abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]- Added the item 'null#null'
kindnamepublisherpurposestatustitletypeurlversion- Values Differ
| Left: | 事前審查-Claim TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas) |
| Right: | 事前審查-Claim TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas) |
| Error | StructureDefinition.version | Values for version differ: '1.0.7' vs '1.0.8' |
| Information | StructureDefinition.date | Values for date differ: '2025-08-26T17:59:03+08:00' vs '2025-09-26T06:51:52+00:00' |
| Information | StructureDefinition.jurisdiction | Added the item 'null#null' |
| Information | Claim.meta | Element minimum cardinalities differ: '0' vs '1' |
| Information | Claim.language | Example/preferred bindings differ at Claim.language using binding from ClaimTWPAS |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/Claim | ||
| copyright | |||
| date | 2025-08-26T17:59:03+08:00 | 2025-09-26T06:51:52+00:00 |
|
| description | 此事前審查-Claim TWPAS Profile說明本IG如何進一步定義FHIR的Claim Resource以呈現癌藥事前審查之內容 | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | null#null |
| |
| kind | resource | ||
| name | ClaimTWPAS | ||
| publisher | 衛生福利部中央健康保險署 | ||
| purpose | |||
| status | active | ||
| title | 事前審查-Claim TWPAS | ||
| type | Claim | ||
| url | https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas | ||
| version | 1.0.7 | 1.0.8 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: sequence-1, supportingInfo, applType | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: sequence-1, supportingInfo, applType | |||||||||
 id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
 meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 1..1 | Meta | Metadata about the resource |
| ||||||||
 id | 0..1 | string | Unique id for inter-element referencing |
| |||||||||||||
 Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| |||||||||||||
| versionId | Σ | 0..1 | id | Version specific identifier |
| ||||||||||||
| lastUpdated | Σ | 0..1 | instant | When the resource version last changed |
| ||||||||||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from |
| ||||||||||||
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas |
| ||||||||||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. |
| ||||||||||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". |
| ||||||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
|
| ||||||||||
| 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 | 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 | 0..* | Resource | Contained, inline Resources | |||||||||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 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。 | 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-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | |||||||||
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]} | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]} | |||||||||
| 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) | 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) | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | Σ | 1..1 | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | 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。 | 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 | Σ | 0..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization | |||||||||
| patient | SΣ | 1..1 | Reference(病人資訊-Patient TWPAS) | 病人資訊 | SΣ | 1..1 | Reference(病人資訊-Patient TWPAS) | 病人資訊 | |||||||||
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim | |||||||||
| created | SΣ | 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。 | SΣ | 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) | 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。 | S | 1..1 | Reference(醫事人員-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 | Σ | 0..1 | Reference(Organization) | Target | |||||||||
| provider | SΣ | 1..1 | Reference(醫事機構-Organization TWPAS) | 醫事機構代碼，必須存在於醫事機構基本資料檔內。 | SΣ | 1..1 | Reference(醫事機構-Organization TWPAS) | 醫事機構代碼，必須存在於醫事機構基本資料檔內。 | |||||||||
| priority | SΣ | 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) | SΣ | 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 funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
| related | 0..* | BackboneElement | Prior or corollary claims | 0..* | BackboneElement | Prior or corollary claims | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| claim | 0..1 | Reference(Claim) | Reference to the related claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||||||||
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | |||||||||||
| reference | 0..1 | Identifier | File or case reference | 0..1 | Identifier | File or case reference | |||||||||||
| prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||||||||
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||||||||
| payee | 0..1 | BackboneElement | Recipient of benefits payable | 0..1 | BackboneElement | Recipient of benefits payable | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
| party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||||||||
| referral | 0..1 | Reference(ServiceRequest) | Treatment referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |||||||||||
| facility | 0..1 | Reference(Location) | Servicing facility | 0..1 | Reference(Location) | Servicing facility | |||||||||||
| careTeam | 0..* | BackboneElement | Members of the care team | 0..* | BackboneElement | Members of the care team | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Order of care team | 1..1 | positiveInt | Order of care team | |||||||||||
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||||||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | 0..1 | boolean | Indicator of the lead practitioner | |||||||||||
| role | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. | |||||||||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | |||||||||||
| Slices for supportingInfo | 2..* | BackboneElement | Supporting information Slice: Unordered, Closed by value:category | 2..* | BackboneElement | Supporting information Slice: Unordered, Closed by value:category | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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。 | 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 information Binding: ?? (required) | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (required) | |||||||||||
| code | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | |||||||||||
| timing[x] | 0..1 | date, Period | When it occurred | 0..1 | date, Period | When it occurred | |||||||||||
| value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |||||||||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | |||||||||||
| diagnosis | SC | 1..* | BackboneElement | sequence=1時為主要疾病；sequence>=2代表共病。 Constraints: diagnosis | SC | 1..* | BackboneElement | sequence=1時為主要疾病；sequence>=2代表共病。 Constraints: diagnosis | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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。 | 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) | 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) | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| Slices for coding | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Closed by value:system | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Closed by value:system | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| type | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | 0..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | Σ | 0..* | Coding | Code defined by a terminology system | |||||||||
| text | SΣC | 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 | SΣC | 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 admission Binding: ?? (example): Present on admission. | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | |||||||||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | |||||||||||
| procedure | 0..* | BackboneElement | Clinical procedures performed | 0..* | BackboneElement | Clinical procedures performed | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Procedure instance identifier | 1..1 | positiveInt | Procedure instance identifier | |||||||||||
| type | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | |||||||||||
| date | S | 1..1 | dateTime | 手術(或其他處置)日期 | 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) | 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) | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| Slices for coding | Σ | 1..1 | Coding | Code defined by a terminology system Slice: Unordered, Closed by value:system | Σ | 1..1 | Coding | Code defined by a terminology system Slice: Unordered, Closed by value:system | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| insurance | Σ | 1..* | BackboneElement | Patient insurance information | Σ | 1..* | BackboneElement | Patient insurance information | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 | Σ | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 | |||||||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication | Σ | 1..1 | boolean | Coverage to be used for adjudication | |||||||||
| identifier | 0..1 | Identifier | Pre-assigned Claim number | 0..1 | Identifier | Pre-assigned Claim number | |||||||||||
| coverage | Σ | 1..1 | Reference(健保事前審查計畫-Coverage TWPAS) | Insurance information | Σ | 1..1 | Reference(健保事前審查計畫-Coverage TWPAS) | Insurance information | |||||||||
| businessArrangement | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
| preAuthRef | 0..* | string | Prior authorization reference number | 0..* | string | Prior authorization reference number | |||||||||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
| accident | 0..1 | BackboneElement | Details of the event | 0..1 | BackboneElement | Details of the event | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| date | 1..1 | date | When the incident occurred | 1..1 | date | When the incident occurred | |||||||||||
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | |||||||||||
| location[x] | 0..1 | Address, Reference(Location) | Where the event occurred | 0..1 | Address, Reference(Location) | Where the event occurred | |||||||||||
| item | 1..* | BackboneElement | Product or service provided | 1..* | BackboneElement | Product or service provided | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | 0..* | positiveInt | Applicable careTeam members | |||||||||||
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | 0..* | positiveInt | Applicable diagnoses | |||||||||||
| procedureSequence | 0..* | positiveInt | Applicable procedures | 0..* | positiveInt | Applicable procedures | |||||||||||
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | 0..* | positiveInt | Applicable exception and supporting information | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | S | 1..1 | CodeableConcept | 醫令類別 Binding: ?? (required) | S | 1..1 | CodeableConcept | 醫令類別 Binding: ?? (required) | |||||||||
| Slices for modifier | 1..2 | CodeableConcept | Product or service billing modifiers Slice: Unordered, Closed by value:coding.system Binding: ?? (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. | 1..2 | CodeableConcept | Product or service billing modifiers Slice: Unordered, Closed by value:coding.system Binding: ?? (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 | SC | 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 | SC | 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 | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| 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) | 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。 | 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, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | |||||||||||
| quantity | S | 1..1 | ?? | Count of products or services | S | 1..1 | ?? | Count of products or services | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| value | SΣ | 1..1 | decimal | 事前審查申請數量 | SΣ | 1..1 | decimal | 事前審查申請數量 | |||||||||
| comparator | ?!Σ | 0..0 | ?!Σ | 0..0 | |||||||||||||
| unit | Σ | 0..1 | string | Unit representation | Σ | 0..1 | string | Unit representation | |||||||||
| system | ΣC | 1..1 | uri | 事前審查申請數量單位之代碼系統，固定為「http://unitsofmeasure.org」。 Required Pattern: http://unitsofmeasure.org | ΣC | 1..1 | uri | 事前審查申請數量單位之代碼系統，固定為「http://unitsofmeasure.org」。 Required Pattern: http://unitsofmeasure.org | |||||||||
| code | SΣ | 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。 | SΣ | 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 | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 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) | 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-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||||||||
 detail | 0..* | BackboneElement | Product or service provided | 0..* | BackboneElement | Product or service provided | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| subDetail | 0..* | BackboneElement | Product or service provided | 0..* | BackboneElement | Product or service provided | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| total | 0..1 | Money | Total claim cost | 0..1 | Money | Total claim cost | |||||||||||
| Documentation for this format | |||||||||||||||||