Belgian MyCareNet eTariff Profiles
1.0.0 - STU Belgium flag

Belgian MyCareNet eTariff Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/etariff/ and changes regularly. See the Directory of published versions

Logical Model: BeModeleTariffResponse

Official URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/BeModeleTariffResponse Version: 1.0.0
Draft as of 2024-10-02 Computable Name: BeModeleTariffResponse

Response for tariff request by careprovider

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. BeModeleTariffResponse 0..* Base BeModeleTariffResponse
Instances of this logical model are not marked to be the target of a Reference
... insurer 1..1 Identifier Identification of the insurer
... patient 1..1 Identifier Patient identification
... holderCode1 1..1 CodeableConcept holder code 1
... tariffRequestType 1..1 CodeableConcept Identification of the type of tariff request
... service 1..* BackboneElement List of services
.... provider 1..1 Identifier Provider ID
.... identifier 1..1 Identifier (pseudo-)nomenclature code of the service that was performed.
.... date 0..1 dateTime Date on which the service was performed.
.... tariff 0..1 BackboneElement Tariff
..... fee 1..1 Money Legal fee for the service (reimbursement amount + co-payment). The AO will provide the unit price, regardless of the rules for applying the nomenclature.
..... reimbursement 1..1 Money Amount paid by insurer
..... patientFee 1..1 Money Personal co-payment paid by the patient
..... commitment 1..1 Identifier Approval number of the tariff commitment that the service provider must indicate in its billing.
.... refusal 0..1 BackboneElement Refusal of the service requested
..... reason 1..1 CodeableConcept code for refusal of intervention by the AO for the requested service The possible values are as follows. 001 Renewal period not yet expired 002 () Maximum number of services already reached within the authorised period (and/or no exemption granted)* 003 () Benefit is no longer authorised (already reimbursed) for this location (tooth, quadrant, ..)* 004 L600 value reached for the authorised period 005 No MC/CTD agreement registered for the requested service 006 Tariff consultation is not allowed for this benefit as it requires TTR approval as per reimbursement conditions. 007 Tariff consultation is not allowed for this service as the tariff is dependent on other services being billed at the same time. 008 Precondition not met. 009 Nomenclature code cannot be certified on this date 010 () Service cannot be combined with another service* In certain cases (), the AO will indicate the nomenclature code and the date of the service received by the patient which justifies the refusal of reimbursement of the service requested.*
..... serviceIdentifier 0..1 CodeableConcept Nomenclature code of the service justifying the refusal
..... serviceDate 0..1 dateTime Date of the service justifying the refusal

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. BeModeleTariffResponse 0..* Base BeModeleTariffResponse
Instances of this logical model are not marked to be the target of a Reference
... insurer 1..1 Identifier Identification of the insurer
... patient 1..1 Identifier Patient identification
... holderCode1 1..1 CodeableConcept holder code 1
... tariffRequestType 1..1 CodeableConcept Identification of the type of tariff request
... service 1..* BackboneElement List of services
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... provider 1..1 Identifier Provider ID
.... identifier 1..1 Identifier (pseudo-)nomenclature code of the service that was performed.
.... date 0..1 dateTime Date on which the service was performed.
.... tariff 0..1 BackboneElement Tariff
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... fee 1..1 Money Legal fee for the service (reimbursement amount + co-payment). The AO will provide the unit price, regardless of the rules for applying the nomenclature.
..... reimbursement 1..1 Money Amount paid by insurer
..... patientFee 1..1 Money Personal co-payment paid by the patient
..... commitment 1..1 Identifier Approval number of the tariff commitment that the service provider must indicate in its billing.
.... refusal 0..1 BackboneElement Refusal of the service requested
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... reason 1..1 CodeableConcept code for refusal of intervention by the AO for the requested service The possible values are as follows. 001 Renewal period not yet expired 002 () Maximum number of services already reached within the authorised period (and/or no exemption granted)* 003 () Benefit is no longer authorised (already reimbursed) for this location (tooth, quadrant, ..)* 004 L600 value reached for the authorised period 005 No MC/CTD agreement registered for the requested service 006 Tariff consultation is not allowed for this benefit as it requires TTR approval as per reimbursement conditions. 007 Tariff consultation is not allowed for this service as the tariff is dependent on other services being billed at the same time. 008 Precondition not met. 009 Nomenclature code cannot be certified on this date 010 () Service cannot be combined with another service* In certain cases (), the AO will indicate the nomenclature code and the date of the service received by the patient which justifies the refusal of reimbursement of the service requested.*
..... serviceIdentifier 0..1 CodeableConcept Nomenclature code of the service justifying the refusal
..... serviceDate 0..1 dateTime Date of the service justifying the refusal

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. BeModeleTariffResponse 0..* Base BeModeleTariffResponse
Instances of this logical model are not marked to be the target of a Reference
... insurer 1..1 Identifier Identification of the insurer
... patient 1..1 Identifier Patient identification
... holderCode1 1..1 CodeableConcept holder code 1
... tariffRequestType 1..1 CodeableConcept Identification of the type of tariff request
... service 1..* BackboneElement List of services
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... provider 1..1 Identifier Provider ID
.... identifier 1..1 Identifier (pseudo-)nomenclature code of the service that was performed.
.... date 0..1 dateTime Date on which the service was performed.
.... tariff 0..1 BackboneElement Tariff
..... @id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... fee 1..1 Money Legal fee for the service (reimbursement amount + co-payment). The AO will provide the unit price, regardless of the rules for applying the nomenclature.
..... reimbursement 1..1 Money Amount paid by insurer
..... patientFee 1..1 Money Personal co-payment paid by the patient
..... commitment 1..1 Identifier Approval number of the tariff commitment that the service provider must indicate in its billing.
.... refusal 0..1 BackboneElement Refusal of the service requested
..... @id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... reason 1..1 CodeableConcept code for refusal of intervention by the AO for the requested service The possible values are as follows. 001 Renewal period not yet expired 002 () Maximum number of services already reached within the authorised period (and/or no exemption granted)* 003 () Benefit is no longer authorised (already reimbursed) for this location (tooth, quadrant, ..)* 004 L600 value reached for the authorised period 005 No MC/CTD agreement registered for the requested service 006 Tariff consultation is not allowed for this benefit as it requires TTR approval as per reimbursement conditions. 007 Tariff consultation is not allowed for this service as the tariff is dependent on other services being billed at the same time. 008 Precondition not met. 009 Nomenclature code cannot be certified on this date 010 () Service cannot be combined with another service* In certain cases (), the AO will indicate the nomenclature code and the date of the service received by the patient which justifies the refusal of reimbursement of the service requested.*
..... serviceIdentifier 0..1 CodeableConcept Nomenclature code of the service justifying the refusal
..... serviceDate 0..1 dateTime Date of the service justifying the refusal

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Base

Summary

Mandatory: 0 element(13 nested mandatory elements)

Differential View

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. BeModeleTariffResponse 0..* Base BeModeleTariffResponse
Instances of this logical model are not marked to be the target of a Reference
... insurer 1..1 Identifier Identification of the insurer
... patient 1..1 Identifier Patient identification
... holderCode1 1..1 CodeableConcept holder code 1
... tariffRequestType 1..1 CodeableConcept Identification of the type of tariff request
... service 1..* BackboneElement List of services
.... provider 1..1 Identifier Provider ID
.... identifier 1..1 Identifier (pseudo-)nomenclature code of the service that was performed.
.... date 0..1 dateTime Date on which the service was performed.
.... tariff 0..1 BackboneElement Tariff
..... fee 1..1 Money Legal fee for the service (reimbursement amount + co-payment). The AO will provide the unit price, regardless of the rules for applying the nomenclature.
..... reimbursement 1..1 Money Amount paid by insurer
..... patientFee 1..1 Money Personal co-payment paid by the patient
..... commitment 1..1 Identifier Approval number of the tariff commitment that the service provider must indicate in its billing.
.... refusal 0..1 BackboneElement Refusal of the service requested
..... reason 1..1 CodeableConcept code for refusal of intervention by the AO for the requested service The possible values are as follows. 001 Renewal period not yet expired 002 () Maximum number of services already reached within the authorised period (and/or no exemption granted)* 003 () Benefit is no longer authorised (already reimbursed) for this location (tooth, quadrant, ..)* 004 L600 value reached for the authorised period 005 No MC/CTD agreement registered for the requested service 006 Tariff consultation is not allowed for this benefit as it requires TTR approval as per reimbursement conditions. 007 Tariff consultation is not allowed for this service as the tariff is dependent on other services being billed at the same time. 008 Precondition not met. 009 Nomenclature code cannot be certified on this date 010 () Service cannot be combined with another service* In certain cases (), the AO will indicate the nomenclature code and the date of the service received by the patient which justifies the refusal of reimbursement of the service requested.*
..... serviceIdentifier 0..1 CodeableConcept Nomenclature code of the service justifying the refusal
..... serviceDate 0..1 dateTime Date of the service justifying the refusal

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. BeModeleTariffResponse 0..* Base BeModeleTariffResponse
Instances of this logical model are not marked to be the target of a Reference
... insurer 1..1 Identifier Identification of the insurer
... patient 1..1 Identifier Patient identification
... holderCode1 1..1 CodeableConcept holder code 1
... tariffRequestType 1..1 CodeableConcept Identification of the type of tariff request
... service 1..* BackboneElement List of services
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... provider 1..1 Identifier Provider ID
.... identifier 1..1 Identifier (pseudo-)nomenclature code of the service that was performed.
.... date 0..1 dateTime Date on which the service was performed.
.... tariff 0..1 BackboneElement Tariff
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... fee 1..1 Money Legal fee for the service (reimbursement amount + co-payment). The AO will provide the unit price, regardless of the rules for applying the nomenclature.
..... reimbursement 1..1 Money Amount paid by insurer
..... patientFee 1..1 Money Personal co-payment paid by the patient
..... commitment 1..1 Identifier Approval number of the tariff commitment that the service provider must indicate in its billing.
.... refusal 0..1 BackboneElement Refusal of the service requested
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... reason 1..1 CodeableConcept code for refusal of intervention by the AO for the requested service The possible values are as follows. 001 Renewal period not yet expired 002 () Maximum number of services already reached within the authorised period (and/or no exemption granted)* 003 () Benefit is no longer authorised (already reimbursed) for this location (tooth, quadrant, ..)* 004 L600 value reached for the authorised period 005 No MC/CTD agreement registered for the requested service 006 Tariff consultation is not allowed for this benefit as it requires TTR approval as per reimbursement conditions. 007 Tariff consultation is not allowed for this service as the tariff is dependent on other services being billed at the same time. 008 Precondition not met. 009 Nomenclature code cannot be certified on this date 010 () Service cannot be combined with another service* In certain cases (), the AO will indicate the nomenclature code and the date of the service received by the patient which justifies the refusal of reimbursement of the service requested.*
..... serviceIdentifier 0..1 CodeableConcept Nomenclature code of the service justifying the refusal
..... serviceDate 0..1 dateTime Date of the service justifying the refusal

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. BeModeleTariffResponse 0..* Base BeModeleTariffResponse
Instances of this logical model are not marked to be the target of a Reference
... insurer 1..1 Identifier Identification of the insurer
... patient 1..1 Identifier Patient identification
... holderCode1 1..1 CodeableConcept holder code 1
... tariffRequestType 1..1 CodeableConcept Identification of the type of tariff request
... service 1..* BackboneElement List of services
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... provider 1..1 Identifier Provider ID
.... identifier 1..1 Identifier (pseudo-)nomenclature code of the service that was performed.
.... date 0..1 dateTime Date on which the service was performed.
.... tariff 0..1 BackboneElement Tariff
..... @id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... fee 1..1 Money Legal fee for the service (reimbursement amount + co-payment). The AO will provide the unit price, regardless of the rules for applying the nomenclature.
..... reimbursement 1..1 Money Amount paid by insurer
..... patientFee 1..1 Money Personal co-payment paid by the patient
..... commitment 1..1 Identifier Approval number of the tariff commitment that the service provider must indicate in its billing.
.... refusal 0..1 BackboneElement Refusal of the service requested
..... @id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... reason 1..1 CodeableConcept code for refusal of intervention by the AO for the requested service The possible values are as follows. 001 Renewal period not yet expired 002 () Maximum number of services already reached within the authorised period (and/or no exemption granted)* 003 () Benefit is no longer authorised (already reimbursed) for this location (tooth, quadrant, ..)* 004 L600 value reached for the authorised period 005 No MC/CTD agreement registered for the requested service 006 Tariff consultation is not allowed for this benefit as it requires TTR approval as per reimbursement conditions. 007 Tariff consultation is not allowed for this service as the tariff is dependent on other services being billed at the same time. 008 Precondition not met. 009 Nomenclature code cannot be certified on this date 010 () Service cannot be combined with another service* In certain cases (), the AO will indicate the nomenclature code and the date of the service received by the patient which justifies the refusal of reimbursement of the service requested.*
..... serviceIdentifier 0..1 CodeableConcept Nomenclature code of the service justifying the refusal
..... serviceDate 0..1 dateTime Date of the service justifying the refusal

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Base

Summary

Mandatory: 0 element(13 nested mandatory elements)

 

Other representations of profile: CSV, Excel