臺灣長期照顧實作指引(TW LTC IG)
1.0.0 - STU 1.0.0
臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions
<ClaimResponse xmlns="http://hl7.org/fhir">
<id value="ltc-claimresponse-feeaudit-example"/>
<meta>
<profile
value="http://ltc-ig.fhir.tw/StructureDefinition/LTCClaimResponseFeeAudit"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse ltc-claimresponse-feeaudit-example</b></p><a name="ltc-claimresponse-feeaudit-example"> </a><a name="hcltc-claimresponse-feeaudit-example"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-LTCClaimResponseFeeAudit.html">長照支付審查－分案審核明細</a></p></div><blockquote><p><b>長照支付審查－分案審核統計與承辦資訊</b></p><ul><li>records: 3</li><li>cases: 2</li><li>approveCaseNum: 2</li><li>approveRecordCount: 1</li><li>tempPaymentStatus: 1: 等待暫付總表</li><li>transNo: 00106</li><li>auditMan: CG碼承辦人</li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type tempPaymentDoc}">暫付總表</span></li><li>url: <a href="http://url/download/doc/dc6a">http://url/download/doc/dc6a</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseSummaryNotice}">總表</span></li><li>url: <a href="http://url/download/doc/dc6adc6a">http://url/download/doc/dc6adc6a</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseSvcList}">清冊</span></li><li>url: <a href="http://url/download/doc/dc6afa306c">http://url/download/doc/dc6afa306c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseSvcListExcel}">清冊EXCEL</span></li><li>url: <a href="http://url/download/doc/dc6a6c">http://url/download/doc/dc6a6c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseASvcList}">A碼清冊</span></li><li>url: <a href="http://url/download/doc/dc6afa306cc554311c">http://url/download/doc/dc6afa306cc554311c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseASvcListExcel}">A碼清冊EXCEL</span></li><li>url: <a href="http://url/download/doc9967-7bddc554311c">http://url/download/doc9967-7bddc554311c</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseErrList}">申請記錄不通過清冊</span></li><li>url: <a href="http://url/download/doc/dc6afa306cc-5ce29d30f843">http://url/download/doc/dc6afa306cc-5ce29d30f843</a></li></ul></blockquote><blockquote><p><b>長照支付審查－清冊文件下載路徑</b></p><ul><li>docType: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type caseErrListExcel}">申請記錄不通過EXCEL清冊</span></li><li>url: <a href="http://url/download/doc/dc6afa306c-5ce29d30f843">http://url/download/doc/dc6afa306c-5ce29d30f843</a></li></ul></blockquote><p><b>identifier</b>: <code>http://ltc-ig.fhir.tw/identifier/feeaudit/case-no</code>/201907C010163, <code>http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver</code>/006, <code>http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm</code>/201907</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient-ltc-patient-chen-ming-hui.html">陳明慧 Female, DoB: 1945-03-15 ( National Person Identifier (TWN): A123456789 (use: official, ))</a></p><p><b>created</b>: 2019-07-23 15:43:51+0800</p><p><b>insurer</b>: <a href="Organization-ltc-organization-feeaudit-authority-example.html">Organization 新北市政府衛生局</a></p><p><b>outcome</b>: Partial Processing</p><p><b>disposition</b>: 請長照機構於5日內將總表送至本局</p><blockquote><p><b>item</b></p><blockquote><p><b>長照支付審查－服務記錄識別資訊</b></p><ul><li>objid: 882601915</li><li>sourceSystem: TranCareCenter</li><li>transNo: A123456789</li></ul></blockquote><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication price}">單價</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>400</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication copayment}">自付額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>85</td><td>New Taiwan dollar</td></tr></table></blockquote></blockquote><blockquote><p><b>addItem</b></p><blockquote><p><b>長照支付審查－服務記錄識別資訊</b></p><ul><li>objid: 882601915</li><li>sourceSystem: TranCareCenter</li></ul></blockquote><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-service-item AA05}">照顧困難之服務加計</span></p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication price}">單價</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>200</td><td>New Taiwan dollar</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication submitted}">申請核銷金額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>4500</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication approveFee}">核定金額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>1596</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication aSvcFee}">政策鼓勵金額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>400</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication tempPaymentFee}">分案暫付金額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>17500</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication incInAcc}">核增金額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>4000</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication decInAcc}">核減金額</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>500</td><td>New Taiwan dollar</td></tr></table></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 1</p><p><b>type</b>: Display</p><p><b>text</b>: 核增原因（inc_in_reason）：因個案身分異動</p></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 2</p><p><b>type</b>: Display</p><p><b>text</b>: 核減原因（dec_in_reason）：因個案CMS等級異動</p></blockquote></div>
</text>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary">
<extension url="records">
<valueInteger value="3"/>
</extension>
<extension url="cases">
<valueInteger value="2"/>
</extension>
<extension url="approveCaseNum">
<valueInteger value="2"/>
</extension>
<extension url="approveRecordCount">
<valueInteger value="1"/>
</extension>
<extension url="tempPaymentStatus">
<valueString value="1: 等待暫付總表"/>
</extension>
<extension url="transNo">
<valueString value="00106"/>
</extension>
<extension url="auditMan">
<valueString value="CG碼承辦人"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="tempPaymentDoc"/>
<display value="暫付總表"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6a"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseSummaryNotice"/>
<display value="總表"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6adc6a"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseSvcList"/>
<display value="清冊"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6afa306c"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseSvcListExcel"/>
<display value="清冊EXCEL"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6a6c"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseASvcList"/>
<display value="A碼清冊"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6afa306cc554311c"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseASvcListExcel"/>
<display value="A碼清冊EXCEL"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc9967-7bddc554311c"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseErrList"/>
<display value="申請記錄不通過清冊"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6afa306cc-5ce29d30f843"/>
</extension>
</extension>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl">
<extension url="docType">
<valueCodeableConcept>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-doc-type"/>
<code value="caseErrListExcel"/>
<display value="申請記錄不通過EXCEL清冊"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="url">
<valueUrl value="http://url/download/doc/dc6afa306c-5ce29d30f843"/>
</extension>
</extension>
<identifier>
<system value="http://ltc-ig.fhir.tw/identifier/feeaudit/case-no"/>
<value value="201907C010163"/>
</identifier>
<identifier>
<system value="http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver"/>
<value value="006"/>
</identifier>
<identifier>
<system value="http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm"/>
<value value="201907"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
<display value="Professional"/>
</coding>
</type>
<use value="claim"/>
<patient>🔗
<reference value="Patient/ltc-patient-chen-ming-hui"/>
</patient>
<created value="2019-07-23T15:43:51+08:00"/>
<insurer>🔗
<reference
value="Organization/ltc-organization-feeaudit-authority-example"/>
</insurer>
<outcome value="partial"/>
<disposition value="請長照機構於5日內將總表送至本局"/>
<item>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef">
<extension url="objid">
<valueString value="882601915"/>
</extension>
<extension url="sourceSystem">
<valueString value="TranCareCenter"/>
</extension>
<extension url="transNo">
<valueString value="A123456789"/>
</extension>
</extension>
<itemSequence value="1"/>
<adjudication>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="price"/>
<display value="單價"/>
</coding>
</category>
<amount>
<value value="400"/>
<currency value="TWD"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="copayment"/>
<display value="自付額"/>
</coding>
</category>
<amount>
<value value="85"/>
<currency value="TWD"/>
</amount>
</adjudication>
</item>
<addItem>
<extension
url="http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef">
<extension url="objid">
<valueString value="882601915"/>
</extension>
<extension url="sourceSystem">
<valueString value="TranCareCenter"/>
</extension>
</extension>
<itemSequence value="1"/>
<productOrService>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-service-item"/>
<code value="AA05"/>
<display value="照顧困難之服務加計"/>
</coding>
</productOrService>
<adjudication>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="price"/>
<display value="單價"/>
</coding>
</category>
<amount>
<value value="200"/>
<currency value="TWD"/>
</amount>
</adjudication>
</addItem>
<total>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="submitted"/>
<display value="申請核銷金額"/>
</coding>
</category>
<amount>
<value value="4500"/>
<currency value="TWD"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="approveFee"/>
<display value="核定金額"/>
</coding>
</category>
<amount>
<value value="1596"/>
<currency value="TWD"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="aSvcFee"/>
<display value="政策鼓勵金額"/>
</coding>
</category>
<amount>
<value value="400"/>
<currency value="TWD"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="tempPaymentFee"/>
<display value="分案暫付金額"/>
</coding>
</category>
<amount>
<value value="17500"/>
<currency value="TWD"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="incInAcc"/>
<display value="核增金額"/>
</coding>
</category>
<amount>
<value value="4000"/>
<currency value="TWD"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-adjudication"/>
<code value="decInAcc"/>
<display value="核減金額"/>
</coding>
</category>
<amount>
<value value="500"/>
<currency value="TWD"/>
</amount>
</total>
<processNote>
<number value="1"/>
<type value="display"/>
<text value="核增原因（inc_in_reason）：因個案身分異動"/>
</processNote>
<processNote>
<number value="2"/>
<type value="display"/>
<text value="核減原因（dec_in_reason）：因個案CMS等級異動"/>
</processNote>
</ClaimResponse>