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

臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.1.0 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

Resource Profile: 長照支付審查－分案審核明細

Official URL: http://ltc-ig.fhir.tw/StructureDefinition/LTCClaimResponseFeeAudit Version: 1.1.0
Draft as of 2026-10-30 Computable Name: LTCClaimResponseFeeAudit

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

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

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:docUrl This element must be supported. 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
ClaimResponse.Slices for extension.extension:auditSummary This element must be supported. 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
ClaimResponse.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
ClaimResponse.Slices for identifier This element must be supported. 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for identifier.identifier:caseNo This element must be supported. 1..1 Identifier 核銷案號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:caseNo.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:caseNo.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no (extensions allowed)
ClaimResponse.Slices for identifier.identifier:caseNo.value This element must be supported. This element is included in summaries. 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:docVer This element must be supported. 0..1 Identifier 總表版次。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:docVer.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:docVer.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver (extensions allowed)
ClaimResponse.Slices for identifier.identifier:docVer.value This element must be supported. This element is included in summaries. 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:accNum This element must be supported. 0..1 Identifier 簽證編號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:accNum.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:accNum.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num (extensions allowed)
ClaimResponse.Slices for identifier.identifier:accNum.value This element must be supported. This element is included in summaries. 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:yyyymm This element must be supported. 0..1 Identifier 支審年月。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:yyyymm.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:yyyymm.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm (extensions allowed)
ClaimResponse.Slices for identifier.identifier:yyyymm.value This element must be supported. This element is included in summaries. 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active (extensions allowed)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }
  ]
}
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim (extensions allowed)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
ClaimResponse.insurer This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
ClaimResponse.requestor This element must be supported. 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition This element must be supported. 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
ClaimResponse.item This element must be supported. 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
ClaimResponse.item.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for extension.extension:recordRef This element must be supported. 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence This element must be supported. 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
ClaimResponse.item.noteNumber This element must be supported. 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
ClaimResponse.item.adjudication This element must be supported. 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.item.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.addItem This element must be supported. 0..* BackboneElement A 碼加成的服務資料
ClaimResponse.addItem.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence This element must be supported. 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
ClaimResponse.addItem.productOrService This element must be supported. 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
ClaimResponse.addItem.adjudication This element must be supported. 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
ClaimResponse.addItem.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.addItem.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement 本分案的各項金額
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category This element must be supported. This element is included in summaries. 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.total.amount This element must be supported. This element is included in summaries. 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.processNote This element must be supported. 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number This element must be supported. 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
ClaimResponse.processNote.text This element must be supported. 1..1 string 審核附註的內容
ClaimResponse.error This element must be supported. 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
ClaimResponse.error.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence This element must be supported. 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
ClaimResponse.error.code This element must be supported. 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

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

Constraints

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

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse ClaimResponse
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:docUrl This element must be supported. 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
ClaimResponse.Slices for extension.extension:auditSummary This element must be supported. 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
ClaimResponse.Slices for identifier This element must be supported. 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for identifier.identifier:caseNo This element must be supported. 1..1 Identifier 核銷案號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:caseNo.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no (extensions allowed)
ClaimResponse.Slices for identifier.identifier:caseNo.value This element must be supported. 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
ClaimResponse.Slices for identifier.identifier:docVer This element must be supported. 0..1 Identifier 總表版次。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:docVer.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver (extensions allowed)
ClaimResponse.Slices for identifier.identifier:docVer.value This element must be supported. 1..1 string 總表版次。[應填入最長 15 個字元的字串]
ClaimResponse.Slices for identifier.identifier:accNum This element must be supported. 0..1 Identifier 簽證編號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:accNum.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num (extensions allowed)
ClaimResponse.Slices for identifier.identifier:accNum.value This element must be supported. 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
ClaimResponse.Slices for identifier.identifier:yyyymm This element must be supported. 0..1 Identifier 支審年月。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:yyyymm.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm (extensions allowed)
ClaimResponse.Slices for identifier.identifier:yyyymm.value This element must be supported. 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
ClaimResponse.status This element must be supported. 1..1 code 審核明細的狀態。[應填入 active]
Required Pattern: active (extensions allowed)
ClaimResponse.use This element must be supported. 1..1 code 申報單的用途。[應填入 claim]
Required Pattern: claim (extensions allowed)
ClaimResponse.patient This element must be supported. 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
ClaimResponse.created This element must be supported. 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
ClaimResponse.insurer This element must be supported. 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
ClaimResponse.requestor This element must be supported. 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
ClaimResponse.outcome This element must be supported. 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
ClaimResponse.disposition This element must be supported. 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
ClaimResponse.item This element must be supported. 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
ClaimResponse.item.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for extension.extension:recordRef This element must be supported. 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.item.itemSequence This element must be supported. 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
ClaimResponse.item.noteNumber This element must be supported. 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
ClaimResponse.item.adjudication This element must be supported. 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
ClaimResponse.item.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.item.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.addItem This element must be supported. 0..* BackboneElement A 碼加成的服務資料
ClaimResponse.addItem.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.addItem.itemSequence This element must be supported. 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
ClaimResponse.addItem.productOrService This element must be supported. 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
ClaimResponse.addItem.adjudication This element must be supported. 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
ClaimResponse.addItem.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.addItem.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.total This element must be supported. 0..* BackboneElement 本分案的各項金額
ClaimResponse.total.category This element must be supported. 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.total.amount This element must be supported. 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.processNote This element must be supported. 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
ClaimResponse.processNote.number This element must be supported. 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
ClaimResponse.processNote.text This element must be supported. 1..1 string 審核附註的內容
ClaimResponse.error This element must be supported. 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
ClaimResponse.error.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.error.itemSequence This element must be supported. 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
ClaimResponse.error.code This element must be supported. 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.item.adjudication.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.1.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.1.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.1.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
ClaimResponse.id This element is included in summaries. 0..1 id Logical id of this artifact
ClaimResponse.meta This element is included in summaries. 0..1 Meta Metadata about the resource
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
ClaimResponse.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
ClaimResponse.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained 0..* Resource Contained, inline Resources
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:docUrl This element must be supported. 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
ClaimResponse.Slices for extension.extension:auditSummary This element must be supported. 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
ClaimResponse.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
ClaimResponse.Slices for identifier This element must be supported. 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for identifier.identifier:caseNo This element must be supported. 1..1 Identifier 核銷案號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:caseNo.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:caseNo.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:caseNo.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:caseNo.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:caseNo.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no (extensions allowed)
ClaimResponse.Slices for identifier.identifier:caseNo.value This element must be supported. This element is included in summaries. 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:caseNo.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:caseNo.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.Slices for identifier.identifier:docVer This element must be supported. 0..1 Identifier 總表版次。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:docVer.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:docVer.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:docVer.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:docVer.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:docVer.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver (extensions allowed)
ClaimResponse.Slices for identifier.identifier:docVer.value This element must be supported. This element is included in summaries. 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:docVer.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:docVer.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.Slices for identifier.identifier:accNum This element must be supported. 0..1 Identifier 簽證編號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:accNum.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:accNum.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:accNum.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:accNum.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:accNum.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num (extensions allowed)
ClaimResponse.Slices for identifier.identifier:accNum.value This element must be supported. This element is included in summaries. 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:accNum.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:accNum.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.Slices for identifier.identifier:yyyymm This element must be supported. 0..1 Identifier 支審年月。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:yyyymm.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:yyyymm.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:yyyymm.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:yyyymm.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:yyyymm.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm (extensions allowed)
ClaimResponse.Slices for identifier.identifier:yyyymm.value This element must be supported. This element is included in summaries. 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:yyyymm.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:yyyymm.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active (extensions allowed)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }
  ]
}
ClaimResponse.subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim (extensions allowed)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
ClaimResponse.insurer This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
ClaimResponse.requestor This element must be supported. 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
ClaimResponse.request This element is included in summaries. 0..1 Reference(Claim) Id of resource triggering adjudication
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition This element must be supported. 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
ClaimResponse.preAuthRef 0..1 string Preauthorization reference
ClaimResponse.preAuthPeriod 0..1 Period Preauthorization reference effective period
ClaimResponse.payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ClaimResponse.item This element must be supported. 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
ClaimResponse.item.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for extension.extension:recordRef This element must be supported. 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence This element must be supported. 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
ClaimResponse.item.noteNumber This element must be supported. 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
ClaimResponse.item.adjudication This element must be supported. 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
ClaimResponse.item.adjudication.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension 0..* Extension Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.item.adjudication.reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.item.adjudication.value 0..1 decimal Non-monetary value
ClaimResponse.item.detail 0..* BackboneElement Adjudication for claim details
ClaimResponse.item.detail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.detail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence 1..1 positiveInt Claim detail instance identifier
ClaimResponse.item.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
ClaimResponse.item.detail.subDetail 0..* BackboneElement Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
ClaimResponse.addItem This element must be supported. 0..* BackboneElement A 碼加成的服務資料
ClaimResponse.addItem.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence This element must be supported. 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
ClaimResponse.addItem.detailSequence 0..* positiveInt Detail sequence number
ClaimResponse.addItem.subdetailSequence 0..* positiveInt Subdetail sequence number
ClaimResponse.addItem.provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
ClaimResponse.addItem.productOrService This element must be supported. 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
ClaimResponse.addItem.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x] 0..1 Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate date
ClaimResponse.addItem.serviced[x].servicedPeriod Period
ClaimResponse.addItem.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept CodeableConcept
ClaimResponse.addItem.location[x].locationAddress Address
ClaimResponse.addItem.location[x].locationReference Reference(Location)
ClaimResponse.addItem.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
ClaimResponse.addItem.unitPrice 0..1 Money Fee, charge or cost per item
ClaimResponse.addItem.factor 0..1 decimal Price scaling factor
ClaimResponse.addItem.net 0..1 Money Total item cost
ClaimResponse.addItem.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.adjudication This element must be supported. 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
ClaimResponse.addItem.adjudication.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.adjudication.extension 0..* Extension Additional content defined by implementations
ClaimResponse.addItem.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.addItem.adjudication.reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.addItem.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.addItem.adjudication.value 0..1 decimal Non-monetary value
ClaimResponse.addItem.detail 0..* BackboneElement Insurer added line details
ClaimResponse.addItem.detail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice 0..1 Money Fee, charge or cost per item
ClaimResponse.addItem.detail.factor 0..1 decimal Price scaling factor
ClaimResponse.addItem.detail.net 0..1 Money Total item cost
ClaimResponse.addItem.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.detail.adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
ClaimResponse.addItem.detail.subDetail 0..* BackboneElement Insurer added line items
ClaimResponse.addItem.detail.subDetail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor 0..1 decimal Price scaling factor
ClaimResponse.addItem.detail.subDetail.net 0..1 Money Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
ClaimResponse.adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement 本分案的各項金額
ClaimResponse.total.id 0..1 string Unique id for inter-element referencing
ClaimResponse.total.extension 0..* Extension Additional content defined by implementations
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category This element must be supported. This element is included in summaries. 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.total.amount This element must be supported. This element is included in summaries. 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.payment 0..1 BackboneElement Payment Details
ClaimResponse.payment.id 0..1 string Unique id for inter-element referencing
ClaimResponse.payment.extension 0..* Extension Additional content defined by implementations
ClaimResponse.payment.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment 0..1 Money Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ClaimResponse.payment.date 0..1 date Expected date of payment
ClaimResponse.payment.amount 1..1 Money Payable amount after adjustment
ClaimResponse.payment.identifier 0..1 Identifier Business identifier for the payment
ClaimResponse.fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
ClaimResponse.form 0..1 Attachment Printed reference or actual form
ClaimResponse.processNote This element must be supported. 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
ClaimResponse.processNote.id 0..1 string Unique id for inter-element referencing
ClaimResponse.processNote.extension 0..* Extension Additional content defined by implementations
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number This element must be supported. 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
ClaimResponse.processNote.type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text This element must be supported. 1..1 string 審核附註的內容
ClaimResponse.processNote.language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
ClaimResponse.insurance 0..* BackboneElement Patient insurance information
ClaimResponse.insurance.id 0..1 string Unique id for inter-element referencing
ClaimResponse.insurance.extension 0..* Extension Additional content defined by implementations
ClaimResponse.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence 1..1 positiveInt Insurance instance identifier
ClaimResponse.insurance.focal 1..1 boolean Coverage to be used for adjudication
ClaimResponse.insurance.coverage 1..1 Reference(Coverage) Insurance information
ClaimResponse.insurance.businessArrangement 0..1 string Additional provider contract number
ClaimResponse.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results
ClaimResponse.error This element must be supported. 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
ClaimResponse.error.id 0..1 string Unique id for inter-element referencing
ClaimResponse.error.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence This element must be supported. 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
ClaimResponse.error.detailSequence 0..1 positiveInt Detail sequence number
ClaimResponse.error.subDetailSequence 0..1 positiveInt Subdetail sequence number
ClaimResponse.error.code This element must be supported. 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

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

Constraints

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

This structure is derived from ClaimResponse

Summary

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

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

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

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:docUrl This element must be supported. 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
ClaimResponse.Slices for extension.extension:auditSummary This element must be supported. 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
ClaimResponse.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
ClaimResponse.Slices for identifier This element must be supported. 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for identifier.identifier:caseNo This element must be supported. 1..1 Identifier 核銷案號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:caseNo.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:caseNo.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no (extensions allowed)
ClaimResponse.Slices for identifier.identifier:caseNo.value This element must be supported. This element is included in summaries. 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:docVer This element must be supported. 0..1 Identifier 總表版次。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:docVer.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:docVer.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver (extensions allowed)
ClaimResponse.Slices for identifier.identifier:docVer.value This element must be supported. This element is included in summaries. 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:accNum This element must be supported. 0..1 Identifier 簽證編號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:accNum.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:accNum.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num (extensions allowed)
ClaimResponse.Slices for identifier.identifier:accNum.value This element must be supported. This element is included in summaries. 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:yyyymm This element must be supported. 0..1 Identifier 支審年月。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:yyyymm.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:yyyymm.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm (extensions allowed)
ClaimResponse.Slices for identifier.identifier:yyyymm.value This element must be supported. This element is included in summaries. 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active (extensions allowed)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }
  ]
}
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim (extensions allowed)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
ClaimResponse.insurer This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
ClaimResponse.requestor This element must be supported. 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition This element must be supported. 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
ClaimResponse.item This element must be supported. 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
ClaimResponse.item.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for extension.extension:recordRef This element must be supported. 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence This element must be supported. 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
ClaimResponse.item.noteNumber This element must be supported. 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
ClaimResponse.item.adjudication This element must be supported. 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.item.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.addItem This element must be supported. 0..* BackboneElement A 碼加成的服務資料
ClaimResponse.addItem.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence This element must be supported. 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
ClaimResponse.addItem.productOrService This element must be supported. 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
ClaimResponse.addItem.adjudication This element must be supported. 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
ClaimResponse.addItem.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.addItem.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement 本分案的各項金額
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category This element must be supported. This element is included in summaries. 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.total.amount This element must be supported. This element is included in summaries. 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.processNote This element must be supported. 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number This element must be supported. 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
ClaimResponse.processNote.text This element must be supported. 1..1 string 審核附註的內容
ClaimResponse.error This element must be supported. 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
ClaimResponse.error.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence This element must be supported. 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
ClaimResponse.error.code This element must be supported. 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

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

Constraints

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

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse ClaimResponse
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:docUrl This element must be supported. 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
ClaimResponse.Slices for extension.extension:auditSummary This element must be supported. 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
ClaimResponse.Slices for identifier This element must be supported. 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for identifier.identifier:caseNo This element must be supported. 1..1 Identifier 核銷案號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:caseNo.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no (extensions allowed)
ClaimResponse.Slices for identifier.identifier:caseNo.value This element must be supported. 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
ClaimResponse.Slices for identifier.identifier:docVer This element must be supported. 0..1 Identifier 總表版次。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:docVer.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver (extensions allowed)
ClaimResponse.Slices for identifier.identifier:docVer.value This element must be supported. 1..1 string 總表版次。[應填入最長 15 個字元的字串]
ClaimResponse.Slices for identifier.identifier:accNum This element must be supported. 0..1 Identifier 簽證編號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:accNum.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num (extensions allowed)
ClaimResponse.Slices for identifier.identifier:accNum.value This element must be supported. 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
ClaimResponse.Slices for identifier.identifier:yyyymm This element must be supported. 0..1 Identifier 支審年月。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:yyyymm.system This element must be supported. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm (extensions allowed)
ClaimResponse.Slices for identifier.identifier:yyyymm.value This element must be supported. 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
ClaimResponse.status This element must be supported. 1..1 code 審核明細的狀態。[應填入 active]
Required Pattern: active (extensions allowed)
ClaimResponse.type This element must be supported. 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }
  ]
}
ClaimResponse.use This element must be supported. 1..1 code 申報單的用途。[應填入 claim]
Required Pattern: claim (extensions allowed)
ClaimResponse.patient This element must be supported. 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
ClaimResponse.created This element must be supported. 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
ClaimResponse.insurer This element must be supported. 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
ClaimResponse.requestor This element must be supported. 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
ClaimResponse.outcome This element must be supported. 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
ClaimResponse.disposition This element must be supported. 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
ClaimResponse.item This element must be supported. 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
ClaimResponse.item.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for extension.extension:recordRef This element must be supported. 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.item.itemSequence This element must be supported. 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
ClaimResponse.item.noteNumber This element must be supported. 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
ClaimResponse.item.adjudication This element must be supported. 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
ClaimResponse.item.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.item.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.addItem This element must be supported. 0..* BackboneElement A 碼加成的服務資料
ClaimResponse.addItem.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.addItem.itemSequence This element must be supported. 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
ClaimResponse.addItem.productOrService This element must be supported. 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
ClaimResponse.addItem.adjudication This element must be supported. 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
ClaimResponse.addItem.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.addItem.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.total This element must be supported. 0..* BackboneElement 本分案的各項金額
ClaimResponse.total.category This element must be supported. 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.total.amount This element must be supported. 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.processNote This element must be supported. 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
ClaimResponse.processNote.number This element must be supported. 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
ClaimResponse.processNote.text This element must be supported. 1..1 string 審核附註的內容
ClaimResponse.error This element must be supported. 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
ClaimResponse.error.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.error.itemSequence This element must be supported. 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
ClaimResponse.error.code This element must be supported. 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

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

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
ClaimResponse.id This element is included in summaries. 0..1 id Logical id of this artifact
ClaimResponse.meta This element is included in summaries. 0..1 Meta Metadata about the resource
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
ClaimResponse.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
ClaimResponse.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained 0..* Resource Contained, inline Resources
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:docUrl This element must be supported. 0..* (Complex) 總表與清冊的下載路徑，如有多份文件，則分別填寫。
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
ClaimResponse.Slices for extension.extension:auditSummary This element must be supported. 0..1 (Complex) 分案的統計資料與承辦人員資訊
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
ClaimResponse.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
ClaimResponse.Slices for identifier This element must be supported. 1..* Identifier 分案資料的識別碼，包含核銷案號、總表版次、簽證編號與支審年月。
Slice: Unordered, Open by value:system

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for identifier.identifier:caseNo This element must be supported. 1..1 Identifier 核銷案號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:caseNo.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:caseNo.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:caseNo.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:caseNo.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:caseNo.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no (extensions allowed)
ClaimResponse.Slices for identifier.identifier:caseNo.value This element must be supported. This element is included in summaries. 1..1 string 核銷案號。[應填入最長 30 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:caseNo.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:caseNo.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.Slices for identifier.identifier:docVer This element must be supported. 0..1 Identifier 總表版次。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:docVer.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:docVer.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:docVer.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:docVer.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:docVer.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver (extensions allowed)
ClaimResponse.Slices for identifier.identifier:docVer.value This element must be supported. This element is included in summaries. 1..1 string 總表版次。[應填入最長 15 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:docVer.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:docVer.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.Slices for identifier.identifier:accNum This element must be supported. 0..1 Identifier 簽證編號。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:accNum.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:accNum.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:accNum.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:accNum.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:accNum.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num (extensions allowed)
ClaimResponse.Slices for identifier.identifier:accNum.value This element must be supported. This element is included in summaries. 1..1 string 簽證編號。[應填入最長 20 個字元的字串]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:accNum.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:accNum.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.Slices for identifier.identifier:yyyymm This element must be supported. 0..1 Identifier 支審年月。[應填入 Identifier]
ClaimResponse.Slices for identifier.identifier:yyyymm.id 0..1 string Unique id for inter-element referencing
ClaimResponse.Slices for identifier.identifier:yyyymm.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ClaimResponse.Slices for identifier.identifier:yyyymm.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.Slices for identifier.identifier:yyyymm.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.Slices for identifier.identifier:yyyymm.system This element must be supported. This element is included in summaries. 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm (extensions allowed)
ClaimResponse.Slices for identifier.identifier:yyyymm.value This element must be supported. This element is included in summaries. 1..1 string 支審年月。[應填入 6 碼西元年月，格式為 yyyyMM]
Example General: 123456
ClaimResponse.Slices for identifier.identifier:yyyymm.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
ClaimResponse.Slices for identifier.identifier:yyyymm.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code 審核明細的狀態。[應填入 active]
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active (extensions allowed)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept 核銷申報的類別。[應填入 professional]
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }
  ]
}
ClaimResponse.subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code 申報單的用途。[應填入 claim]
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim (extensions allowed)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－住民基本資料) 本分案的個案。[應填入對應 Patient 的 Reference]
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime 總表版次的產生時間。[應填入日期時間]
ClaimResponse.insurer This element must be supported. This element is included in summaries. 1..1 Reference(長期照顧－機構) 受理本分案的縣市主管機關。[應填入對應 Organization 的 Reference]
ClaimResponse.requestor This element must be supported. 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出申報的服務提供單位或人員。[應填入對應 Organization、Practitioner 或 PractitionerRole 的 Reference]
ClaimResponse.request This element is included in summaries. 0..1 Reference(Claim) Id of resource triggering adjudication
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition This element must be supported. 0..1 string 承辦人員的審核意見。[應填入最長 4000 個字元的字串]
ClaimResponse.preAuthRef 0..1 string Preauthorization reference
ClaimResponse.preAuthPeriod 0..1 Period Preauthorization reference effective period
ClaimResponse.payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ClaimResponse.item This element must be supported. 0..* BackboneElement 審核通過的服務紀錄，每筆服務紀錄應分別填寫。
ClaimResponse.item.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for extension.extension:recordRef This element must be supported. 1..1 (Complex) 審核通過的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence This element must be supported. 1..1 positiveInt 審核通過的服務紀錄序號。[應依序填入 1、2、3 等整數]
ClaimResponse.item.noteNumber This element must be supported. 0..* positiveInt 審核附註的編號。[應填入 processNote.number 的內容]
ClaimResponse.item.adjudication This element must be supported. 1..* BackboneElement 服務紀錄的核定金額明細，至少應包含單價與自付額。
ClaimResponse.item.adjudication.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension 0..* Extension Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price，自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.item.adjudication.reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.item.adjudication.value 0..1 decimal Non-monetary value
ClaimResponse.item.detail 0..* BackboneElement Adjudication for claim details
ClaimResponse.item.detail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.detail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence 1..1 positiveInt Claim detail instance identifier
ClaimResponse.item.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
ClaimResponse.item.detail.subDetail 0..* BackboneElement Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
ClaimResponse.addItem This element must be supported. 0..* BackboneElement A 碼加成的服務資料
ClaimResponse.addItem.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 加成所對應的服務紀錄識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence This element must be supported. 0..* positiveInt 原申報服務明細的序號。[如需填寫，應填入 1]
ClaimResponse.addItem.detailSequence 0..* positiveInt Detail sequence number
ClaimResponse.addItem.subdetailSequence 0..* positiveInt Subdetail sequence number
ClaimResponse.addItem.provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
ClaimResponse.addItem.productOrService This element must be supported. 1..1 CodeableConcept A 碼加成的給付項目。[應填入最長 10 個字元的代碼，例如 AA05]
Binding: 臺灣長照服務項目 (extensible)
ClaimResponse.addItem.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x] 0..1 Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate date
ClaimResponse.addItem.serviced[x].servicedPeriod Period
ClaimResponse.addItem.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept CodeableConcept
ClaimResponse.addItem.location[x].locationAddress Address
ClaimResponse.addItem.location[x].locationReference Reference(Location)
ClaimResponse.addItem.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
ClaimResponse.addItem.unitPrice 0..1 Money Fee, charge or cost per item
ClaimResponse.addItem.factor 0..1 decimal Price scaling factor
ClaimResponse.addItem.net 0..1 Money Total item cost
ClaimResponse.addItem.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.adjudication This element must be supported. 1..* BackboneElement A 碼加成的金額明細，至少應包含單價。
ClaimResponse.addItem.adjudication.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.adjudication.extension 0..* Extension Additional content defined by implementations
ClaimResponse.addItem.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category This element must be supported. 1..1 CodeableConcept 金額的類別。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.addItem.adjudication.reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.addItem.adjudication.amount This element must be supported. 0..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.addItem.adjudication.value 0..1 decimal Non-monetary value
ClaimResponse.addItem.detail 0..* BackboneElement Insurer added line details
ClaimResponse.addItem.detail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice 0..1 Money Fee, charge or cost per item
ClaimResponse.addItem.detail.factor 0..1 decimal Price scaling factor
ClaimResponse.addItem.detail.net 0..1 Money Total item cost
ClaimResponse.addItem.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.detail.adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
ClaimResponse.addItem.detail.subDetail 0..* BackboneElement Insurer added line items
ClaimResponse.addItem.detail.subDetail.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension 0..* Extension Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor 0..1 decimal Price scaling factor
ClaimResponse.addItem.detail.subDetail.net 0..1 Money Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
ClaimResponse.adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement 本分案的各項金額
ClaimResponse.total.id 0..1 string Unique id for inter-element referencing
ClaimResponse.total.extension 0..* Extension Additional content defined by implementations
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category This element must be supported. This element is included in summaries. 1..1 CodeableConcept 金額的類別，用以區分申請核銷、核定、政策鼓勵、核增、核減與暫付金額。
Binding: 支付審查－核定金額類別 (extensible)
ClaimResponse.total.amount This element must be supported. This element is included in summaries. 1..1 Money 金額的內容。[應填入新臺幣金額，幣別為 TWD]
ClaimResponse.payment 0..1 BackboneElement Payment Details
ClaimResponse.payment.id 0..1 string Unique id for inter-element referencing
ClaimResponse.payment.extension 0..* Extension Additional content defined by implementations
ClaimResponse.payment.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment 0..1 Money Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ClaimResponse.payment.date 0..1 date Expected date of payment
ClaimResponse.payment.amount 1..1 Money Payable amount after adjustment
ClaimResponse.payment.identifier 0..1 Identifier Business identifier for the payment
ClaimResponse.fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
ClaimResponse.form 0..1 Attachment Printed reference or actual form
ClaimResponse.processNote This element must be supported. 0..* BackboneElement 審核結果的附註，例如核增或核減原因。
ClaimResponse.processNote.id 0..1 string Unique id for inter-element referencing
ClaimResponse.processNote.extension 0..* Extension Additional content defined by implementations
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number This element must be supported. 1..1 positiveInt 審核附註的編號。[應填入正整數，供服務紀錄的 noteNumber 引用]
ClaimResponse.processNote.type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text This element must be supported. 1..1 string 審核附註的內容
ClaimResponse.processNote.language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
ClaimResponse.insurance 0..* BackboneElement Patient insurance information
ClaimResponse.insurance.id 0..1 string Unique id for inter-element referencing
ClaimResponse.insurance.extension 0..* Extension Additional content defined by implementations
ClaimResponse.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence 1..1 positiveInt Insurance instance identifier
ClaimResponse.insurance.focal 1..1 boolean Coverage to be used for adjudication
ClaimResponse.insurance.coverage 1..1 Reference(Coverage) Insurance information
ClaimResponse.insurance.businessArrangement 0..1 string Additional provider contract number
ClaimResponse.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results
ClaimResponse.error This element must be supported. 0..* BackboneElement 審核未通過的服務紀錄及錯誤內容
ClaimResponse.error.id 0..1 string Unique id for inter-element referencing
ClaimResponse.error.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.Slices for extension.extension:recordRef This element must be supported. 0..1 (Complex) 錯誤服務紀錄的識別資料
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence This element must be supported. 0..1 positiveInt 錯誤服務紀錄的序號。[應填入正整數]
ClaimResponse.error.detailSequence 0..1 positiveInt Detail sequence number
ClaimResponse.error.subDetailSequence 0..1 positiveInt Subdetail sequence number
ClaimResponse.error.code This element must be supported. 1..1 CodeableConcept 檢核錯誤代碼。[應填入 5 個字元的代碼]
Binding: 支付審查－錯誤代碼 (extensible)

doco Documentation for this format

Terminology Bindings

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

Constraints

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

This structure is derived from ClaimResponse

Summary

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

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

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

 

Other representations of profile: CSV, Excel, Schematron