臺灣長期照顧實作指引(TW LTC IG)
1.0.0 - STU 1.0.0

臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions

Resource Profile: 長照支付審查－分案審核明細

Official URL: http://ltc-ig.fhir.tw/StructureDefinition/LTCClaimResponseFeeAudit Version: 1.0.0
Draft as of 2026-07-29 Computable Name: LTCClaimResponseFeeAudit

此 Profile 說明本 IG 如何進一步定義 FHIR 的 ClaimResponse Resource，以呈現支付審核系統「(查詢B)分案審核明細查詢」（……/appResultQuery，query_type = B）所回覆之單一核銷案號分案審核明細。一份 ClaimResponse 代表一個核銷案號（case_no）之審核結果，內容包含核銷案號、總表版次與版次時間、承辦人員與承辦審核意見、申請核銷金額、核定金額、政策鼓勵金額、核增／核減金額與原因、暫付申請狀態與分案暫付金額、各式總表與清冊下載路徑、審核通過服務記錄（approve_records）、A 碼加成資料區（a_svc_records）以及錯誤服務記錄（err_records）。

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊下載路徑，逐份文件一筆，涵蓋暫付總表（temp_payment_doc_url）、總表（case_summary_notice_url）、清冊（case_svc_list_url）、清冊 EXCEL（case_svc_list_excel_url）、A 碼清冊（case_a_svc_list_url）、A 碼清冊 EXCEL（case_a_svc_list_excel_url）、申請記錄不通過清冊（case_err_list_url）與申請記錄不通過 EXCEL 清冊（case_err_list_excel_url）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案審核統計與承辦資訊：服務記錄筆數（records）、個案數（cases）、核定個案數（approve_case_num）、核定服務記錄數（approve_record_count）、暫付申請狀態（temp_payment_status）、分案已處理之單號（trans_nos）與承辦人員（audit_man）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... identifier:caseNo S 1..1 Identifier 核銷案號（case_no），長度上限 30
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號值
Example General: 123456
.... identifier:docVer S 0..1 Identifier 總表版次（doc_ver），長度上限 15
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次值
Example General: 123456
.... identifier:accNum S 0..1 Identifier 簽證編號（acc_num），長度上限 20
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號值
Example General: 123456
.... identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），格式 yyyyMM，長度 6
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月值，格式 yyyyMM
Example General: 123456
... status ?!SΣ 1..1 code 資源狀態，分案審核明細固定為 active（有效）
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報類別，長照支付審查固定為 professional（專業服務申報）
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use SΣ 1..1 code 申報用途，分案審核明細固定為 claim（費用申報核銷）
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案所對應之服務對象（個案）；FHIR R4 基底 ClaimResponse.patient 為必填 1..1，故本 Profile 無法放寬為 0..1。若一個核銷案號涵蓋多位個案（cases 個案數 > 1），請以代表個案或分案受理之個案填入，實際個案數另以審核通過服務記錄逐筆表達
... created SΣ 1..1 dateTime 版次時間（ver_dt），總表版次之產生時間，原電文格式為 yyyyMMddhhmmss，於本 Profile 以 dateTime 表達
... insurer SΣ 1..1 Reference(長期照顧－機構) 支付審查之保險人／給付機關，即受理本分案之縣市主管機關（city_cd 縣市代碼）
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出本次申報之服務提供方（FHIR R4 定義：The provider which is responsible for the claim）。承辦人員（audit_man）為審查機關之審核承辦人，語意方向相反，不得填於本元素，應以 extension[auditSummary].auditMan 表達。
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦審核意見（audit_reason），長度上限 4000
... item S 0..* BackboneElement 審核通過服務記錄（approve_records），逐筆對應一筆通過審核之服務紀錄。本元素之筆數等於核定服務記錄數（approve_record_count）；服務記錄筆數（records，即本分案申請之總筆數）則須合計本元素與 ClaimResponse.error（err_records）之筆數，另亦得以 extension[auditSummary].records 明示
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 該筆審核通過服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過服務記錄於本資源內之流水序號（1、2、3……）。FHIR R4 此元素之原始語意為指向 ClaimResponse.request 所參照之單一 Claim 內的 item.sequence；惟本模組一份 ClaimResponse 涵蓋多筆各自獨立之服務紀錄申報（LTCClaimFeeApply，其 item.sequence 固定為 1），且未定義 request，故本序號僅供本資源內部引用（例如 addItem 之對照說明），不具跨 Claim 之指向能力。實際服務記錄一律以 extension[recordRef].objid 識別。
.... noteNumber S 0..* positiveInt 指向 ClaimResponse.processNote.number 之編號，用以補充該筆服務記錄之審核附註文字
.... adjudication S 1..* BackboneElement 該筆服務記錄之核定金額明細，至少包含單價（price）與自付額（copayment）
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price；自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... addItem S 0..* BackboneElement A 碼加成資料區（a_svc_records），為審查機關於審核後另行加計之政策鼓勵給付項目，非由服務單位原申報
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 所加成之審核通過服務記錄之識別資訊：識別碼（ref_objid）與來源系統別（ref_source_system）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt FHIR R4 定義為「本服務項目所欲取代之原申請單（Claim）項目序號」。本模組每筆服務紀錄申報（LTCClaimFeeApply）僅一個 item 且 item.sequence 固定為 1，故本元素僅能填 1，不具區辨力。所加成之審核通過服務記錄（ref_objid、ref_source_system）一律以 addItem.extension[recordRef] 識別。
.... productOrService S 1..1 CodeableConcept A 碼加成之給付項目代碼（a_gov_item_cd），長度上限 10，如 AA05
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成之金額明細，至少包含單價（price）
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... total SΣ 0..* BackboneElement 分案層級之各項金額。以 total.category 區分：申請核銷金額（amount，submitted）、核定金額（approve_fee，approveFee）、政策鼓勵金額（a_svc_fee，aSvcFee）、核增金額（inc_in_acc，incInAcc）、核減金額（dec_in_acc，decInAcc）、分案暫付金額（temp_payment_fee，tempPaymentFee，有申請暫付才顯示）
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額類別代碼，用以區分申請核銷金額、核定金額、政策鼓勵金額、核增金額、核減金額與分案暫付金額
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 該類別之金額，幣別為新臺幣（TWD）
... processNote S 0..* BackboneElement 審核附註，用以承載核增原因（inc_in_reason）與核減原因（dec_in_reason）等自由文字說明；亦供 item.noteNumber 或 addItem.noteNumber 引用。統計值、暫付申請狀態、分案已處理之單號與承辦人員請改以 extension[auditSummary] 承載，服務記錄識別碼請改以 extension[recordRef] 承載，以確保可運算性
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 附註編號，供 ClaimResponse.item.noteNumber 或 ClaimResponse.addItem.noteNumber 引用
.... text S 1..1 string 附註內容，如核增原因、核減原因、暫付申請狀態或服務記錄識別資訊
... error S 0..* BackboneElement 錯誤服務記錄（err_records），逐筆對應一筆審核不通過之服務紀錄及其檢核錯誤
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 該筆錯誤服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務記錄於本資源內之流水序號。同 item.itemSequence，本序號不具跨 Claim 之指向能力；實際服務記錄一律以 error.extension[recordRef].objid 識別。
.... code S 1..1 CodeableConcept 檢核錯誤代碼（err_code），長度 5；錯誤原因（err_message，長度上限 200）以 error.code.text 表達
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 📦1.0.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.0.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.0.0 This IG

Constraints

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

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊下載路徑，逐份文件一筆，涵蓋暫付總表（temp_payment_doc_url）、總表（case_summary_notice_url）、清冊（case_svc_list_url）、清冊 EXCEL（case_svc_list_excel_url）、A 碼清冊（case_a_svc_list_url）、A 碼清冊 EXCEL（case_a_svc_list_excel_url）、申請記錄不通過清冊（case_err_list_url）與申請記錄不通過 EXCEL 清冊（case_err_list_excel_url）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案審核統計與承辦資訊：服務記錄筆數（records）、個案數（cases）、核定個案數（approve_case_num）、核定服務記錄數（approve_record_count）、暫付申請狀態（temp_payment_status）、分案已處理之單號（trans_nos）與承辦人員（audit_man）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... Slices for identifier S 1..* Identifier 分案審核明細之業務識別碼，包含核銷案號、總表版次、簽證編號與支審年月
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號（case_no），長度上限 30
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value S 1..1 string 核銷案號值
.... identifier:docVer S 0..1 Identifier 總表版次（doc_ver），長度上限 15
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value S 1..1 string 總表版次值
.... identifier:accNum S 0..1 Identifier 簽證編號（acc_num），長度上限 20
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value S 1..1 string 簽證編號值
.... identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），格式 yyyyMM，長度 6
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value S 1..1 string 支審年月值，格式 yyyyMM
... status S 1..1 code 資源狀態，分案審核明細固定為 active（有效）
Required Pattern: active
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
... use S 1..1 code 申報用途，分案審核明細固定為 claim（費用申報核銷）
Required Pattern: claim
... patient S 1..1 Reference(長期照顧－住民基本資料) 本分案所對應之服務對象（個案）；FHIR R4 基底 ClaimResponse.patient 為必填 1..1，故本 Profile 無法放寬為 0..1。若一個核銷案號涵蓋多位個案（cases 個案數 > 1），請以代表個案或分案受理之個案填入，實際個案數另以審核通過服務記錄逐筆表達
... created S 1..1 dateTime 版次時間（ver_dt），總表版次之產生時間，原電文格式為 yyyyMMddhhmmss，於本 Profile 以 dateTime 表達
... insurer S 1..1 Reference(長期照顧－機構) 支付審查之保險人／給付機關，即受理本分案之縣市主管機關（city_cd 縣市代碼）
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出本次申報之服務提供方（FHIR R4 定義：The provider which is responsible for the claim）。承辦人員（audit_man）為審查機關之審核承辦人，語意方向相反，不得填於本元素，應以 extension[auditSummary].auditMan 表達。
... outcome S 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
... disposition S 0..1 string 承辦審核意見（audit_reason），長度上限 4000
... item S 0..* BackboneElement 審核通過服務記錄（approve_records），逐筆對應一筆通過審核之服務紀錄。本元素之筆數等於核定服務記錄數（approve_record_count）；服務記錄筆數（records，即本分案申請之總筆數）則須合計本元素與 ClaimResponse.error（err_records）之筆數，另亦得以 extension[auditSummary].records 明示
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 該筆審核通過服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 1..1 positiveInt 審核通過服務記錄於本資源內之流水序號（1、2、3……）。FHIR R4 此元素之原始語意為指向 ClaimResponse.request 所參照之單一 Claim 內的 item.sequence；惟本模組一份 ClaimResponse 涵蓋多筆各自獨立之服務紀錄申報（LTCClaimFeeApply，其 item.sequence 固定為 1），且未定義 request，故本序號僅供本資源內部引用（例如 addItem 之對照說明），不具跨 Claim 之指向能力。實際服務記錄一律以 extension[recordRef].objid 識別。
.... noteNumber S 0..* positiveInt 指向 ClaimResponse.processNote.number 之編號，用以補充該筆服務記錄之審核附註文字
.... adjudication S 1..* BackboneElement 該筆服務記錄之核定金額明細，至少包含單價（price）與自付額（copayment）
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price；自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... addItem S 0..* BackboneElement A 碼加成資料區（a_svc_records），為審查機關於審核後另行加計之政策鼓勵給付項目，非由服務單位原申報
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 所加成之審核通過服務記錄之識別資訊：識別碼（ref_objid）與來源系統別（ref_source_system）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..* positiveInt FHIR R4 定義為「本服務項目所欲取代之原申請單（Claim）項目序號」。本模組每筆服務紀錄申報（LTCClaimFeeApply）僅一個 item 且 item.sequence 固定為 1，故本元素僅能填 1，不具區辨力。所加成之審核通過服務記錄（ref_objid、ref_source_system）一律以 addItem.extension[recordRef] 識別。
.... productOrService S 1..1 CodeableConcept A 碼加成之給付項目代碼（a_gov_item_cd），長度上限 10，如 AA05
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成之金額明細，至少包含單價（price）
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... total S 0..* BackboneElement 分案層級之各項金額。以 total.category 區分：申請核銷金額（amount，submitted）、核定金額（approve_fee，approveFee）、政策鼓勵金額（a_svc_fee，aSvcFee）、核增金額（inc_in_acc，incInAcc）、核減金額（dec_in_acc，decInAcc）、分案暫付金額（temp_payment_fee，tempPaymentFee，有申請暫付才顯示）
.... category S 1..1 CodeableConcept 金額類別代碼，用以區分申請核銷金額、核定金額、政策鼓勵金額、核增金額、核減金額與分案暫付金額
Binding: 支付審查－核定金額類別 (extensible)
.... amount S 1..1 Money 該類別之金額，幣別為新臺幣（TWD）
... processNote S 0..* BackboneElement 審核附註，用以承載核增原因（inc_in_reason）與核減原因（dec_in_reason）等自由文字說明；亦供 item.noteNumber 或 addItem.noteNumber 引用。統計值、暫付申請狀態、分案已處理之單號與承辦人員請改以 extension[auditSummary] 承載，服務記錄識別碼請改以 extension[recordRef] 承載，以確保可運算性
.... number S 1..1 positiveInt 附註編號，供 ClaimResponse.item.noteNumber 或 ClaimResponse.addItem.noteNumber 引用
.... text S 1..1 string 附註內容，如核增原因、核減原因、暫付申請狀態或服務記錄識別資訊
... error S 0..* BackboneElement 錯誤服務記錄（err_records），逐筆對應一筆審核不通過之服務紀錄及其檢核錯誤
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 該筆錯誤服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..1 positiveInt 錯誤服務記錄於本資源內之流水序號。同 item.itemSequence，本序號不具跨 Claim 之指向能力；實際服務記錄一律以 error.extension[recordRef].objid 識別。
.... code S 1..1 CodeableConcept 檢核錯誤代碼（err_code），長度 5；錯誤原因（err_message，長度上限 200）以 error.code.text 表達
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 📦1.0.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.0.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.0.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊下載路徑，逐份文件一筆，涵蓋暫付總表（temp_payment_doc_url）、總表（case_summary_notice_url）、清冊（case_svc_list_url）、清冊 EXCEL（case_svc_list_excel_url）、A 碼清冊（case_a_svc_list_url）、A 碼清冊 EXCEL（case_a_svc_list_excel_url）、申請記錄不通過清冊（case_err_list_url）與申請記錄不通過 EXCEL 清冊（case_err_list_excel_url）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案審核統計與承辦資訊：服務記錄筆數（records）、個案數（cases）、核定個案數（approve_case_num）、核定服務記錄數（approve_record_count）、暫付申請狀態（temp_payment_status）、分案已處理之單號（trans_nos）與承辦人員（audit_man）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier 分案審核明細之業務識別碼，包含核銷案號、總表版次、簽證編號與支審年月
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號（case_no），長度上限 30
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號值
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:docVer S 0..1 Identifier 總表版次（doc_ver），長度上限 15
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次值
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:accNum S 0..1 Identifier 簽證編號（acc_num），長度上限 20
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號值
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），格式 yyyyMM，長度 6
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月值，格式 yyyyMM
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code 資源狀態，分案審核明細固定為 active（有效）
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報類別，長照支付審查固定為 professional（專業服務申報）
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code 申報用途，分案審核明細固定為 claim（費用申報核銷）
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案所對應之服務對象（個案）；FHIR R4 基底 ClaimResponse.patient 為必填 1..1，故本 Profile 無法放寬為 0..1。若一個核銷案號涵蓋多位個案（cases 個案數 > 1），請以代表個案或分案受理之個案填入，實際個案數另以審核通過服務記錄逐筆表達
... created SΣ 1..1 dateTime 版次時間（ver_dt），總表版次之產生時間，原電文格式為 yyyyMMddhhmmss，於本 Profile 以 dateTime 表達
... insurer SΣ 1..1 Reference(長期照顧－機構) 支付審查之保險人／給付機關，即受理本分案之縣市主管機關（city_cd 縣市代碼）
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出本次申報之服務提供方（FHIR R4 定義：The provider which is responsible for the claim）。承辦人員（audit_man）為審查機關之審核承辦人，語意方向相反，不得填於本元素，應以 extension[auditSummary].auditMan 表達。
... request Σ 0..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦審核意見（audit_reason），長度上限 4000
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement 審核通過服務記錄（approve_records），逐筆對應一筆通過審核之服務紀錄。本元素之筆數等於核定服務記錄數（approve_record_count）；服務記錄筆數（records，即本分案申請之總筆數）則須合計本元素與 ClaimResponse.error（err_records）之筆數，另亦得以 extension[auditSummary].records 明示
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 該筆審核通過服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過服務記錄於本資源內之流水序號（1、2、3……）。FHIR R4 此元素之原始語意為指向 ClaimResponse.request 所參照之單一 Claim 內的 item.sequence；惟本模組一份 ClaimResponse 涵蓋多筆各自獨立之服務紀錄申報（LTCClaimFeeApply，其 item.sequence 固定為 1），且未定義 request，故本序號僅供本資源內部引用（例如 addItem 之對照說明），不具跨 Claim 之指向能力。實際服務記錄一律以 extension[recordRef].objid 識別。
.... noteNumber S 0..* positiveInt 指向 ClaimResponse.processNote.number 之編號，用以補充該筆服務記錄之審核附註文字
.... adjudication S 1..* BackboneElement 該筆服務記錄之核定金額明細，至少包含單價（price）與自付額（copayment）
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price；自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement A 碼加成資料區（a_svc_records），為審查機關於審核後另行加計之政策鼓勵給付項目，非由服務單位原申報
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 所加成之審核通過服務記錄之識別資訊：識別碼（ref_objid）與來源系統別（ref_source_system）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt FHIR R4 定義為「本服務項目所欲取代之原申請單（Claim）項目序號」。本模組每筆服務紀錄申報（LTCClaimFeeApply）僅一個 item 且 item.sequence 固定為 1，故本元素僅能填 1，不具區辨力。所加成之審核通過服務記錄（ref_objid、ref_source_system）一律以 addItem.extension[recordRef] 識別。
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... productOrService S 1..1 CodeableConcept A 碼加成之給付項目代碼（a_gov_item_cd），長度上限 10，如 AA05
Binding: 臺灣長照服務項目 (extensible)
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication S 1..* BackboneElement A 碼加成之金額明細，至少包含單價（price）
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement 分案層級之各項金額。以 total.category 區分：申請核銷金額（amount，submitted）、核定金額（approve_fee，approveFee）、政策鼓勵金額（a_svc_fee，aSvcFee）、核增金額（inc_in_acc，incInAcc）、核減金額（dec_in_acc，decInAcc）、分案暫付金額（temp_payment_fee，tempPaymentFee，有申請暫付才顯示）
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額類別代碼，用以區分申請核銷金額、核定金額、政策鼓勵金額、核增金額、核減金額與分案暫付金額
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 該類別之金額，幣別為新臺幣（TWD）
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement 審核附註，用以承載核增原因（inc_in_reason）與核減原因（dec_in_reason）等自由文字說明；亦供 item.noteNumber 或 addItem.noteNumber 引用。統計值、暫付申請狀態、分案已處理之單號與承辦人員請改以 extension[auditSummary] 承載，服務記錄識別碼請改以 extension[recordRef] 承載，以確保可運算性
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 附註編號，供 ClaimResponse.item.noteNumber 或 ClaimResponse.addItem.noteNumber 引用
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string 附註內容，如核增原因、核減原因、暫付申請狀態或服務記錄識別資訊
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement 錯誤服務記錄（err_records），逐筆對應一筆審核不通過之服務紀錄及其檢核錯誤
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 該筆錯誤服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務記錄於本資源內之流水序號。同 item.itemSequence，本序號不具跨 Claim 之指向能力；實際服務記錄一律以 error.extension[recordRef].objid 識別。
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept 檢核錯誤代碼（err_code），長度 5；錯誤原因（err_message，長度上限 200）以 error.code.text 表達
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 📦1.0.0 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 📦1.0.0 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 📦1.0.0 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 📦1.0.0 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 📦1.0.0 This IG

Constraints

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

This structure is derived from ClaimResponse

Summary

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

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

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

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊下載路徑，逐份文件一筆，涵蓋暫付總表（temp_payment_doc_url）、總表（case_summary_notice_url）、清冊（case_svc_list_url）、清冊 EXCEL（case_svc_list_excel_url）、A 碼清冊（case_a_svc_list_url）、A 碼清冊 EXCEL（case_a_svc_list_excel_url）、申請記錄不通過清冊（case_err_list_url）與申請記錄不通過 EXCEL 清冊（case_err_list_excel_url）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案審核統計與承辦資訊：服務記錄筆數（records）、個案數（cases）、核定個案數（approve_case_num）、核定服務記錄數（approve_record_count）、暫付申請狀態（temp_payment_status）、分案已處理之單號（trans_nos）與承辦人員（audit_man）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... identifier:caseNo S 1..1 Identifier 核銷案號（case_no），長度上限 30
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號值
Example General: 123456
.... identifier:docVer S 0..1 Identifier 總表版次（doc_ver），長度上限 15
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次值
Example General: 123456
.... identifier:accNum S 0..1 Identifier 簽證編號（acc_num），長度上限 20
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號值
Example General: 123456
.... identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），格式 yyyyMM，長度 6
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月值，格式 yyyyMM
Example General: 123456
... status ?!SΣ 1..1 code 資源狀態，分案審核明細固定為 active（有效）
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報類別，長照支付審查固定為 professional（專業服務申報）
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use SΣ 1..1 code 申報用途，分案審核明細固定為 claim（費用申報核銷）
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案所對應之服務對象（個案）；FHIR R4 基底 ClaimResponse.patient 為必填 1..1，故本 Profile 無法放寬為 0..1。若一個核銷案號涵蓋多位個案（cases 個案數 > 1），請以代表個案或分案受理之個案填入，實際個案數另以審核通過服務記錄逐筆表達
... created SΣ 1..1 dateTime 版次時間（ver_dt），總表版次之產生時間，原電文格式為 yyyyMMddhhmmss，於本 Profile 以 dateTime 表達
... insurer SΣ 1..1 Reference(長期照顧－機構) 支付審查之保險人／給付機關，即受理本分案之縣市主管機關（city_cd 縣市代碼）
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出本次申報之服務提供方（FHIR R4 定義：The provider which is responsible for the claim）。承辦人員（audit_man）為審查機關之審核承辦人，語意方向相反，不得填於本元素，應以 extension[auditSummary].auditMan 表達。
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦審核意見（audit_reason），長度上限 4000
... item S 0..* BackboneElement 審核通過服務記錄（approve_records），逐筆對應一筆通過審核之服務紀錄。本元素之筆數等於核定服務記錄數（approve_record_count）；服務記錄筆數（records，即本分案申請之總筆數）則須合計本元素與 ClaimResponse.error（err_records）之筆數，另亦得以 extension[auditSummary].records 明示
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 該筆審核通過服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過服務記錄於本資源內之流水序號（1、2、3……）。FHIR R4 此元素之原始語意為指向 ClaimResponse.request 所參照之單一 Claim 內的 item.sequence；惟本模組一份 ClaimResponse 涵蓋多筆各自獨立之服務紀錄申報（LTCClaimFeeApply，其 item.sequence 固定為 1），且未定義 request，故本序號僅供本資源內部引用（例如 addItem 之對照說明），不具跨 Claim 之指向能力。實際服務記錄一律以 extension[recordRef].objid 識別。
.... noteNumber S 0..* positiveInt 指向 ClaimResponse.processNote.number 之編號，用以補充該筆服務記錄之審核附註文字
.... adjudication S 1..* BackboneElement 該筆服務記錄之核定金額明細，至少包含單價（price）與自付額（copayment）
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price；自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... addItem S 0..* BackboneElement A 碼加成資料區（a_svc_records），為審查機關於審核後另行加計之政策鼓勵給付項目，非由服務單位原申報
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 所加成之審核通過服務記錄之識別資訊：識別碼（ref_objid）與來源系統別（ref_source_system）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt FHIR R4 定義為「本服務項目所欲取代之原申請單（Claim）項目序號」。本模組每筆服務紀錄申報（LTCClaimFeeApply）僅一個 item 且 item.sequence 固定為 1，故本元素僅能填 1，不具區辨力。所加成之審核通過服務記錄（ref_objid、ref_source_system）一律以 addItem.extension[recordRef] 識別。
.... productOrService S 1..1 CodeableConcept A 碼加成之給付項目代碼（a_gov_item_cd），長度上限 10，如 AA05
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成之金額明細，至少包含單價（price）
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... total SΣ 0..* BackboneElement 分案層級之各項金額。以 total.category 區分：申請核銷金額（amount，submitted）、核定金額（approve_fee，approveFee）、政策鼓勵金額（a_svc_fee，aSvcFee）、核增金額（inc_in_acc，incInAcc）、核減金額（dec_in_acc，decInAcc）、分案暫付金額（temp_payment_fee，tempPaymentFee，有申請暫付才顯示）
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額類別代碼，用以區分申請核銷金額、核定金額、政策鼓勵金額、核增金額、核減金額與分案暫付金額
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 該類別之金額，幣別為新臺幣（TWD）
... processNote S 0..* BackboneElement 審核附註，用以承載核增原因（inc_in_reason）與核減原因（dec_in_reason）等自由文字說明；亦供 item.noteNumber 或 addItem.noteNumber 引用。統計值、暫付申請狀態、分案已處理之單號與承辦人員請改以 extension[auditSummary] 承載，服務記錄識別碼請改以 extension[recordRef] 承載，以確保可運算性
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 附註編號，供 ClaimResponse.item.noteNumber 或 ClaimResponse.addItem.noteNumber 引用
.... text S 1..1 string 附註內容，如核增原因、核減原因、暫付申請狀態或服務記錄識別資訊
... error S 0..* BackboneElement 錯誤服務記錄（err_records），逐筆對應一筆審核不通過之服務紀錄及其檢核錯誤
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 該筆錯誤服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務記錄於本資源內之流水序號。同 item.itemSequence，本序號不具跨 Claim 之指向能力；實際服務記錄一律以 error.extension[recordRef].objid 識別。
.... code S 1..1 CodeableConcept 檢核錯誤代碼（err_code），長度 5；錯誤原因（err_message，長度上限 200）以 error.code.text 表達
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 📦1.0.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.0.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.0.0 This IG

Constraints

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

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊下載路徑，逐份文件一筆，涵蓋暫付總表（temp_payment_doc_url）、總表（case_summary_notice_url）、清冊（case_svc_list_url）、清冊 EXCEL（case_svc_list_excel_url）、A 碼清冊（case_a_svc_list_url）、A 碼清冊 EXCEL（case_a_svc_list_excel_url）、申請記錄不通過清冊（case_err_list_url）與申請記錄不通過 EXCEL 清冊（case_err_list_excel_url）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案審核統計與承辦資訊：服務記錄筆數（records）、個案數（cases）、核定個案數（approve_case_num）、核定服務記錄數（approve_record_count）、暫付申請狀態（temp_payment_status）、分案已處理之單號（trans_nos）與承辦人員（audit_man）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... Slices for identifier S 1..* Identifier 分案審核明細之業務識別碼，包含核銷案號、總表版次、簽證編號與支審年月
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號（case_no），長度上限 30
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value S 1..1 string 核銷案號值
.... identifier:docVer S 0..1 Identifier 總表版次（doc_ver），長度上限 15
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value S 1..1 string 總表版次值
.... identifier:accNum S 0..1 Identifier 簽證編號（acc_num），長度上限 20
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value S 1..1 string 簽證編號值
.... identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），格式 yyyyMM，長度 6
..... system S 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value S 1..1 string 支審年月值，格式 yyyyMM
... status S 1..1 code 資源狀態，分案審核明細固定為 active（有效）
Required Pattern: active
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
... use S 1..1 code 申報用途，分案審核明細固定為 claim（費用申報核銷）
Required Pattern: claim
... patient S 1..1 Reference(長期照顧－住民基本資料) 本分案所對應之服務對象（個案）；FHIR R4 基底 ClaimResponse.patient 為必填 1..1，故本 Profile 無法放寬為 0..1。若一個核銷案號涵蓋多位個案（cases 個案數 > 1），請以代表個案或分案受理之個案填入，實際個案數另以審核通過服務記錄逐筆表達
... created S 1..1 dateTime 版次時間（ver_dt），總表版次之產生時間，原電文格式為 yyyyMMddhhmmss，於本 Profile 以 dateTime 表達
... insurer S 1..1 Reference(長期照顧－機構) 支付審查之保險人／給付機關，即受理本分案之縣市主管機關（city_cd 縣市代碼）
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出本次申報之服務提供方（FHIR R4 定義：The provider which is responsible for the claim）。承辦人員（audit_man）為審查機關之審核承辦人，語意方向相反，不得填於本元素，應以 extension[auditSummary].auditMan 表達。
... outcome S 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
... disposition S 0..1 string 承辦審核意見（audit_reason），長度上限 4000
... item S 0..* BackboneElement 審核通過服務記錄（approve_records），逐筆對應一筆通過審核之服務紀錄。本元素之筆數等於核定服務記錄數（approve_record_count）；服務記錄筆數（records，即本分案申請之總筆數）則須合計本元素與 ClaimResponse.error（err_records）之筆數，另亦得以 extension[auditSummary].records 明示
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 該筆審核通過服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 1..1 positiveInt 審核通過服務記錄於本資源內之流水序號（1、2、3……）。FHIR R4 此元素之原始語意為指向 ClaimResponse.request 所參照之單一 Claim 內的 item.sequence；惟本模組一份 ClaimResponse 涵蓋多筆各自獨立之服務紀錄申報（LTCClaimFeeApply，其 item.sequence 固定為 1），且未定義 request，故本序號僅供本資源內部引用（例如 addItem 之對照說明），不具跨 Claim 之指向能力。實際服務記錄一律以 extension[recordRef].objid 識別。
.... noteNumber S 0..* positiveInt 指向 ClaimResponse.processNote.number 之編號，用以補充該筆服務記錄之審核附註文字
.... adjudication S 1..* BackboneElement 該筆服務記錄之核定金額明細，至少包含單價（price）與自付額（copayment）
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price；自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... addItem S 0..* BackboneElement A 碼加成資料區（a_svc_records），為審查機關於審核後另行加計之政策鼓勵給付項目，非由服務單位原申報
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 所加成之審核通過服務記錄之識別資訊：識別碼（ref_objid）與來源系統別（ref_source_system）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..* positiveInt FHIR R4 定義為「本服務項目所欲取代之原申請單（Claim）項目序號」。本模組每筆服務紀錄申報（LTCClaimFeeApply）僅一個 item 且 item.sequence 固定為 1，故本元素僅能填 1，不具區辨力。所加成之審核通過服務記錄（ref_objid、ref_source_system）一律以 addItem.extension[recordRef] 識別。
.... productOrService S 1..1 CodeableConcept A 碼加成之給付項目代碼（a_gov_item_cd），長度上限 10，如 AA05
Binding: 臺灣長照服務項目 (extensible)
.... adjudication S 1..* BackboneElement A 碼加成之金額明細，至少包含單價（price）
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
... total S 0..* BackboneElement 分案層級之各項金額。以 total.category 區分：申請核銷金額（amount，submitted）、核定金額（approve_fee，approveFee）、政策鼓勵金額（a_svc_fee，aSvcFee）、核增金額（inc_in_acc，incInAcc）、核減金額（dec_in_acc，decInAcc）、分案暫付金額（temp_payment_fee，tempPaymentFee，有申請暫付才顯示）
.... category S 1..1 CodeableConcept 金額類別代碼，用以區分申請核銷金額、核定金額、政策鼓勵金額、核增金額、核減金額與分案暫付金額
Binding: 支付審查－核定金額類別 (extensible)
.... amount S 1..1 Money 該類別之金額，幣別為新臺幣（TWD）
... processNote S 0..* BackboneElement 審核附註，用以承載核增原因（inc_in_reason）與核減原因（dec_in_reason）等自由文字說明；亦供 item.noteNumber 或 addItem.noteNumber 引用。統計值、暫付申請狀態、分案已處理之單號與承辦人員請改以 extension[auditSummary] 承載，服務記錄識別碼請改以 extension[recordRef] 承載，以確保可運算性
.... number S 1..1 positiveInt 附註編號，供 ClaimResponse.item.noteNumber 或 ClaimResponse.addItem.noteNumber 引用
.... text S 1..1 string 附註內容，如核增原因、核減原因、暫付申請狀態或服務記錄識別資訊
... error S 0..* BackboneElement 錯誤服務記錄（err_records），逐筆對應一筆審核不通過之服務紀錄及其檢核錯誤
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 該筆錯誤服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... itemSequence S 0..1 positiveInt 錯誤服務記錄於本資源內之流水序號。同 item.itemSequence，本序號不具跨 Claim 之指向能力；實際服務記錄一律以 error.extension[recordRef].objid 識別。
.... code S 1..1 CodeableConcept 檢核錯誤代碼（err_code），長度 5；錯誤原因（err_message，長度上限 200）以 error.code.text 表達
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 📦1.0.0 This IG
ClaimResponse.addItem.​productOrService Base extensible 臺灣長照服務項目 📦1.0.0 This IG
ClaimResponse.addItem.​adjudication.category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.total.​category Base extensible 支付審查－核定金額類別 📦1.0.0 This IG
ClaimResponse.error.​code Base extensible 支付審查－錯誤代碼 📦1.0.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:docUrl S 0..* (Complex) 總表與清冊下載路徑，逐份文件一筆，涵蓋暫付總表（temp_payment_doc_url）、總表（case_summary_notice_url）、清冊（case_svc_list_url）、清冊 EXCEL（case_svc_list_excel_url）、A 碼清冊（case_a_svc_list_url）、A 碼清冊 EXCEL（case_a_svc_list_excel_url）、申請記錄不通過清冊（case_err_list_url）與申請記錄不通過 EXCEL 清冊（case_err_list_excel_url）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-DocUrl
.... extension:auditSummary S 0..1 (Complex) 分案審核統計與承辦資訊：服務記錄筆數（records）、個案數（cases）、核定個案數（approve_case_num）、核定服務記錄數（approve_record_count）、暫付申請狀態（temp_payment_status）、分案已處理之單號（trans_nos）與承辦人員（audit_man）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-AuditSummary
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier 分案審核明細之業務識別碼，包含核銷案號、總表版次、簽證編號與支審年月
Slice: Unordered, Open by value:system
.... identifier:caseNo S 1..1 Identifier 核銷案號（case_no），長度上限 30
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/case-no
..... value SΣ 1..1 string 核銷案號值
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:docVer S 0..1 Identifier 總表版次（doc_ver），長度上限 15
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/doc-ver
..... value SΣ 1..1 string 總表版次值
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:accNum S 0..1 Identifier 簽證編號（acc_num），長度上限 20
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/acc-num
..... value SΣ 1..1 string 簽證編號值
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:yyyymm S 0..1 Identifier 支審年月（writeoff_yyyymm），格式 yyyyMM，長度 6
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system SΣ 1..1 uri The namespace for the identifier value
Required Pattern: http://ltc-ig.fhir.tw/identifier/feeaudit/yyyymm
..... value SΣ 1..1 string 支審年月值，格式 yyyyMM
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code 資源狀態，分案審核明細固定為 active（有效）
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept 核銷申報類別，長照支付審查固定為 professional（專業服務申報）
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: professional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code 申報用途，分案審核明細固定為 claim（費用申報核銷）
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: claim
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) 本分案所對應之服務對象（個案）；FHIR R4 基底 ClaimResponse.patient 為必填 1..1，故本 Profile 無法放寬為 0..1。若一個核銷案號涵蓋多位個案（cases 個案數 > 1），請以代表個案或分案受理之個案填入，實際個案數另以審核通過服務記錄逐筆表達
... created SΣ 1..1 dateTime 版次時間（ver_dt），總表版次之產生時間，原電文格式為 yyyyMMddhhmmss，於本 Profile 以 dateTime 表達
... insurer SΣ 1..1 Reference(長期照顧－機構) 支付審查之保險人／給付機關，即受理本分案之縣市主管機關（city_cd 縣市代碼）
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) 提出本次申報之服務提供方（FHIR R4 定義：The provider which is responsible for the claim）。承辦人員（audit_man）為審查機關之審核承辦人，語意方向相反，不得填於本元素，應以 extension[auditSummary].auditMan 表達。
... request Σ 0..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code 審核處理結果。[應填入以下字串之一：queued | complete | error | partial]
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string 承辦審核意見（audit_reason），長度上限 4000
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement 審核通過服務記錄（approve_records），逐筆對應一筆通過審核之服務紀錄。本元素之筆數等於核定服務記錄數（approve_record_count）；服務記錄筆數（records，即本分案申請之總筆數）則須合計本元素與 ClaimResponse.error（err_records）之筆數，另亦得以 extension[auditSummary].records 明示
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 1..1 (Complex) 該筆審核通過服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt 審核通過服務記錄於本資源內之流水序號（1、2、3……）。FHIR R4 此元素之原始語意為指向 ClaimResponse.request 所參照之單一 Claim 內的 item.sequence；惟本模組一份 ClaimResponse 涵蓋多筆各自獨立之服務紀錄申報（LTCClaimFeeApply，其 item.sequence 固定為 1），且未定義 request，故本序號僅供本資源內部引用（例如 addItem 之對照說明），不具跨 Claim 之指向能力。實際服務記錄一律以 extension[recordRef].objid 識別。
.... noteNumber S 0..* positiveInt 指向 ClaimResponse.processNote.number 之編號，用以補充該筆服務記錄之審核附註文字
.... adjudication S 1..* BackboneElement 該筆服務記錄之核定金額明細，至少包含單價（price）與自付額（copayment）
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price；自付額填入 copayment]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement A 碼加成資料區（a_svc_records），為審查機關於審核後另行加計之政策鼓勵給付項目，非由服務單位原申報
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 所加成之審核通過服務記錄之識別資訊：識別碼（ref_objid）與來源系統別（ref_source_system）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..* positiveInt FHIR R4 定義為「本服務項目所欲取代之原申請單（Claim）項目序號」。本模組每筆服務紀錄申報（LTCClaimFeeApply）僅一個 item 且 item.sequence 固定為 1，故本元素僅能填 1，不具區辨力。所加成之審核通過服務記錄（ref_objid、ref_source_system）一律以 addItem.extension[recordRef] 識別。
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... productOrService S 1..1 CodeableConcept A 碼加成之給付項目代碼（a_gov_item_cd），長度上限 10，如 AA05
Binding: 臺灣長照服務項目 (extensible)
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication S 1..* BackboneElement A 碼加成之金額明細，至少包含單價（price）
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept 金額類別代碼。[單價填入 price]
Binding: 支付審查－核定金額類別 (extensible)
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 0..1 Money 該類別之金額，幣別為新臺幣（TWD）
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement 分案層級之各項金額。以 total.category 區分：申請核銷金額（amount，submitted）、核定金額（approve_fee，approveFee）、政策鼓勵金額（a_svc_fee，aSvcFee）、核增金額（inc_in_acc，incInAcc）、核減金額（dec_in_acc，decInAcc）、分案暫付金額（temp_payment_fee，tempPaymentFee，有申請暫付才顯示）
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept 金額類別代碼，用以區分申請核銷金額、核定金額、政策鼓勵金額、核增金額、核減金額與分案暫付金額
Binding: 支付審查－核定金額類別 (extensible)
.... amount SΣ 1..1 Money 該類別之金額，幣別為新臺幣（TWD）
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement 審核附註，用以承載核增原因（inc_in_reason）與核減原因（dec_in_reason）等自由文字說明；亦供 item.noteNumber 或 addItem.noteNumber 引用。統計值、暫付申請狀態、分案已處理之單號與承辦人員請改以 extension[auditSummary] 承載，服務記錄識別碼請改以 extension[recordRef] 承載，以確保可運算性
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt 附註編號，供 ClaimResponse.item.noteNumber 或 ClaimResponse.addItem.noteNumber 引用
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string 附註內容，如核增原因、核減原因、暫付申請狀態或服務記錄識別資訊
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement 錯誤服務記錄（err_records），逐筆對應一筆審核不通過之服務紀錄及其檢核錯誤
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:recordRef S 0..1 (Complex) 該筆錯誤服務記錄之識別資訊：識別碼（objid）、來源系統別（source_system）與交易序號（trans_no）
URL: http://ltc-ig.fhir.tw/StructureDefinition/Ext-TW-LTC-FeeAudit-RecordRef
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 0..1 positiveInt 錯誤服務記錄於本資源內之流水序號。同 item.itemSequence，本序號不具跨 Claim 之指向能力；實際服務記錄一律以 error.extension[recordRef].objid 識別。
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept 檢核錯誤代碼（err_code），長度 5；錯誤原因（err_message，長度上限 200）以 error.code.text 表達
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 📦1.0.0 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 📦1.0.0 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 📦1.0.0 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 📦1.0.0 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 📦1.0.0 This IG

Constraints

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

This structure is derived from ClaimResponse

Summary

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

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

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

 

Other representations of profile: CSV, Excel, Schematron