Australian Digital Health Agency FHIR Implementation Guide
1.2.0-ci-build - draft Australia flag

Australian Digital Health Agency FHIR Implementation Guide, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 1.2.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/ci-fhir-r4/ and changes regularly. See the Directory of published versions

Resource Profile: ADHA MBS Service Claim Item

Official URL: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-servicerequest-mbs-claim-1 Version: 0.0.2
Draft as of 2024-09-12 Computable Name: ADHAServiceRequestMBSClaim

Copyright/Legal: Copyright © 2023 Australian Digital Health Agency - All rights reserved. This content is licensed under a Creative Commons Attribution 4.0 International License. See https://creativecommons.org/licenses/by/4.0/.

The purpose of this profile is to define a representation of the service item claimed in a claim against the Medicare Benefits Schedule (MBS) or Department of Veterans' Affairs (DVA) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.

This profile identifies the additional constraints, extensions, and value sets that build on and extend ServiceRequest that are supported.

This profile is designed to set a ServiceRequest standard for:

  • Recording or updating a service item in an MBS or DVA claim (ExplanationOfBenefit) resource
  • Reading a service item in an MBS or DVA claim (ExplanationOfBenefit) resource

Operations, including querying, on service items in MBS or DVA claims (ServiceRequest resource) are expected to be within the context of an ExplanationOfBenefit resource query.

This profile may be referred to by APIs, which will be listed here when available.

Profile specific guidance

None.

Usage:

  • This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

This structure is derived from ADHAServiceRequestCore

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..* ADHAServiceRequestCore MBS claim item
... status 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Fixed Value: completed
... intent 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Fixed Value: order
... category 0..* CodeableConcept Classification of the claimed service, e.g. specialty
... requester 1..1 Reference(ADHA Authoring PractitionerRole) Who/what is requesting service

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ADHAServiceRequestCore MBS claim item
prr-1: orderDetail SHALL only be present if code is present
inv-dh-srr-01: If present, a performer shall at least have a reference or display or a valid identifier
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Identifiers assigned to this order
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.


Fixed Value: completed
... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category SΣ 0..* CodeableConcept Classification of the claimed service, e.g. specialty
Binding: Service Type . (example)
... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 1..1 CodeableConcept What service was claimed
Binding: Procedure . (preferred)
... subject SΣC 1..1 Reference(ADHA Core Patient) Individual or Entity the service is ordered for
inv-dh-srr-02: At least reference or a valid identifier shall be present
... encounter SΣ 0..1 Reference(ADHA Core Encounter) Encounter in which the request was created
... authoredOn SΣ 0..1 dateTime Date request signed
... requester SΣC 1..1 Reference(ADHA Authoring PractitionerRole) Who/what is requesting service
inv-dh-srr-03: At least reference or display or a valid identifier shall be present
... performerType SΣ 0..1 CodeableConcept Performer role
Binding: Practitioner Role . (preferred)
... performer SΣC 0..* Reference(ADHA Core PractitionerRole | ADHA Core Organization | CareTeam | ADHA Core HealthcareService | ADHA Core Patient | ADHA Core RelatedPerson) Requested performer
... reasonCode SΣ 0..* CodeableConcept Explanation/Justification for procedure or service
Binding: Reason for Request . (preferred)
... reasonReference SΣ 0..* Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core DiagnosticReport | ADHA Core DocumentReference) Explanation/Justification for service or service
... supportingInfo S 0..* Reference(Resource) Additional clinical information

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.statusrequiredFixed Value: completed
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.categoryexampleServiceType .
https://healthterminologies.gov.au/fhir/ValueSet/service-type-1
ServiceRequest.codepreferredProcedure .
https://healthterminologies.gov.au/fhir/ValueSet/procedure-1
ServiceRequest.performerTypepreferredPractitionerRole .
https://healthterminologies.gov.au/fhir/ValueSet/practitioner-role-1
ServiceRequest.reasonCodepreferredReasonForRequest .
https://healthterminologies.gov.au/fhir/ValueSet/reason-for-request-1
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ADHAServiceRequestCore MBS claim item
prr-1: orderDetail SHALL only be present if code is present
inv-dh-srr-01: If present, a performer shall at least have a reference or display or a valid identifier
... 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
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Identifiers assigned to this order
... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn SΣ 0..* Reference(ADHA Core MedicationRequest | ADHA Core ServiceRequest) What request fulfills
... replaces Σ 0..* Reference(ServiceRequest) What request replaces
... requisition Σ 0..1 Identifier Composite Request ID
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.


Fixed Value: completed
... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category SΣ 0..* CodeableConcept Classification of the claimed service, e.g. specialty
Binding: Service Type . (example)
... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 1..1 CodeableConcept What service was claimed
Binding: Procedure . (preferred)
... orderDetail ΣC 0..* CodeableConcept Additional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] Σ 0..1 Service amount
.... quantityQuantity Quantity
.... quantityRatio Ratio
.... quantityRange Range
... subject SΣC 1..1 Reference(ADHA Core Patient) Individual or Entity the service is ordered for
inv-dh-srr-02: At least reference or a valid identifier shall be present
... encounter SΣ 0..1 Reference(ADHA Core Encounter) Encounter in which the request was created
... occurrence[x] Σ 0..1 When service should occur
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
.... occurrenceTiming Timing
... asNeeded[x] Σ 0..1 Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBoolean boolean
.... asNeededCodeableConcept CodeableConcept
... authoredOn SΣ 0..1 dateTime Date request signed
... requester SΣC 1..1 Reference(ADHA Authoring PractitionerRole) Who/what is requesting service
inv-dh-srr-03: At least reference or display or a valid identifier shall be present
... performerType SΣ 0..1 CodeableConcept Performer role
Binding: Practitioner Role . (preferred)
... performer SΣC 0..* Reference(ADHA Core PractitionerRole | ADHA Core Organization | CareTeam | ADHA Core HealthcareService | ADHA Core Patient | ADHA Core RelatedPerson) Requested performer
... locationCode Σ 0..* CodeableConcept Requested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ 0..* Reference(Location) Requested location
... reasonCode SΣ 0..* CodeableConcept Explanation/Justification for procedure or service
Binding: Reason for Request . (preferred)
... reasonReference SΣ 0..* Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core DiagnosticReport | ADHA Core DocumentReference) Explanation/Justification for service or service
... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
... supportingInfo S 0..* Reference(Resource) Additional clinical information
... specimen Σ 0..* Reference(Specimen) Procedure Samples
... bodySite Σ 0..* CodeableConcept Location on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..* Annotation Comments
... patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
... relevantHistory 0..* Reference(Provenance) Request provenance

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
ServiceRequest.statusrequiredFixed Value: completed
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.categoryexampleServiceType .
https://healthterminologies.gov.au/fhir/ValueSet/service-type-1
ServiceRequest.priorityrequiredRequestPriority
http://hl7.org/fhir/ValueSet/request-priority|4.0.1
from the FHIR Standard
ServiceRequest.codepreferredProcedure .
https://healthterminologies.gov.au/fhir/ValueSet/procedure-1
ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
http://hl7.org/fhir/ValueSet/servicerequest-orderdetail
from the FHIR Standard
ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
ServiceRequest.performerTypepreferredPractitionerRole .
https://healthterminologies.gov.au/fhir/ValueSet/practitioner-role-1
ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCodepreferredReasonForRequest .
https://healthterminologies.gov.au/fhir/ValueSet/reason-for-request-1
ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard

This structure is derived from ADHAServiceRequestCore

Summary

Fixed: 2 elements

Structures

This structure refers to these other structures:

Differential View

This structure is derived from ADHAServiceRequestCore

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..* ADHAServiceRequestCore MBS claim item
... status 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Fixed Value: completed
... intent 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Fixed Value: order
... category 0..* CodeableConcept Classification of the claimed service, e.g. specialty
... requester 1..1 Reference(ADHA Authoring PractitionerRole) Who/what is requesting service

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ADHAServiceRequestCore MBS claim item
prr-1: orderDetail SHALL only be present if code is present
inv-dh-srr-01: If present, a performer shall at least have a reference or display or a valid identifier
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Identifiers assigned to this order
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.


Fixed Value: completed
... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category SΣ 0..* CodeableConcept Classification of the claimed service, e.g. specialty
Binding: Service Type . (example)
... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 1..1 CodeableConcept What service was claimed
Binding: Procedure . (preferred)
... subject SΣC 1..1 Reference(ADHA Core Patient) Individual or Entity the service is ordered for
inv-dh-srr-02: At least reference or a valid identifier shall be present
... encounter SΣ 0..1 Reference(ADHA Core Encounter) Encounter in which the request was created
... authoredOn SΣ 0..1 dateTime Date request signed
... requester SΣC 1..1 Reference(ADHA Authoring PractitionerRole) Who/what is requesting service
inv-dh-srr-03: At least reference or display or a valid identifier shall be present
... performerType SΣ 0..1 CodeableConcept Performer role
Binding: Practitioner Role . (preferred)
... performer SΣC 0..* Reference(ADHA Core PractitionerRole | ADHA Core Organization | CareTeam | ADHA Core HealthcareService | ADHA Core Patient | ADHA Core RelatedPerson) Requested performer
... reasonCode SΣ 0..* CodeableConcept Explanation/Justification for procedure or service
Binding: Reason for Request . (preferred)
... reasonReference SΣ 0..* Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core DiagnosticReport | ADHA Core DocumentReference) Explanation/Justification for service or service
... supportingInfo S 0..* Reference(Resource) Additional clinical information

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.statusrequiredFixed Value: completed
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.categoryexampleServiceType .
https://healthterminologies.gov.au/fhir/ValueSet/service-type-1
ServiceRequest.codepreferredProcedure .
https://healthterminologies.gov.au/fhir/ValueSet/procedure-1
ServiceRequest.performerTypepreferredPractitionerRole .
https://healthterminologies.gov.au/fhir/ValueSet/practitioner-role-1
ServiceRequest.reasonCodepreferredReasonForRequest .
https://healthterminologies.gov.au/fhir/ValueSet/reason-for-request-1

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ADHAServiceRequestCore MBS claim item
prr-1: orderDetail SHALL only be present if code is present
inv-dh-srr-01: If present, a performer shall at least have a reference or display or a valid identifier
... 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
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Identifiers assigned to this order
... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn SΣ 0..* Reference(ADHA Core MedicationRequest | ADHA Core ServiceRequest) What request fulfills
... replaces Σ 0..* Reference(ServiceRequest) What request replaces
... requisition Σ 0..1 Identifier Composite Request ID
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.


Fixed Value: completed
... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category SΣ 0..* CodeableConcept Classification of the claimed service, e.g. specialty
Binding: Service Type . (example)
... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 1..1 CodeableConcept What service was claimed
Binding: Procedure . (preferred)
... orderDetail ΣC 0..* CodeableConcept Additional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] Σ 0..1 Service amount
.... quantityQuantity Quantity
.... quantityRatio Ratio
.... quantityRange Range
... subject SΣC 1..1 Reference(ADHA Core Patient) Individual or Entity the service is ordered for
inv-dh-srr-02: At least reference or a valid identifier shall be present
... encounter SΣ 0..1 Reference(ADHA Core Encounter) Encounter in which the request was created
... occurrence[x] Σ 0..1 When service should occur
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
.... occurrenceTiming Timing
... asNeeded[x] Σ 0..1 Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBoolean boolean
.... asNeededCodeableConcept CodeableConcept
... authoredOn SΣ 0..1 dateTime Date request signed
... requester SΣC 1..1 Reference(ADHA Authoring PractitionerRole) Who/what is requesting service
inv-dh-srr-03: At least reference or display or a valid identifier shall be present
... performerType SΣ 0..1 CodeableConcept Performer role
Binding: Practitioner Role . (preferred)
... performer SΣC 0..* Reference(ADHA Core PractitionerRole | ADHA Core Organization | CareTeam | ADHA Core HealthcareService | ADHA Core Patient | ADHA Core RelatedPerson) Requested performer
... locationCode Σ 0..* CodeableConcept Requested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ 0..* Reference(Location) Requested location
... reasonCode SΣ 0..* CodeableConcept Explanation/Justification for procedure or service
Binding: Reason for Request . (preferred)
... reasonReference SΣ 0..* Reference(ADHA Core Condition | ADHA Core Observation | ADHA Core DiagnosticReport | ADHA Core DocumentReference) Explanation/Justification for service or service
... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
... supportingInfo S 0..* Reference(Resource) Additional clinical information
... specimen Σ 0..* Reference(Specimen) Procedure Samples
... bodySite Σ 0..* CodeableConcept Location on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..* Annotation Comments
... patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
... relevantHistory 0..* Reference(Provenance) Request provenance

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
ServiceRequest.statusrequiredFixed Value: completed
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.categoryexampleServiceType .
https://healthterminologies.gov.au/fhir/ValueSet/service-type-1
ServiceRequest.priorityrequiredRequestPriority
http://hl7.org/fhir/ValueSet/request-priority|4.0.1
from the FHIR Standard
ServiceRequest.codepreferredProcedure .
https://healthterminologies.gov.au/fhir/ValueSet/procedure-1
ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
http://hl7.org/fhir/ValueSet/servicerequest-orderdetail
from the FHIR Standard
ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
ServiceRequest.performerTypepreferredPractitionerRole .
https://healthterminologies.gov.au/fhir/ValueSet/practitioner-role-1
ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCodepreferredReasonForRequest .
https://healthterminologies.gov.au/fhir/ValueSet/reason-for-request-1
ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard

This structure is derived from ADHAServiceRequestCore

Summary

Fixed: 2 elements

Structures

This structure refers to these other structures:

 

Other representations of profile: CSV, Excel, Schematron

Notes:

No mandatory or optional search parameters for ADHA MBS Service Claim Item profile.