This is the set of resources that conform to both 自主審查報備-ClaimResponse Self Assessment TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas) and 自主審查報備-ClaimResponse Self Assessment TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas).
Name Flags Card. Type Description & Constraints Filter: Bindings
ClaimResponse 0..* Response to a claim predetermination or preauthorization 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 0..* Extension Additional content defined by implementations modifierExtension ?! 0..* Extension Extensions that cannot be ignored identifier 0..* Identifier Business Identifier for a claim response 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 More granular claim typeBinding: ?? ( extensible ) : The type or discipline-style of the claim. subType 0..1 CodeableConcept More granular claim typeBinding: ?? ( example ) : A more granular claim typecode. use Σ 1..1 code claim | preauthorization | predeterminationBinding: ?? ( required ) : Claim, preauthorization, predetermination. patient Σ 1..1 Reference (病人資訊-Patient TWPAS | #sd-Patient-twpas-Patient-twpas )The recipient of the products and services created S Σ 1..1 dateTime 核定日期。若申請案件類別為3時須填寫。YYYY-MM-DD，西元年月日。 insurer Σ 1..1 Reference (TW Core Organization Government )Party responsible for reimbursement requestor 0..1 Reference (Practitioner | PractitionerRole | Organization )Party responsible for the claim request Σ 0..1 Reference (Claim )Id of resource triggering adjudication outcome Σ 1..1 code queued | complete | error | partialBinding: ?? ( required ) : The result of the claim processing. disposition 0..1 string Disposition Message preAuthRef 0..1 string Preauthorization reference preAuthPeriod 0..1 Period Preauthorization reference effective period payeeType 0..1 CodeableConcept Party to be paid any benefits payableBinding: ?? ( example ) : A code for the party to be reimbursed. item 0..* BackboneElement Adjudication for claim line items extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized itemSequence 1..1 positiveInt Claim item instance identifier noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* BackboneElement Adjudication details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason S 1..1 CodeableConcept 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) amount 0..1 Money Monetary amount value S 1..1 decimal 核定數量，若申請案件類別為3時須填寫。 detail 0..* BackboneElement Adjudication for claim details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized detailSequence 1..1 positiveInt 請填寫對應的Claim.item.sequence noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* BackboneElement Detail level adjudication details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason 1..1 CodeableConcept 個別醫令核定註記。0:審核中 | 1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 | 6:不予同意:對應手術亦不支付 | 7:改核:如審查核定意見Binding: ?? ( required ) amount 0..1 Money Monetary amount value 0..1 decimal Non-monetary value subDetail 0..* BackboneElement Adjudication for claim sub-details 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..* Subdetail level adjudication details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted display Σ 0..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason S 1..1 CodeableConcept 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) amount 0..1 Money Monetary amount value S 1..1 decimal 核定數量，若申請案件類別為3時須填寫。 addItem 0..* BackboneElement Insurer added line items extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized itemSequence 0..* positiveInt Item sequence number detailSequence 0..* positiveInt Detail sequence number subdetailSequence 0..* positiveInt Subdetail sequence number provider 0..* Reference (Practitioner | PractitionerRole | Organization )Authorized providers 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. 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 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 locationBinding: ?? ( example ) : The code for the teeth, quadrant, sextant and arch. subSite 0..* CodeableConcept Anatomical sub-locationBinding: ?? ( example ) : The code for the tooth surface and surface combinations. noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* Added items adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted display Σ 0..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason S 1..1 CodeableConcept 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) amount 0..1 Money Monetary amount value S 1..1 decimal 核定數量，若申請案件類別為3時須填寫。 detail 0..* BackboneElement Insurer added line details 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 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. 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 noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* Added items detail adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted display Σ 0..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason S 1..1 CodeableConcept 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) amount 0..1 Money Monetary amount value S 1..1 decimal 核定數量，若申請案件類別為3時須填寫。 subDetail 0..* BackboneElement Insurer added line items 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 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. 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 noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* Added items detail adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted display Σ 0..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason S 1..1 CodeableConcept 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) amount 0..1 Money Monetary amount value S 1..1 decimal 核定數量，若申請案件類別為3時須填寫。 adjudication 0..* Header-level adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 extension 0..* Extension Additional content defined by implementations coding Σ 0..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted display Σ 0..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user extension 0..* Extension Additional content defined by implementations system Σ 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication version Σ 0..1 string Version of the system - if relevant code Σ 0..1 code Symbol in syntax defined by the systemExample General: submitted 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 reason S 1..1 CodeableConcept 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) amount 0..1 Money Monetary amount value S 1..1 decimal 核定數量，若申請案件類別為3時須填寫。 total Σ 0..* BackboneElement Adjudication totals extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category Σ 1..1 CodeableConcept Type of adjudication informationBinding: ?? ( example ) : The adjudication codes. amount Σ 1..1 Money Financial total for the category payment 0..1 BackboneElement Payment Details 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 paymentBinding: ?? ( 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 adjustmentBinding: ?? ( 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 statusBinding: ?? ( example ) : For whom funds are to be reserved: (Patient, Provider, None). formCode 0..1 CodeableConcept Printed form identifierBinding: ?? ( example ) : The forms codes. form 0..1 Attachment Printed reference or actual form processNote 0..* BackboneElement Note concerning adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized number 0..1 positiveInt Note instance identifier type 0..1 code display | print | printoperBinding: ?? ( required ) : The presentation types of notes. text 1..1 string Note explanatory text language 0..1 CodeableConcept Language of the textBinding: ?? ( preferred ) : A human language. communicationRequest 0..* Reference (CommunicationRequest )Request for additional information insurance 0..* 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 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 0..* BackboneElement Processing errors extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized itemSequence 0..1 positiveInt Item sequence number detailSequence 0..1 positiveInt Detail sequence number subDetailSequence 0..1 positiveInt Subdetail sequence number code 1..1 CodeableConcept Error code detailing processing issuesBinding: ?? ( example ) : The adjudication error codes.
ClaimResponse 
meta 
implicitRules 
contained 
extension 
modifierExtension 
patient 
serviced[x]