTCClaimResponseFeeAudit Version: 1.1.0
Draft as of 2026-09-29 Computable Name: LTCClaimResponseFeeAudit

此 ClaimResponse 以衛生福利部支付審核系統的分案審核明細查詢結果為基礎，用以表述一個核銷案號的審核結果。

每份 ClaimResponse 填寫一個核銷案號的審核結果，包含總表版次、審核意見、各項金額、通過與未通過的服務紀錄，以及 A 碼加成資料。相關統計資料與清冊下載網址可一併填寫。

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... identifier:caseNo S 1..1 Identifier 核銷案號。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
.... identifier:docVer S 0..1 Identifier 總表版次。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
.... identifier:accNum S 0..1 Identifier 簽證編號。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
.... identifier:yyyymm S 0..1 Identifier 支審年月。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
... status ?!SΣ 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use SΣ 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
... created SΣ 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
... insurer SΣ 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
... item S 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
.... noteNumber S 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
.... adjudication S 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... addItem S 0..* BackboneElement A 碼加成的服務資料
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
.... productOrService S 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... total SΣ 0..* BackboneElement 本分案的各項金額
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... processNote S 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
.... text S 1..1 string 審核附註的內容
... error S 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
.... code S 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.identifier:caseNo.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:docVer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:accNum.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:yyyymm.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... Slices for identifier S 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value S 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
.... identifier:docVer S 0..1 Identifier 總表版次。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value S 1..1 string 總表版次。[應填入最長 15 個字元的字串]
.... identifier:accNum S 0..1 Identifier 簽證編號。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value S 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
.... identifier:yyyymm S 0..1 Identifier 支審年月。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value S 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
... status S 1..1 code 審核明細的狀態。[應填入 active]
Required Pattern: active
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
... use S 1..1 code 申報單的用途。[應填入 claim]
Required Pattern: claim
... patient S 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
... created S 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
... insurer S 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
... outcome S 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
... disposition S 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
... item S 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
.... noteNumber S 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
.... adjudication S 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... addItem S 0..* BackboneElement A 碼加成的服務資料
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
.... productOrService S 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... total S 0..* BackboneElement 本分案的各項金額
.... category S 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
.... amount S 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... processNote S 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
.... number S 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
.... text S 1..1 string 審核附註的內容
... error S 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
.... code S 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:docVer S 0..1 Identifier 總表版次。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:accNum S 0..1 Identifier 簽證編號。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:yyyymm S 0..1 Identifier 支審年月。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
... created SΣ 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
... insurer SΣ 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
... request Σ 0..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
.... noteNumber S 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
.... adjudication S 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement A 碼加成的服務資料
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... productOrService S 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication S 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement 本分案的各項金額
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string 審核附註的內容
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.identifier:caseNo.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:caseNo.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.identifier:docVer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:docVer.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.identifier:accNum.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:accNum.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.identifier:yyyymm.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:yyyymm.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.payeeType Base example PayeeType 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Forms 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ClaimResponse

Summary

Mandatory: 4 elements(9 nested mandatory elements)
Must-Support: 48 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of ClaimResponse.identifier

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... identifier:caseNo S 1..1 Identifier 核銷案號。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
.... identifier:docVer S 0..1 Identifier 總表版次。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
.... identifier:accNum S 0..1 Identifier 簽證編號。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
.... identifier:yyyymm S 0..1 Identifier 支審年月。[應填入 Identifier]
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
... status ?!SΣ 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use SΣ 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
... created SΣ 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
... insurer SΣ 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
... item S 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
.... noteNumber S 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
.... adjudication S 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... addItem S 0..* BackboneElement A 碼加成的服務資料
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
.... productOrService S 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... total SΣ 0..* BackboneElement 本分案的各項金額
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... processNote S 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
.... text S 1..1 string 審核附註的內容
... error S 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
.... code S 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.identifier:caseNo.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:docVer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:accNum.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:yyyymm.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... Slices for identifier S 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value S 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
.... identifier:docVer S 0..1 Identifier 總表版次。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value S 1..1 string 總表版次。[應填入最長 15 個字元的字串]
.... identifier:accNum S 0..1 Identifier 簽證編號。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value S 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
.... identifier:yyyymm S 0..1 Identifier 支審年月。[應填入 Identifier]
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value S 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
... status S 1..1 code 審核明細的狀態。[應填入 active]
Required Pattern: active
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
... use S 1..1 code 申報單的用途。[應填入 claim]
Required Pattern: claim
... patient S 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
... created S 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
... insurer S 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
... outcome S 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
... disposition S 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
... item S 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
.... noteNumber S 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
.... adjudication S 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... addItem S 0..* BackboneElement A 碼加成的服務資料
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
.... productOrService S 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... total S 0..* BackboneElement 本分案的各項金額
.... category S 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
.... amount S 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... processNote S 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
.... number S 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
.... text S 1..1 string 審核附註的內容
... error S 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
.... code S 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:docVer S 0..1 Identifier 總表版次。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:accNum S 0..1 Identifier 簽證編號。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:yyyymm S 0..1 Identifier 支審年月。[應填入 Identifier]
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
... created SΣ 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
... insurer SΣ 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
... request Σ 0..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
.... noteNumber S 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
.... adjudication S 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement A 碼加成的服務資料
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... productOrService S 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication S 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement 本分案的各項金額
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string 審核附註的內容
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.identifier:caseNo.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:caseNo.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.identifier:docVer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:docVer.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.identifier:accNum.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:accNum.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.identifier:yyyymm.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier:yyyymm.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.payeeType Base example PayeeType 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Forms 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ClaimResponse

Summary

Mandatory: 4 elements(9 nested mandatory elements)
Must-Support: 48 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of ClaimResponse.identifier

 

Other representations of profile: CSV, Excel, Schematron