Profile Comparison between https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas vs https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Claim
copyright
date	2026-09-24T22:23:31+08:00	2026-10-14T06:35:06+00:00	Values Differ
description	此免疫製劑事前審查-Claim Immunologic Aagent TWPAS Profile說明本IG如何進一步定義FHIR的Claim Resource以呈現免疫製劑事前審查之內容
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction / jurisdiction[0]		null#null	Added the item 'null#null'
kind	resource
name	ClaimImmTWPAS
publisher	衛生福利部中央健康保險署
purpose
status	active
title	免疫製劑事前審查-Claim Immunologic Aagent TWPAS
type	Claim
url	https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas
version	1.2.7	1.2.8	Values Differ

Structure

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, applType, diagnosis-imm	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: sequence-1, applType, diagnosis-imm
Claim.id	Σ This element is included in summaries.	0..1	id	收件序號/案件編號，供案件追蹤與識別使用，醫院上傳時無須填寫。	Σ This element is included in summaries.	0..1	id	收件序號/案件編號，供案件追蹤與識別使用，醫院上傳時無須填寫。
Claim.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.meta.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
Claim.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier	Σ This element is included in summaries.	0..1	id	Version specific identifier
Claim.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	上傳日期時間。供案件追蹤與識別使用，醫院上傳時無須填寫。	Σ This element is included in summaries.	0..1	instant	上傳日期時間。供案件追蹤與識別使用，醫院上傳時無須填寫。
Claim.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-immunologic-agent-twpas
Claim.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Claim.meta.tag	Σ This element is included in summaries.	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".	Σ This element is included in summaries.	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".
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
Claim.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
Claim.contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.Slices for identifier	S This element must be supported.	0..*	Identifier	Business Identifier for claim Slice: Unordered, Open by value:use Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	S This element must be supported.	0..*	Identifier	Business Identifier for claim Slice: Unordered, Open by value:use Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active
Claim.type	Σ This element is included in summaries.	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 This element is included in summaries.	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"}]}
Claim.subType	S This element must be supported.	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:old_acpt_no填寫原送核案件之受理編號。 Binding: ?? (required)	S This element must be supported.	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:old_acpt_no填寫原送核案件之受理編號。 Binding: ?? (required)
Claim.subType.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.subType.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
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.subType.coding.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
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-apply-type
Claim.subType.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.subType.coding.code	Σ This element is included in summaries.	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 This element is included in summaries.	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。
Claim.subType.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.subType.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.subType.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWPAS)	病人資訊	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWPAS)	病人資訊
Claim.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	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。	S This element must be supported. Σ This element is included in summaries.	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。
Claim.enterer	S This element must be supported.	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 This element must be supported.	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。
Claim.insurer	Σ This element is included in summaries.	0..1	Reference(Organization)	Target	Σ This element is included in summaries.	0..1	Reference(Organization)	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	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。	S This element must be supported. Σ This element is included in summaries.	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。
Claim.priority	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: ?? (required)	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: ?? (required)
Claim.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).
Claim.related		0..*	BackboneElement	Prior or corollary claims		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.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.
Claim.related.reference		0..1	Identifier	File or case reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.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
Claim.payee		0..1	BackboneElement	Recipient of benefits payable		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.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.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility		0..1	Reference(Location)	Servicing facility
Claim.careTeam		0..*	BackboneElement	Members of the care team		0..*	BackboneElement	Members of the care team
Claim.careTeam.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.careTeam.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence		1..1	positiveInt	Order of care team		1..1	positiveInt	Order of care team
Claim.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner		0..1	boolean	Indicator of the lead practitioner
Claim.careTeam.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.
Claim.careTeam.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.
Claim.Slices for supportingInfo		2..*	BackboneElement	Supporting information Slice: Unordered, Closed by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		2..*	BackboneElement	Supporting information Slice: Unordered, Closed by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.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。
Claim.Slices for supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (required)		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (required)
Claim.Slices for supportingInfo.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.
Claim.Slices for supportingInfo.timing[x]		0..1	date, Period	When it occurred		0..1	date, Period	When it occurred
Claim.Slices for supportingInfo.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
Claim.Slices for supportingInfo.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.
Claim.diagnosis	S This element must be supported. C	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。 Constraints: diagnosis	S This element must be supported. C	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。 Constraints: diagnosis
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.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。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	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 This element must be supported.	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)
Claim.diagnosis.diagnosis[x].id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].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
Claim.diagnosis.diagnosis[x].Slices for coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.diagnosis.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.
Claim.diagnosis.type.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.type.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
Claim.diagnosis.type.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
Claim.diagnosis.type.text	S This element must be supported. Σ This element is included in summaries. 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	S This element must be supported. Σ This element is included in summaries. 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
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.
Claim.diagnosis.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.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes.		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes.
Claim.procedure.date	S This element must be supported.	1..1	dateTime	手術(或其他處置)日期	S This element must be supported.	1..1	dateTime	手術(或其他處置)日期
Claim.procedure.procedure[x]	S This element must be supported.	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 This element must be supported.	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)
Claim.procedure.procedure[x].id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.procedure.procedure[x].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
Claim.procedure.procedure[x].Slices for coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.procedure.procedure[x].text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.insurance	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Required Pattern: 1	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Required Pattern: 1
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(健保事前審查計畫-Coverage TWPAS)	Insurance information	Σ This element is included in summaries.	1..1	Reference(健保事前審查計畫-Coverage TWPAS)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date		1..1	date	When the incident occurred		1..1	date	When the incident occurred
Claim.accident.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.
Claim.accident.location[x]		0..1	Address, Reference(Location)	Where the event occurred		0..1	Address, Reference(Location)	Where the event occurred
Claim.item		1..*	BackboneElement	Product or service provided		1..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information		0..*	positiveInt	Applicable exception and supporting information
Claim.item.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.
Claim.item.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.
Claim.item.productOrService	S This element must be supported.	1..1	CodeableConcept	醫令類別 Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	醫令類別 Binding: ?? (required)
Claim.item.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. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		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. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.programCode	S This element must be supported. 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	S This element must be supported. 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
Claim.item.programCode.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.programCode.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
Claim.item.programCode.coding	Σ This element is included in summaries.	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 This element is included in summaries.	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)
Claim.item.programCode.text	Σ This element is included in summaries.	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 This element is included in summaries.	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。
Claim.item.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
Claim.item.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.
Claim.item.quantity	S This element must be supported.	1..1	??	Count of products or services Binding: ?? (required)	S This element must be supported. C	1..1	??	Count of products or services Binding: ?? (required)
Claim.item.quantity.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.quantity.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
Claim.item.quantity.value	S This element must be supported. Σ This element is included in summaries.	1..1	decimal	事前審查申請數量	S This element must be supported. Σ This element is included in summaries.	1..1	decimal	事前審查申請數量
Claim.item.quantity.comparator	?! This element is a modifier element. Σ This element is included in summaries.	0..0		< | <= | >= | > - how to understand the value Binding: ?? (required): How the Quantity should be understood and represented.	?! This element is a modifier element. Σ This element is included in summaries.	0..0		< | <= | >= | > - how to understand the value Binding: ?? (required): How the Quantity should be understood and represented.
Claim.item.quantity.unit	Σ This element is included in summaries.	0..1	string	Unit representation	Σ This element is included in summaries.	0..1	string	Unit representation
Claim.item.quantity.system	Σ This element is included in summaries. C	1..1	uri	事前審查申請數量單位及包裝類型之代碼系統	Σ This element is included in summaries. C	1..1	uri	事前審查申請數量單位及包裝類型之代碼系統
Claim.item.quantity.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	事前審查申請數量單位及包裝類型	S This element must be supported. Σ This element is included in summaries.	1..1	code	事前審查申請數量單位及包裝類型
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.item.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)
Claim.item.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.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier		1..1	positiveInt	Item instance identifier
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.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.
Claim.item.detail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.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.
Claim.item.detail.subDetail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
Claim.total		0..1	Money	Total claim cost		0..1	Money	Total claim cost
Documentation for this format