Generated Narrative: StructureDefinition LTCClaimFeeApply Name Flags Card. Type Description & Constraints Claim <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( ltc-feeaudit-1, ltc-feeaudit-2, ltc-feeaudit-3, ltc-feeaudit-4 )">C 0..* Claim Claim, Pre-determination or Pre-authorization Constraints: ltc-feeaudit-1, ltc-feeaudit-2, ltc-feeaudit-3, ltc-feeaudit-4 #xD; Slices for identifier S 1..* Identifier 支付審查業務識別碼，以 system 區分服務紀錄識別碼、交易序號與支審年月。 Slice: Unordered, Open by value:system #xD; identifier:objid S 1..1 Identifier 服務紀錄識別碼（objid），字串長度 20，由服務提供單位系統產生且全域唯一；識別碼不存在時新增支審系統之服務紀錄，已存在時則更新之。 #xD; system S 1..1 uri The namespace for the identifier value Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/objid #xD; value S 1..1 string The value that is unique #xD; identifier:transNo S 0..1 Identifier 交易序號（trans_no），字串長度 10，識別本筆服務紀錄所屬之申報交易批次；每個交易序號每次申報最多 5000 筆個案服務紀錄。 #xD; system S 1..1 uri The namespace for the identifier value Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/trans-no #xD; value S 1..1 string The value that is unique #xD; identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），字串長度 6，為西元年月格式 yyyyMM（例如 201901），非民國年。 #xD; system S 1..1 uri The namespace for the identifier value Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm #xD; value S 1..1 string The value that is unique #xD; status S 1..1 code 申報單狀態。個案服務紀錄申報固定為 active。 Required Pattern: active #xD; type S 1..1 CodeableConcept 申報單類別。長照服務紀錄申報固定使用 professional（專業服務）。 #xD; coding S 1..1 Coding Code defined by a terminology system #xD; system S 1..1 uri Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/claim-type #xD; code S 1..1 code Symbol in syntax defined by the system Required Pattern: professional #xD; use S 1..1 code 用途。個案服務紀錄申報為實際請款，固定為 claim。 Required Pattern: claim #xD; patient S 1..1 Reference(長期照顧－住民基本資料) 接受服務之長照需要者，對應規格書欄位 idn（個案身分證字號）。 #xD; created S 1..1 dateTime 本筆服務紀錄之申報建立時間。 #xD; insurer S 0..1 Reference(Organization) 受理審查之單位，如直轄市、縣（市）主管機關或衛生福利部支付審核系統。 #xD; provider S 1..1 Reference(長期照顧－機構) 申報之服務提供單位（特約單位）。 #xD; priority 1..1 CodeableConcept 申報處理優先序。長照支付審查情境無優先序區分，建議固定填 normal。 #xD; careTeam S 0..* BackboneElement 提供本筆服務之照顧服務員，對應規格書欄位 svc_user_no1 至 svc_user_no5（照顧服務員身分證字號 1 至 5）；careTeam.sequence 之 1 至 5 依序對應 svc_user_no1 至 svc_user_no5。申報 AA00、B 碼、G 碼、SC 碼、C 碼、BD03、DA01 時 svc_user_no1（sequence = 1）為必填。 #xD; sequence S 1..1 positiveInt 照顧服務員序號，1 至 5 依序對應規格書之 svc_user_no1 至 svc_user_no5。 #xD; provider S 1..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－服務人員角色 | 長期照顧－機構) 照顧服務員，以身分證字號作為 Practitioner.identifier 之值。 #xD; Slices for supportingInfo S 0..* BackboneElement 隨照顧組合代碼（gov_item_cd）而特化之補充資訊，依規格書「表1: 支付碼必填欄位一覽表」條件填寫。 Slice: Unordered, Open by pattern:category #xD; supportingInfo:All Slices Content/Rules for all slices #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Binding: 支付審查－服務紀錄補充資訊類別 (extensible) #xD; supportingInfo:svcItem S 0..* BackboneElement 服務項目（svc_item）。申報 AA00 必填；申報 AA03 必填（填寫 C 碼服務）。原始電文可複選並以「|」分隔，於本 Profile 中每個選項各為一個 supportingInfo 切片實例；代碼以 supportingInfo.code 承載。選填「9 其他」時另以 svcItemOther 切片補充。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcItem #xD; code S 1..1 CodeableConcept Type of information Binding: 支付審查－服務項目 (required) #xD; value[x] 0..0 Data to be provided #xD; supportingInfo:svcItemOther S 0..1 BackboneElement 服務項目－其他（svc_item_other），字串長度 255。服務項目選填「9 其他」時填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcItemOther #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svcPeople S 0..* BackboneElement 服務對象（svc_people）。申報 AA00 必填：1 服務使用者、2 家庭照顧者。原始電文可複選並以「|」分隔，於本 Profile 中每個選項各為一個 supportingInfo 切片實例；代碼以 supportingInfo.code 承載。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcPeople #xD; code S 1..1 CodeableConcept Type of information Binding: 支付審查－服務對象 (required) #xD; value[x] 0..0 Data to be provided #xD; supportingInfo:svcContent S 0..1 BackboneElement 服務內容（svc_content），字串長度 4000。申報 AA00 必填。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcContent #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svcPoint S 0..* BackboneElement 服務重點（svc_point）。申報 AA00 填寫。原始電文可複選並以「|」分隔，於本 Profile 中每個選項各為一個 supportingInfo 切片實例；代碼以 supportingInfo.code 承載。選填「9 其他」時另以 svcPointOther 切片補充。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcPoint #xD; code S 1..1 CodeableConcept Type of information Binding: 支付審查－服務重點 (required) #xD; value[x] 0..0 Data to be provided #xD; supportingInfo:svcPointOther S 0..1 BackboneElement 服務重點－其他（svc_point_other），字串長度 255。服務重點選填「9 其他」時填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcPointOther #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svcTrace S 0..1 BackboneElement 追蹤服務適應與介入情形（svc_trace），字串長度 4000。申報 AA00 填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcTrace #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svcGoal S 0..1 BackboneElement 各項服務目標及整體計畫目標達成情形（svc_goal），字串長度 4000。申報 AA00 填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcGoal #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svcSuitable S 0..1 BackboneElement 整體計畫的適切性及需求異動（svc_suitable），字串長度 4000。申報 AA00 填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcSuitable #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svcUnit S 0..1 BackboneElement 提供專業服務單位（svc_unit），字串長度 20，內容為 C 單位之單位代碼。申報 AA03 必填。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svcUnit #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svccGoalType S 0..1 BackboneElement 專業服務復能目標達成情形（svcc_goal_type），單選。申報 C 碼填寫；代碼以 supportingInfo.code 承載。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svccGoalType #xD; code S 1..1 CodeableConcept Type of information Binding: 支付審查－專業服務復能目標達成情形 (required) #xD; value[x] 0..0 Data to be provided #xD; supportingInfo:svccGoal S 0..1 BackboneElement 專業服務復能目標（svcc_goal），字串長度 4000。申報 C 碼填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svccGoal #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svccContentTarget S 0..1 BackboneElement 專業服務指導對象（svcc_content_target），字串長度 4000。申報 C 碼填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svccContentTarget #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svccContent S 0..1 BackboneElement 專業服務服務內容（svcc_content），字串長度 4000。申報 C 碼填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svccContent #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:svccSuggest S 0..1 BackboneElement 專業服務指導建議摘要（svcc_suggest），字串長度 4000。申報 C 碼填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: svccSuggest #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:addrFrom S 0..1 BackboneElement 出發地（addr1），申報 BD03、DA01 填寫，以 Reference(LTCLocationFeeAuditPlace) 表達。地址或地點名稱以 Location.name／Location.address 表達；出發地緯度（addrlat1）與經度（addrlng1）以 Location.position.latitude 與 Location.position.longitude 表達。依 v2.2.1 規定，出發地與出發地經緯度需至少填寫一組。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: addrFrom #xD; value[x] S 1..1 Reference(長照支付審查－交通接送起訖地) Data to be provided #xD; supportingInfo:addrTo S 0..1 BackboneElement 目的地（addr2），申報 BD03、DA01 填寫，以 Reference(LTCLocationFeeAuditPlace) 表達。目的地可為醫院、社區式長照機構等非住家地點，故不使用 type 已固定為個案住所之 LTCLocation。地址或地點名稱以 Location.name／Location.address 表達；目的地緯度（addrlat2）與經度（addrlng2）以 Location.position.latitude 與 Location.position.longitude 表達。依 v2.2.1 規定，目的地與目的地經緯度需至少填寫一組。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: addrTo #xD; value[x] S 1..1 Reference(長照支付審查－交通接送起訖地) Data to be provided #xD; supportingInfo:carNo S 0..1 BackboneElement 車號（car_no），字串長度 10。申報 BD03、DA01 必填。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: carNo #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:driver S 0..1 BackboneElement 駕駛員（driver），字串長度 20。申報 BD03、DA01 填寫。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: driver #xD; value[x] S 1..1 string Data to be provided #xD; supportingInfo:milage S 0..1 BackboneElement 里程數（milage），數值型態，建議單位為公里（km）。申報 BD03、DA01 必填。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: milage #xD; value[x] S 1..1 Quantity Data to be provided #xD; supportingInfo:bd03Type S 0..1 BackboneElement 社區式服務交通接送（BD03）服務使用類型（bd03_type），預設為 1（社區式長照機構）。申報 BD03 必填；代碼以 supportingInfo.code 承載。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: bd03Type #xD; code S 1..1 CodeableConcept Type of information Binding: 支付審查－社區式服務交通接送服務使用類型 (required) #xD; value[x] 0..0 Data to be provided #xD; supportingInfo:lastSvc S 0..1 BackboneElement 臨終日照顧（last_svc）。原始電文 Y 對應 true、N 對應 false，預設為 N（false）。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: lastSvc #xD; value[x] S 1..1 boolean Data to be provided #xD; supportingInfo:missedVisit S 0..1 BackboneElement 訪視／服務未遇（missed_visit）。原始電文 Y（未遇）對應 true、N（正常）對應 false，預設為 N（false）。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: missedVisit #xD; value[x] S 1..1 boolean Data to be provided #xD; supportingInfo:applyCovid19 S 0..1 BackboneElement 是否為陪同施打 COVID-19 疫苗（apply_covid19）。原始電文 Y（陪同）對應 true、N（未陪同）對應 false，預設為 N（false）；僅開放 BA13、BA13a 申報。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: applyCovid19 #xD; value[x] S 1..1 boolean Data to be provided #xD; supportingInfo:applyAA03 S 0..1 BackboneElement 是否申報 AA03（apply_aa03）。原始電文 Y 對應 true、N 對應 false，預設為 N（false）。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: applyAA03 #xD; value[x] S 1..1 boolean Data to be provided #xD; supportingInfo:applyAA09 S 0..1 BackboneElement 是否申報 AA09（apply_aa09）。原始電文 Y 對應 true、N 對應 false，預設為 Y（true）。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: applyAA09 #xD; value[x] S 1..1 boolean Data to be provided #xD; supportingInfo:aa10Status S 0..1 BackboneElement AA10 申報狀態（aa10_status），預設為 0（未申報）；代碼以 supportingInfo.code 承載。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: aa10Status #xD; code S 1..1 CodeableConcept Type of information Binding: 支付審查－AA10 申報狀態 (required) #xD; value[x] 0..0 Data to be provided #xD; supportingInfo:remark S 0..1 BackboneElement 備註（remark），字串長度 4000。 #xD; category 1..1 CodeableConcept 補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://ltc-ig.fhir.tw/CodeSystem/cs-tw-ltc-feeaudit-supporting-info #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: remark #xD; value[x] S 1..1 string Data to be provided #xD; insurance S 1..* BackboneElement 保險／給付來源區塊。此為 FHIR Claim 之必填結構；長照情境下僅需一個最小保險區塊，填 insurance.sequence = 1、insurance.focal = true，並以 insurance.coverage 指向長照給付額度（如 Coverage 或以 display 註明「長期照顧給付及支付基準」）。 #xD; item S 1..1 BackboneElement 服務明細。一筆個案服務紀錄（objid）僅對應一個 item。 #xD; sequence 1..1 positiveInt 服務明細序號。一筆服務紀錄僅一個 item，固定填 1。 #xD; category S 0..1 CodeableConcept 服務類別，對應規格書欄位 svc_fee_tp。1：補助、2：自費。 Binding: 支付審查－服務類別 (required) #xD; productOrService S 1..1 CodeableConcept 照顧組合代碼，對應規格書欄位 gov_item_cd（字串長度 10）；A 單位之個案管理服務紀錄請填 AA00（該代碼已收錄於臺灣長照服務項目代碼系統 CS_TW_LTC_ServiceItem，須以 coding 承載，方能觸發 invariant ltc-feeaudit-3 之條件必填檢核）。 Binding: 臺灣長照服務項目 (extensible) #xD; serviced[x] S 1..1 Period 服務起訖時間。start 由服務日期（svc_dt，yyyyMMdd）與起始時段（start_hh、start_mm）組成；end 由服務結束日期（svc_end_dt，空白時同 svc_dt）與結束時段（end_hh、end_mm）組成。時段採 24 小時制且不足兩碼補 0。 #xD; location[x] 0..1 Reference(長照支付審查－交通接送起訖地) 服務地點。申報 BD03、DA01 交通接送時，可用以表達目的地；出發地與目的地之完整資訊另以 supportingInfo 之 addrFrom、addrTo 切片承載。 #xD; quantity S 0..1 SimpleQuantity(4.0.1) 申報數量，對應規格書欄位 amount（數量）。表1 中各支付碼皆為必填。 #xD; unitPrice S 0..1 Money 單價，對應規格書欄位 price。表1 條件必填：申報 BD03、DA01 為必填，其餘支付碼為非必填。 #xD; net S 0..1 Money 本筆服務明細之小計金額（單價 × 數量）。 #xD; total S 0..1 Money 本筆服務紀錄之申報金額，對應規格書之服務紀錄金額（amount）。 #xD; Documentation for this format
此 Profile 說明本 IG 如何進一步定義 FHIR 的 Claim Resource，以呈現服務提供單位向衛生福利部支付審核系統（照管平台）執行「服務記錄申報（FeeApply）」時所傳送之單筆個案服務紀錄。一筆 Claim 對應規格書中一筆具唯一識別碼（objid）之個案服務紀錄，識別碼不存在時於支審系統新增服務紀錄、已存在時則更新服務紀錄；同一次申報交易（trans_no，最多 5000 筆）之多筆服務紀錄以 Bundle 打包。共通欄位以 Claim 基本元素及 Claim.item 承載；隨照顧組合代碼（gov_item_cd）而特化之欄位，依規格書「表1: 支付碼必填欄位一覽表」以 Claim.supportingInfo 之具名切片承載。因 FHIR R4 之 Claim.supportingInfo.value[x] 型別僅允許 boolean、string、Quantity、Attachment 與 Reference，故代碼型欄位（服務項目、服務對象、服務重點、專業服務復能目標達成情形、BD03 服務使用類型、AA10 申報狀態）改以 supportingInfo.code 承載並綁定對應 ValueSet。條件必填規則因隨支付碼而異，於本 Profile 中以 severity 為 warning 之 invariant（ltc-feeaudit-1 至 ltc-feeaudit-4）表達。
Claim, Pre-determination or Pre-authorization
A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
申報照顧組合代碼 BD03 或 DA01（交通接送）時，應填寫里程數（milage）與車號（carNo）。
item.productOrService.coding.where(code = 'BD03' or code = 'DA01').exists() implies (supportingInfo.category.coding.where(code = 'milage').exists() and supportingInfo.category.coding.where(code = 'carNo').exists())
申報照顧組合代碼 BD03（社區式服務交通接送）時，應填寫服務使用類型（bd03Type）。
item.productOrService.coding.where(code = 'BD03').exists() implies supportingInfo.category.coding.where(code = 'bd03Type').exists()
申報照顧組合代碼 AA00（A 單位個案管理服務）時，應填寫服務項目（svcItem）、服務對象（svcPeople）與服務內容（svcContent）。
item.productOrService.coding.where(code = 'AA00').exists() implies (supportingInfo.category.coding.where(code = 'svcItem').exists() and supportingInfo.category.coding.where(code = 'svcPeople').exists() and supportingInfo.category.coding.where(code = 'svcContent').exists())
申報照顧組合代碼 AA03（專業服務）時，應填寫服務項目（svcItem）與提供專業服務單位（svcUnit）。
item.productOrService.coding.where(code = 'AA03').exists() implies (supportingInfo.category.coding.where(code = 'svcItem').exists() and supportingInfo.category.coding.where(code = 'svcUnit').exists())
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
支付審查業務識別碼，以 system 區分服務紀錄識別碼、交易序號與支審年月。
A unique identifier assigned to this claim.
Allows claims to be distinguished and referenced.
服務紀錄識別碼（objid），字串長度 20，由服務提供單位系統產生且全域唯一；識別碼不存在時新增支審系統之服務紀錄，已存在時則更新之。
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
交易序號（trans_no），字串長度 10，識別本筆服務紀錄所屬之申報交易批次；每個交易序號每次申報最多 5000 筆個案服務紀錄。
支審年月（writeoff_yyyymm），字串長度 6，為西元年月格式 yyyyMM（例如 201901），非民國年。
申報單狀態。個案服務紀錄申報固定為 active。
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A code specifying the state of the resource instance.
申報單類別。長照服務紀錄申報固定使用 professional（專業服務）。
The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
Claim type determine the general sets of business rules applied for information requirements and adjudication.
The type or discipline-style of the claim.
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The identification of the code system that defines the meaning of the symbol in the code.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
Some jurisdictions need a finer grained claim type for routing and adjudication.
用途。個案服務紀錄申報為實際請款，固定為 claim。
A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
This element is required to understand the nature of the request for adjudication.
The purpose of the Claim: predetermination, preauthorization, claim.
接受服務之長照需要者，對應規格書欄位 idn（個案身分證字號）。
The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.
The period for which charges are being submitted.
Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.
A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.
This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.
Need to record a timestamp for use by both the recipient and the issuer.
Individual who created the claim, predetermination or preauthorization.
Some jurisdictions require the contact information for personnel completing claims.
受理審查之單位，如直轄市、縣（市）主管機關或衛生福利部支付審核系統。
The Insurer who is target of the request.
The provider which is responsible for the claim, predetermination or preauthorization.
Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
申報處理優先序。長照支付審查情境無優先序區分，建議固定填 normal。
The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.
The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.
The timeliness with which processing is required: stat, normal, deferred.
A code to indicate whether and for whom funds are to be reserved for future claims.
This field is only used for preauthorizations.
In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
For whom funds are to be reserved: (Patient, Provider, None).
Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
For example, for the original treatment and follow-up exams.
For workplace or other accidents it is common to relate separate claims arising from the same event.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
A code to convey how the claims are related.
Some insurers need a declaration of the type of relationship.
Relationship of this claim to a related Claim.
An alternate organizational reference to the case or file to which this particular claim pertains.
For example, Property/Casualty insurer claim # or Workers Compensation case # .
In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.
Prescription authorizing services and products
Prescription to support the dispensing of pharmacy, device or vision products.
Required to authorize the dispensing of controlled substances and devices.
Original prescription if superseded by fulfiller
Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.
The party to be reimbursed for cost of the products and services according to the terms of the policy.
Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.
The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.
Type of Party to be reimbursed: subscriber, provider, other.
Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.
Reference to the individual or organization to whom any payment will be made.
Not required if the payee is 'subscriber' or 'provider'.
Need to provide demographics if the payee is not 'subscriber' nor 'provider'.
The referral resource which lists the date, practitioner, reason and other supporting information.
Some insurers require proof of referral to pay for services or to pay specialist rates for services.
Facility where the services were provided.
Insurance adjudication can be dependant on where services were delivered.
提供本筆服務之照顧服務員，對應規格書欄位 svc_user_no1 至 svc_user_no5（照顧服務員身分證字號 1 至 5）；careTeam.sequence 之 1 至 5 依序對應 svc_user_no1 至 svc_user_no5。申報 AA00、B 碼、G 碼、SC 碼、C 碼、BD03、DA01 時 svc_user_no1（sequence = 1）為必填。
The members of the team who provided the products and services.
Common to identify the responsible and supporting practitioners.
照顧服務員序號，1 至 5 依序對應規格書之 svc_user_no1 至 svc_user_no5。
A number to uniquely identify care team entries.
Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.
照顧服務員，以身分證字號作為 Practitioner.identifier 之值。
Member of the team who provided the product or service.
Often a regulatory requirement to specify the responsible provider.
The party who is billing and/or responsible for the claimed products or services.
Responsible might not be required when there is only a single provider listed.
When multiple parties are present it is required to distinguish the lead or responsible individual.
The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Role might not be required when there is only a single provider listed.
When multiple parties are present it is required to distinguish the roles performed by each member.
The role codes for the care team members.
Practitioner credential or specialization
The qualification of the practitioner which is applicable for this service.
Need to specify which qualification a provider is delivering the product or service under.
隨照顧組合代碼（gov_item_cd）而特化之補充資訊，依規格書「表1: 支付碼必填欄位一覽表」條件填寫。
Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
Often there are multiple jurisdiction specific valuesets which are required.
Typically these information codes are required to support the services rendered or the adjudication of the services rendered.
Attachments Exception Codes Occurrence Codes Value codes
A number to uniquely identify supporting information entries.
Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.
補充資訊類別，取值自支付審查服務紀錄補充資訊類別代碼系統。
The general class of the information supplied: information; exception; accident, employment; onset, etc.
This may contain a category for the local bill type codes.
Required to group or associate information items with common characteristics. For example: admission information or prior treatments.
System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Required to identify the kind of additional information.
The valuset used for additional information codes.
The date when or period to which this information refers.
Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.
To convey the data content to be provided when the information is more than a simple code or period.
Provides the reason in the situation where a reason code is required in addition to the content.
For example: the reason for the additional stay, or why a tooth is missing.
Needed when the supporting information has both a date and amount/value and requires explanation.
服務項目（svc_item）。申報 AA00 必填；申報 AA03 必填（填寫 C 碼服務）。原始電文可複選並以「|」分隔，於本 Profile 中每個選項各為一個 supportingInfo 切片實例；代碼以 supportingInfo.code 承載。選填「9 其他」時另以 svcItemOther 切片補充。
服務項目－其他（svc_item_other），字串長度 255。服務項目選填「9 其他」時填寫。
服務對象（svc_people）。申報 AA00 必填：1 服務使用者、2 家庭照顧者。原始電文可複選並以「|」分隔，於本 Profile 中每個選項各為一個 supportingInfo 切片實例；代碼以 supportingInfo.code 承載。
服務重點（svc_point）。申報 AA00 填寫。原始電文可複選並以「|」分隔，於本 Profile 中每個選項各為一個 supportingInfo 切片實例；代碼以 supportingInfo.code 承載。選填「9 其他」時另以 svcPointOther 切片補充。
服務重點－其他（svc_point_other），字串長度 255。服務重點選填「9 其他」時填寫。
追蹤服務適應與介入情形（svc_trace），字串長度 4000。申報 AA00 填寫。
各項服務目標及整體計畫目標達成情形（svc_goal），字串長度 4000。申報 AA00 填寫。
整體計畫的適切性及需求異動（svc_suitable），字串長度 4000。申報 AA00 填寫。
提供專業服務單位（svc_unit），字串長度 20，內容為 C 單位之單位代碼。申報 AA03 必填。
專業服務復能目標達成情形（svcc_goal_type），單選。申報 C 碼填寫；代碼以 supportingInfo.code 承載。
專業服務指導對象（svcc_content_target），字串長度 4000。申報 C 碼填寫。
專業服務服務內容（svcc_content），字串長度 4000。申報 C 碼填寫。
專業服務指導建議摘要（svcc_suggest），字串長度 4000。申報 C 碼填寫。
出發地（addr1），申報 BD03、DA01 填寫，以 Reference(LTCLocationFeeAuditPlace) 表達。地址或地點名稱以 Location.name／Location.address 表達；出發地緯度（addrlat1）與經度（addrlng1）以 Location.position.latitude 與 Location.position.longitude 表達。依 v2.2.1 規定，出發地與出發地經緯度需至少填寫一組。
目的地（addr2），申報 BD03、DA01 填寫，以 Reference(LTCLocationFeeAuditPlace) 表達。目的地可為醫院、社區式長照機構等非住家地點，故不使用 type 已固定為個案住所之 LTCLocation。地址或地點名稱以 Location.name／Location.address 表達；目的地緯度（addrlat2）與經度（addrlng2）以 Location.position.latitude 與 Location.position.longitude 表達。依 v2.2.1 規定，目的地與目的地經緯度需至少填寫一組。
里程數（milage），數值型態，建議單位為公里（km）。申報 BD03、DA01 必填。
社區式服務交通接送（BD03）服務使用類型（bd03_type），預設為 1（社區式長照機構）。申報 BD03 必填；代碼以 supportingInfo.code 承載。
臨終日照顧（last_svc）。原始電文 Y 對應 true、N 對應 false，預設為 N（false）。
訪視／服務未遇（missed_visit）。原始電文 Y（未遇）對應 true、N（正常）對應 false，預設為 N（false）。
是否為陪同施打 COVID-19 疫苗（apply_covid19）。原始電文 Y（陪同）對應 true、N（未陪同）對應 false，預設為 N（false）；僅開放 BA13、BA13a 申報。
是否申報 AA03（apply_aa03）。原始電文 Y 對應 true、N 對應 false，預設為 N（false）。
是否申報 AA09（apply_aa09）。原始電文 Y 對應 true、N 對應 false，預設為 Y（true）。
AA10 申報狀態（aa10_status），預設為 0（未申報）；代碼以 supportingInfo.code 承載。
Information about diagnoses relevant to the claim items.
Required for the adjudication by provided context for the services and product listed.
A number to uniquely identify diagnosis entries.
Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.
The nature of illness or problem in a coded form or as a reference to an external defined Condition.
Provides health context for the evaluation of the products and/or services.
When the condition was observed or the relative ranking.
For example: admitting, primary, secondary, discharge.
Often required to capture a particular diagnosis, for example: primary or discharge.
The type of the diagnosis: admitting, principal, discharge.
Indication of whether the diagnosis was present on admission to a facility.
Many systems need to understand for adjudication if the diagnosis was present a time of admission.
A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.
For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.
Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.
The DRG codes associated with the diagnosis.
Procedures performed on the patient relevant to the billing items with the claim.
The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
A number to uniquely identify procedure entries.
Necessary to provide a mechanism to link to claim details.
Date and optionally time the procedure was performed.
The code or reference to a Procedure resource which identifies the clinical intervention performed.
This identifies the actual clinical procedure.
Unique Device Identifiers associated with this line item.
The UDI code allows the insurer to obtain device level information on the product supplied.
保險／給付來源區塊。此為 FHIR Claim 之必填結構；長照情境下僅需一個最小保險區塊，填 insurance.sequence = 1、insurance.focal = true，並以 insurance.coverage 指向長照給付額度（如 Coverage 或以 display 註明「長期照顧給付及支付基準」）。
Financial instruments for reimbursement for the health care products and services specified on the claim.
All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
At least one insurer is required for a claim to be a claim.
A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
To identify which coverage in the list is being used to adjudicate this claim.
The business identifier to be used when the claim is sent for adjudication against this insurance policy.
Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.
This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.
Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
Required to allow the adjudicator to locate the correct policy and history within their information system.
A business agreement number established between the provider and the insurer for special business processing purposes.
Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.
Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.
Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.
The result of the adjudication of the line items for the Coverage specified in this insurance.
Must not be specified when 'focal=true' for this insurance.
An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.
Details of an accident which resulted in injuries which required the products and services listed in the claim.
When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.
Date of an accident event related to the products and services contained in the claim.
The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.
Required for audit purposes and adjudication.
The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.
Coverage may be dependant on the type of accident.
Type of accident: work place, auto, etc.
The physical location of the accident event.
Required for audit purposes and determination of applicable insurance liability.
服務明細。一筆個案服務紀錄（objid）僅對應一個 item。
A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
The items to be processed for adjudication.
服務明細序號。一筆服務紀錄僅一個 item，固定填 1。
A number to uniquely identify item entries.
Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
CareTeam members related to this service or product.
Need to identify the individuals and their roles in the provision of the product or service.
Diagnosis applicable for this service or product.
Need to related the product or service to the associated diagnoses.
Procedures applicable for this service or product.
Need to provide any listed specific procedures to support the product or service being claimed.
Applicable exception and supporting information
Exceptions, special conditions and supporting information applicable for this service or product.
Need to reference the supporting information items that relate directly to this product or service.
The type of revenue or cost center providing the product and/or service.
Needed in the processing of institutional claims.
Codes for the revenue or cost centers supplying the service and/or products.
Code to identify the general type of benefits under which products and services are provided.
Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
照顧組合代碼，對應規格書欄位 gov_item_cd（字串長度 10）；A 單位之個案管理服務紀錄請填 AA00（該代碼已收錄於臺灣長照服務項目代碼系統 CS_TW_LTC_ServiceItem，須以 coding 承載，方能觸發 invariant ltc-feeaudit-3 之條件必填檢核）。
When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Necessary to state what was provided or done.
Item typification or modifiers codes to convey additional context for the product or service.
For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
To support inclusion of the item for adjudication or to charge an elevated fee.
Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Program the product or service is provided under
Identifies the program under which this may be recovered.
For example: Neonatal program, child dental program or drug users recovery program.
Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
服務起訖時間。start 由服務日期（svc_dt，yyyyMMdd）與起始時段（start_hh、start_mm）組成；end 由服務結束日期（svc_end_dt，空白時同 svc_dt）與結束時段（end_hh、end_mm）組成。時段採 24 小時制且不足兩碼補 0。
The date or dates when the service or product was supplied, performed or completed.
Needed to determine whether the service or product was provided during the term of the insurance coverage.
服務地點。申報 BD03、DA01 交通接送時，可用以表達目的地；出發地與目的地之完整資訊另以 supportingInfo 之 addrFrom、addrTo 切片承載。
Where the product or service was provided.
The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
申報數量，對應規格書欄位 amount（數量）。表1 中各支付碼皆為必填。
The number of repetitions of a service or product.
Required when the product or service code does not convey the quantity provided.
單價，對應規格書欄位 price。表1 條件必填：申報 BD03、DA01 為必填，其餘支付碼為非必填。
If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
The amount charged to the patient by the provider for a single unit.
A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
本筆服務明細之小計金額（單價 × 數量）。
The quantity times the unit price for an additional service or product or charge.
For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Provides the total amount claimed for the group (if a grouper) or the line item.
Physical service site on the patient (limb, tooth, etc.).
For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
Allows insurer to validate specific procedures.
The code for the teeth, quadrant, sextant and arch.
A region or surface of the bodySite, e.g. limb region or tooth surface(s).
The code for the tooth surface and surface combinations.
The Encounters during which this Claim was created or to which the creation of this record is tightly associated.
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
Used in some jurisdictions to link clinical events to claim items.
A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
Benefit categories such as: oral-basic, major, glasses.
For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
本筆服務紀錄之申報金額，對應規格書之服務紀錄金額（amount）。
The total value of the all the items in the claim.