This is the set of resources that conform to both 事前審查-Claim TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas) and 事前審查-Claim TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas).
Name Flags Card. Type Description & Constraints Filter: Bindings
Claim C 0..* Claim, Pre-determination or Pre-authorizationConstraints: sequence-1 , supportingInfo , applType meta Σ 1..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 contentBinding: ?? ( preferred ) : A human language. text 0..1 Narrative Text summary of the resource, for human interpretationThis profile does not constrain the narrative in regard to content, language, or traceability to data elements contained 0..* Resource Contained, inline Resources extension 1..* Extension Extension modifierExtension ?! 0..* Extension Extensions that cannot be ignored identifier S 0..1 Identifier 原受理編號。院所上傳送核(subType = #1)案件時，不需填寫「原受理編號」資訊，受理成功後會由系統自動產生受理編號。當Claim.subType(申報類別)為2(送核補件)、3(申復)、4(爭議審議)或5(申復補件)時，院所才需於Claim.identifier填寫原送核案件之受理編號。 status ?! Σ 1..1 code active | cancelled | draft | entered-in-errorBinding: ?? ( required ) : A code specifying the state of the resource instance. type Σ 1..1 CodeableConcept Category or disciplineBinding: ?? ( extensible ) : The type or discipline-style of the claim. subType S 1..1 CodeableConcept 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。院所上傳送核(subType = #1)案件時，不需填寫「原受理編號」資訊，受理成功後會由系統自動產生受理編號。當Claim.subType(申報類別)為2(送核補件)、3(申復)、4(爭議審議)或5(申復補件)時，院所才需於Claim.identifier填寫原送核案件之受理編號。Binding: ?? ( required ) extension 0..* Extension Additional content defined by implementations coding Σ 1..1 Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 1..1 uri Identity of the terminology system version Σ 0..1 string Version of the system - if relevant code Σ 1..1 code 申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。當申報類別為2(送核補件)、3(申復)、4(爭議審議)、5(申復補件)時，院所才需於Claim.identifier填寫原送核案件之受理編號。 display Σ 0..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user text Σ 0..1 string Plain text representation of the concept use Σ 1..1 code claim | preauthorization | predeterminationBinding: ?? ( required ) : The purpose of the Claim: predetermination, preauthorization, claim. patient S Σ 1..1 Reference (病人資訊-Patient TWPAS | #sd-Patient-twpas-Patient-twpas )病人資訊 billablePeriod Σ 0..1 Period Relevant time frame for the claim created S Σ 1..1 dateTime 申請日期，YYYY-MM-DD，機構自填。健保署收案後另建受理日期，將呈現在ClaimResponse的disposition和created欄位。 enterer S 1..1 Reference (醫事人員-Practitioner TWPAS | #sd-Practitioner-twpas-Practitioner-twpas )申請醫師，必須存在於醫事人員基本資料檔內，並於合約生效起迄日內。 insurer Σ 0..1 Reference (Organization )Target provider S Σ 1..1 Reference (醫事機構-Organization TWPAS | #sd-Organization-twpas-Organization-twpas )醫事機構代碼，必須存在於醫事機構基本資料檔內。 priority S Σ 1..1 CodeableConcept 申請案件類別，1:一般事前審查申請 | 3:自主審查報備 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。Binding: ?? ( required ) fundsReserve 0..1 CodeableConcept For whom to reserve fundsBinding: ?? ( example ) : For whom funds are to be reserved: (Patient, Provider, None). related 0..* BackboneElement Prior or corollary claims extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized claim 0..1 Reference (Claim )Reference to the related claim relationship 0..1 CodeableConcept How the reference claim is relatedBinding: ?? ( example ) : Relationship of this claim to a related Claim. reference 0..1 Identifier File or case reference prescription 0..1 Reference (DeviceRequest | MedicationRequest | VisionPrescription )Prescription authorizing services and products originalPrescription 0..1 Reference (DeviceRequest | MedicationRequest | VisionPrescription )Original prescription if superseded by fulfiller payee 0..1 BackboneElement Recipient of benefits payable extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized type 1..1 CodeableConcept Category of recipientBinding: ?? ( example ) : A code for the party to be reimbursed. party 0..1 Reference (Practitioner | PractitionerRole | Organization | Patient | RelatedPerson )Recipient reference referral 0..1 Reference (ServiceRequest )Treatment referral facility 0..1 Reference (Location )Servicing facility careTeam 0..* BackboneElement Members of the care team extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt Order of care team provider 1..1 Reference (Practitioner | PractitionerRole | Organization )Practitioner or organization responsible 0..1 boolean Indicator of the lead practitioner role 0..1 CodeableConcept Function within the teamBinding: ?? ( example ) : The role codes for the care team members. qualification 0..1 CodeableConcept Practitioner credential or specializationBinding: ?? ( example ) : Provider professional qualifications. supportingInfo 2..* BackboneElement Supporting information extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt 因FHIR設計而必填、自動流水號（建議每次加1）、不得重複，作為每筆supportingInfo的唯一識別碼。最後一筆sequence號碼即表示總筆數。 category 1..1 CodeableConcept Classification of the supplied informationBinding: ?? ( required ) code 0..1 CodeableConcept Type of informationBinding: ?? ( example ) : The valuset used for additional information codes. timing[x] 0..1 When it occurred timingDate date timingPeriod Period value[x] 0..1 Data to be provided valueBoolean boolean valueString string valueQuantity Quantity valueAttachment Attachment Reference (Resource )reason 0..1 CodeableConcept Explanation for the informationBinding: ?? ( example ) : Reason codes for the missing teeth. diagnosis S C 1..* BackboneElement sequence=1時為主要疾病；sequence>=2代表共病。Constraints: diagnosis extension 0..* Extension Extension modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt sequence=1時為主要疾病；sequence>=2代表共病。 diagnosis[x] S 1..1 CodeableConcept 國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。Binding: ?? ( preferred ) extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system text Σ 0..1 string Plain text representation of the concept type 0..1 CodeableConcept Timing or nature of the diagnosisBinding: ?? ( example ) : The type of the diagnosis: admitting, principal, discharge. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system text S Σ C 0..1 string 簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。Constraints: pas-2 onAdmission 0..1 CodeableConcept Present on admissionBinding: ?? ( example ) : Present on admission. packageCode 0..1 CodeableConcept Package billing codeBinding: ?? ( example ) : The DRG codes associated with the diagnosis. procedure 0..* BackboneElement Clinical procedures performed extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt Procedure instance identifier type 0..* CodeableConcept Category of ProcedureBinding: ?? ( example ) : Example procedure type codes. date S 1..1 dateTime 手術(或其他處置)日期 procedure[x] S 1..1 CodeableConcept 手術(或其他處置)項目，經動脈導管肝臟腫瘤化學栓塞術(TACE)及冷凍療法等非屬手術。ICD-10-PCS 或 健保代碼 或 其他。Binding: ?? ( preferred ) extension 0..* Extension Additional content defined by implementations coding Σ 1..1 Coding Code defined by a terminology system text Σ 0..1 string Plain text representation of the concept udi 0..* Reference (Device )Unique device identifier insurance Σ 1..* BackboneElement Patient insurance information extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence Σ 1..1 positiveInt Insurance instance identifier focal Σ 1..1 boolean Coverage to be used for adjudication identifier 0..1 Identifier Pre-assigned Claim number coverage Σ 1..1 Reference (健保事前審查計畫-Coverage TWPAS | #sd-Coverage-twpas-Coverage-twpas )Insurance information businessArrangement 0..1 string Additional provider contract number preAuthRef 0..* string Prior authorization reference number claimResponse 0..1 Reference (ClaimResponse )Adjudication results accident 0..1 BackboneElement Details of the event extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized date 1..1 date When the incident occurred type 0..1 CodeableConcept The nature of the accidentBinding: ?? ( extensible ) : Type of accident: work place, auto, etc. location[x] 0..1 Where the event occurred locationAddress Address Reference (Location )item 1..* BackboneElement Product or service provided extension 1..* Extension Extension modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt Item instance identifier careTeamSequence 0..* positiveInt Applicable careTeam members diagnosisSequence 0..* positiveInt Applicable diagnoses procedureSequence 0..* positiveInt Applicable procedures informationSequence 0..* positiveInt Applicable exception and supporting information revenue 0..1 CodeableConcept Revenue or cost center codeBinding: ?? ( example ) : Codes for the revenue or cost centers supplying the service and/or products. category 0..1 CodeableConcept Benefit classificationBinding: ?? ( example ) : Benefit categories such as: oral-basic, major, glasses. productOrService S 1..1 CodeableConcept 醫令類別Binding: ?? ( required ) modifier 1..2 CodeableConcept Product or service billing modifiersBinding: ?? ( 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 S C 1..1 CodeableConcept 給付適應症條件，藥品給付規定內所規範之適應症或條件，若有特定事前審查品項代碼應以代碼填報。Binding: ?? ( example ) : Program specific reason codes. Constraints: pas-1 extension 0..* Extension Additional content defined by implementations coding Σ 0..1 Coding 給付適應症條件，當事前審查品項代碼為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5、KC01013229、KC01013230、KC01025219、KC01050238、KC01085229、KC00958229、JC00154261、KC01088229時，才可填寫。Binding: ?? ( required ) text Σ 0..1 string 給付適應症條件，事前審查品項代碼不為KC009612B5、KC010892B5、KC011112DE、KC011162B5、KC011362B5、KC01013229、KC01013230、KC01025219、KC01050238、KC01085229、KC00958229、JC00154261、KC01088229時，請自行輸入文字。 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 suppliedBinding: ?? ( example ) : Place of service: pharmacy, school, prison, etc. locationCodeableConcept CodeableConcept locationAddress Address Reference (Location )quantity S 1..1 ?? , ?? Count of products or services extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal 事前審查申請數量 unit Σ 0..1 string Unit representation system Σ 1..1 uri 事前審查申請數量單位之代碼系統，固定為「http://unitsofmeasure.org」。 code S Σ 1..1 code 事前審查申請數量單位Binding: ?? ( required ) : 事前審查申請數量單位的代碼範圍請參考[Common UCUM units]。 unitPrice 0..1 Money Fee, charge or cost per item factor 0..1 decimal Price scaling factor net 0..1 Money Total item cost udi 0..* Reference (Device )Unique device identifier bodySite 0..1 CodeableConcept 申請部位，R:右側 | L:左側 | B:兩側。(此專案暫不檢核，未來待確認)Binding: ?? ( required ) subSite 0..* CodeableConcept Anatomical sub-locationBinding: ?? ( example ) : The code for the tooth surface and surface combinations. encounter 0..* Reference (Encounter )Encounters related to this billed item detail 0..* BackboneElement Product or service provided extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt Item instance identifier revenue 0..1 CodeableConcept Revenue or cost center codeBinding: ?? ( example ) : Codes for the revenue or cost centers supplying the service and/or products. category 0..1 CodeableConcept Benefit classificationBinding: ?? ( example ) : Benefit categories such as: oral-basic, major, glasses. productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. modifier 0..* CodeableConcept Service/Product billing modifiersBinding: ?? ( 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 underBinding: ?? ( example ) : Program specific reason codes. quantity 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 udi 0..* Reference (Device )Unique device identifier subDetail 0..* BackboneElement Product or service provided extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt Item instance identifier revenue 0..1 CodeableConcept Revenue or cost center codeBinding: ?? ( example ) : Codes for the revenue or cost centers supplying the service and/or products. category 0..1 CodeableConcept Benefit classificationBinding: ?? ( example ) : Benefit categories such as: oral-basic, major, glasses. productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. modifier 0..* CodeableConcept Service/Product billing modifiersBinding: ?? ( 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 underBinding: ?? ( example ) : Program specific reason codes. quantity 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 udi 0..* Reference (Device )Unique device identifier total 0..1 Money Total claim cost
Claim 
meta 
implicitRules 
contained 
extension 
modifierExtension 
patient 
timing[x] 
