This is the set of resources that conform to both 事前審查回覆-ClaimResponse TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas) and 事前審查回覆-ClaimResponse TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas).
Name Flags Card. Type Description & Constraints Filter: Bindings Constraints Obligations
ClaimResponse 0..* Response to a claim predetermination or preauthorization ClaimResponse. meta Σ This element is included in summaries. 1..1 Meta Metadata about the resource ClaimResponse.meta. extension 0..* Extension Additional content defined by implementations ClaimResponse.meta. versionId Σ This element is included in summaries. 0..1 id Version specific identifier ClaimResponse.meta. lastUpdated Σ This element is included in summaries. 0..1 instant When the resource version last changed ClaimResponse.meta. source Σ This element is included in summaries. 0..1 uri Identifies where the resource comes from ClaimResponse.meta. profile Σ This element is included in summaries. 1..1 canonical (StructureDefinition )Profiles this resource claims to conform to ClaimResponse.meta. security Σ This element is included in summaries. 0..* Coding Security Labels applied to this resourceBinding: ?? ( extensible ) : Security Labels from the Healthcare Privacy and Security Classification System. ClaimResponse.meta. tag Σ This element is included in summaries. 0..* Coding Tags applied to this resourceBinding: ?? ( example ) : Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". ClaimResponse. 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 ClaimResponse. language 0..1 code Language of the resource contentBinding: ?? ( preferred ) : A human language. ClaimResponse. 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 ClaimResponse. contained 0..* Resource Contained, inline Resources ClaimResponse. extension 0..* Extension Additional content defined by implementations ClaimResponse. modifierExtension ?! This element is a modifier element. 0..* Extension Extensions that cannot be ignored ClaimResponse. identifier 0..* Identifier 受理編號。供案件追蹤與識別使用，醫院上傳時無須填寫。 ClaimResponse.identifier. extension 0..* Extension Additional content defined by implementations ClaimResponse.identifier. use ?! This element is a modifier element. Σ This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)Binding: ?? ( required ) : Identifies the purpose for this identifier, if known . ClaimResponse.identifier. type Σ This element is included in summaries. 0..1 CodeableConcept Description of identifierBinding: ?? ( extensible ) : A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ClaimResponse.identifier. system Σ This element is included in summaries. 0..1 uri The namespace for the identifier valueExample General: http://www.acme.com/identifiers/patient ClaimResponse.identifier. value Σ This element is included in summaries. 0..1 string The value that is uniqueExample General: 123456 ClaimResponse.identifier. period Σ This element is included in summaries. 0..1 Period Time period when id is/was valid for use ClaimResponse.identifier. assigner Σ This element is included in summaries. 0..1 Reference (Organization )Organization that issued id (may be just text) ClaimResponse. status ?! This element is a modifier element. Σ This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-errorBinding: ?? ( required ) : A code specifying the state of the resource instance. ClaimResponse. type Σ This element is included in summaries. 1..1 CodeableConcept More granular claim typeBinding: ?? ( extensible ) : The type or discipline-style of the claim. ClaimResponse. subType 0..1 CodeableConcept More granular claim typeBinding: ?? ( example ) : A more granular claim typecode. ClaimResponse. use Σ This element is included in summaries. 1..1 code claim | preauthorization | predeterminationBinding: ?? ( required ) : Claim, preauthorization, predetermination. ClaimResponse. patient Σ This element is included in summaries. 1..1 Reference (病人資訊-Patient TWPAS | #sd-25-Patient-twpas-Patient-twpas )The recipient of the products and services ClaimResponse. created S This element must be supported. Σ This element is included in summaries. 1..1 dateTime 核定日期或受理日期，即為案件受理狀態(disposition)之異動日期，依據其狀態不同而有不同日期，例如案件受理狀態為已受理，此日期則為受理日期；若為審畢結果則為核定日期。 ClaimResponse. insurer Σ This element is included in summaries. 1..1 Reference (TW Core Organization Government )Party responsible for reimbursement ClaimResponse. requestor S This element must be supported. 1..1 Reference (醫事機構-Organization TWPAS | #sd-36-Organization-twpas-Organization-twpas )Party responsible for the claim ClaimResponse. request S This element must be supported. Σ This element is included in summaries. 1..1 Reference (癌藥事前審查-Claim TWPAS | #sd-40-Claim-twpas-Claim-twpas )Id of resource triggering adjudication ClaimResponse. outcome Σ This element is included in summaries. 1..1 code queued | complete | error | partialBinding: ?? ( required ) : The result of the claim processing. ClaimResponse. disposition S This element must be supported. 1..1 string 案件受理狀態。待處理 | 處理中 | 處理中(等待附件檔) | 處理中(檔案檢核中) | 處理中(等待檢查申報資料) | 資料檢核失敗 | 檔案傳送失敗 | 附件檔轉檔失敗 | 影像檔轉檔失敗 | 電子病歷檔轉檔失敗 | 申請檔案檢核失敗 | 申請檔案未備齊 | 已受理 | 審查中 | 審畢結果Binding: ?? ( required ) ClaimResponse. preAuthRef 0..1 string Preauthorization reference ClaimResponse. preAuthPeriod 0..1 Period Preauthorization reference effective period ClaimResponse. payeeType 0..1 CodeableConcept Party to be paid any benefits payableBinding: ?? ( example ) : A code for the party to be reimbursed. ClaimResponse. item 1..1 BackboneElement Adjudication for claim line items ClaimResponse.item. extension 0..* Extension Additional content defined by implementations ClaimResponse.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 ClaimResponse.item. itemSequence 1..1 positiveInt Claim item instance identifier ClaimResponse.item. noteNumber 0..* positiveInt Applicable note numbers ClaimResponse.item. adjudication 1..1 BackboneElement Adjudication details ClaimResponse.item.adjudication. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.adjudication. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.item.adjudication. category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. ClaimResponse.item.adjudication.category. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.adjudication.category. coding Σ This element is included in summaries. 0..* Coding Code defined by a terminology system ClaimResponse.item.adjudication.category.coding. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.adjudication.category.coding. system Σ This element is included in summaries. 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication ClaimResponse.item.adjudication.category.coding. version Σ This element is included in summaries. 0..1 string Version of the system - if relevant ClaimResponse.item.adjudication.category.coding. code Σ This element is included in summaries. 0..1 code Symbol in syntax defined by the systemExample General: submitted ClaimResponse.item.adjudication.category.coding. display Σ This element is included in summaries. 0..1 string Representation defined by the system ClaimResponse.item.adjudication.category.coding. userSelected Σ This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user ClaimResponse.item.adjudication.category. text Σ This element is included in summaries. 0..1 string Plain text representation of the concept ClaimResponse.item.adjudication. reason S This element must be supported. 1..1 CodeableConcept 受理審查案件核定註記。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件Binding: ?? ( required ) ClaimResponse.item.adjudication.reason. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.adjudication.reason. coding Σ This element is included in summaries. 0..* Coding Code defined by a terminology system ClaimResponse.item.adjudication.reason. text S This element must be supported. Σ This element is included in summaries. 0..1 string 核定意見 ClaimResponse.item.adjudication. amount 0..1 Money Monetary amount ClaimResponse.item.adjudication. value 0..1 decimal Non-monetary value ClaimResponse.item. detail 1..* BackboneElement Adjudication for claim details ClaimResponse.item.detail. extension 0..* Extension Additional content defined by implementations ClaimResponse.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 ClaimResponse.item.detail. detailSequence 1..1 positiveInt 請填寫對應的Claim.item.sequence ClaimResponse.item.detail. noteNumber 0..* positiveInt Applicable note numbers ClaimResponse.item.detail. adjudication 1..* BackboneElement Detail level adjudication details ClaimResponse.item.detail.adjudication. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.detail.adjudication. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.item.detail.adjudication. category 1..1 CodeableConcept 【因FHIR設計而需必填】Binding: ?? ( example ) : The adjudication codes. ClaimResponse.item.detail.adjudication.category. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.detail.adjudication.category. coding Σ This element is included in summaries. 0..* Coding Code defined by a terminology system ClaimResponse.item.detail.adjudication.category.coding. extension 0..* Extension Additional content defined by implementations ClaimResponse.item.detail.adjudication.category.coding. system Σ This element is included in summaries. 0..1 uri Identity of the terminology systemExample General: http://terminology.hl7.org/CodeSystem/adjudication ClaimResponse.item.detail.adjudication.category.coding. version Σ This element is included in summaries. 0..1 string Version of the system - if relevant ClaimResponse.item.detail.adjudication.category.coding. code Σ This element is included in summaries. 0..1 code Symbol in syntax defined by the systemExample General: submitted ClaimResponse.item.detail.adjudication.category.coding. display Σ This element is included in summaries. 0..1 string Representation defined by the system ClaimResponse.item.detail.adjudication.category.coding. userSelected Σ This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user ClaimResponse.item.detail.adjudication.category. text Σ This element is included in summaries. 0..1 string Plain text representation of the concept ClaimResponse.item.detail.adjudication. reason S This element must be supported. 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 ) ClaimResponse.item.detail.adjudication. amount 0..1 Money Monetary amount ClaimResponse.item.detail.adjudication. value S This element must be supported. 1..1 decimal 個別醫令核定數量 ClaimResponse.item.detail. subDetail 0..* BackboneElement Adjudication for claim sub-details ClaimResponse.item.detail.subDetail. extension 0..* Extension Additional content defined by implementations ClaimResponse.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 ClaimResponse.item.detail.subDetail. subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier ClaimResponse.item.detail.subDetail. noteNumber 0..* positiveInt Applicable note numbers ClaimResponse.item.detail.subDetail. adjudication 0..* Subdetail level adjudication details ClaimResponse. addItem 0..* BackboneElement Insurer added line items ClaimResponse.addItem. extension 0..* Extension Additional content defined by implementations ClaimResponse.addItem. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.addItem. itemSequence 0..* positiveInt Item sequence number ClaimResponse.addItem. detailSequence 0..* positiveInt Detail sequence number ClaimResponse.addItem. subdetailSequence 0..* positiveInt Subdetail sequence number ClaimResponse.addItem. provider 0..* Reference (Practitioner | PractitionerRole | Organization )Authorized providers ClaimResponse.addItem. productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. ClaimResponse.addItem. 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. ClaimResponse.addItem. programCode 0..* CodeableConcept Program the product or service is provided underBinding: ?? ( example ) : Program specific reason codes. ClaimResponse.addItem. serviced[x] 0..1 Date or dates of service or product delivery ClaimResponse.addItem.serviced[x]. servicedDate date ClaimResponse.addItem.serviced[x]. servicedPeriod Period ClaimResponse.addItem. location[x] 0..1 Place of service or where product was suppliedBinding: ?? ( example ) : Place of service: pharmacy, school, prison, etc. ClaimResponse.addItem.location[x]. locationCodeableConcept CodeableConcept ClaimResponse.addItem.location[x]. locationAddress Address ClaimResponse.addItem.location[x]. locationReferenceReference (Location )ClaimResponse.addItem. quantity 0..1 ?? ?? Count of products or services ClaimResponse.addItem. unitPrice 0..1 Money Fee, charge or cost per item ClaimResponse.addItem. factor 0..1 decimal Price scaling factor ClaimResponse.addItem. net 0..1 Money Total item cost ClaimResponse.addItem. bodySite 0..1 CodeableConcept Anatomical locationBinding: ?? ( example ) : The code for the teeth, quadrant, sextant and arch. ClaimResponse.addItem. subSite 0..* CodeableConcept Anatomical sub-locationBinding: ?? ( example ) : The code for the tooth surface and surface combinations. ClaimResponse.addItem. noteNumber 0..* positiveInt Applicable note numbers ClaimResponse.addItem. adjudication 1..* Added items adjudication ClaimResponse.addItem. detail 0..* BackboneElement Insurer added line details ClaimResponse.addItem.detail. extension 0..* Extension Additional content defined by implementations ClaimResponse.addItem.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 ClaimResponse.addItem.detail. productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. ClaimResponse.addItem.detail. 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. ClaimResponse.addItem.detail. quantity 0..1 ?? ?? Count of products or services ClaimResponse.addItem.detail. unitPrice 0..1 Money Fee, charge or cost per item ClaimResponse.addItem.detail. factor 0..1 decimal Price scaling factor ClaimResponse.addItem.detail. net 0..1 Money Total item cost ClaimResponse.addItem.detail. noteNumber 0..* positiveInt Applicable note numbers ClaimResponse.addItem.detail. adjudication 1..* Added items detail adjudication ClaimResponse.addItem.detail. subDetail 0..* BackboneElement Insurer added line items ClaimResponse.addItem.detail.subDetail. extension 0..* Extension Additional content defined by implementations ClaimResponse.addItem.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 ClaimResponse.addItem.detail.subDetail. productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. ClaimResponse.addItem.detail.subDetail. 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. ClaimResponse.addItem.detail.subDetail. quantity 0..1 ?? ?? Count of products or services ClaimResponse.addItem.detail.subDetail. unitPrice 0..1 Money Fee, charge or cost per item ClaimResponse.addItem.detail.subDetail. factor 0..1 decimal Price scaling factor ClaimResponse.addItem.detail.subDetail. net 0..1 Money Total item cost ClaimResponse.addItem.detail.subDetail. noteNumber 0..* positiveInt Applicable note numbers ClaimResponse.addItem.detail.subDetail. adjudication 1..* Added items detail adjudication ClaimResponse. adjudication 0..* Header-level adjudication ClaimResponse. total Σ This element is included in summaries. 0..* BackboneElement Adjudication totals ClaimResponse.total. extension 0..* Extension Additional content defined by implementations ClaimResponse.total. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.total. category Σ This element is included in summaries. 1..1 CodeableConcept Type of adjudication informationBinding: ?? ( example ) : The adjudication codes. ClaimResponse.total. amount Σ This element is included in summaries. 1..1 Money Financial total for the category ClaimResponse. payment 0..1 BackboneElement Payment Details ClaimResponse.payment. extension 0..* Extension Additional content defined by implementations ClaimResponse.payment. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.payment. type 1..1 CodeableConcept Partial or complete paymentBinding: ?? ( example ) : The type (partial, complete) of the payment. ClaimResponse.payment. adjustment 0..1 Money Payment adjustment for non-claim issues ClaimResponse.payment. adjustmentReason 0..1 CodeableConcept Explanation for the adjustmentBinding: ?? ( example ) : Payment Adjustment reason codes. ClaimResponse.payment. date 0..1 date Expected date of payment ClaimResponse.payment. amount 1..1 Money Payable amount after adjustment ClaimResponse.payment. identifier 0..1 Identifier Business identifier for the payment ClaimResponse. fundsReserve 0..1 CodeableConcept Funds reserved statusBinding: ?? ( example ) : For whom funds are to be reserved: (Patient, Provider, None). ClaimResponse. formCode 0..1 CodeableConcept Printed form identifierBinding: ?? ( example ) : The forms codes. ClaimResponse. form 0..1 Attachment Printed reference or actual form ClaimResponse. processNote 0..* BackboneElement Note concerning adjudication ClaimResponse.processNote. extension 0..* Extension Additional content defined by implementations ClaimResponse.processNote. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.processNote. number 0..1 positiveInt Note instance identifier ClaimResponse.processNote. type 0..1 code display | print | printoperBinding: ?? ( required ) : The presentation types of notes. ClaimResponse.processNote. text 1..1 string Note explanatory text ClaimResponse.processNote. language 0..1 CodeableConcept Language of the textBinding: ?? ( preferred ) : A human language. ClaimResponse. communicationRequest 0..* Reference (CommunicationRequest )Request for additional information ClaimResponse. insurance 0..* BackboneElement Patient insurance information ClaimResponse.insurance. extension 0..* Extension Additional content defined by implementations ClaimResponse.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 ClaimResponse.insurance. sequence 1..1 positiveInt Insurance instance identifier ClaimResponse.insurance. focal 1..1 boolean Coverage to be used for adjudication ClaimResponse.insurance. coverage 1..1 Reference (Coverage )Insurance information ClaimResponse.insurance. businessArrangement 0..1 string Additional provider contract number ClaimResponse.insurance. claimResponse 0..1 Reference (ClaimResponse )Adjudication results ClaimResponse. error 0..* BackboneElement Processing errors ClaimResponse.error. extension 0..* Extension Additional content defined by implementations ClaimResponse.error. modifierExtension ?! This element is a modifier element. Σ This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized ClaimResponse.error. itemSequence 0..1 positiveInt Item sequence number ClaimResponse.error. detailSequence 0..1 positiveInt Detail sequence number ClaimResponse.error. subDetailSequence 0..1 positiveInt Subdetail sequence number ClaimResponse.error. code 1..1 CodeableConcept Error code detailing processing issuesBinding: ?? ( example ) : The adjudication error codes.
ClaimResponse 
meta 
extension 
versionId 
contained 
modifierExtension 
assigner 
serviced[x] 
, ??