Belgian MyCareNet Profiles
2.1.0 - STU Belgium flag

Belgian MyCareNet Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/mycarenet/ and changes regularly. See the Directory of published versions

Resource Profile: MyCareNet eAgreement Claim Response BE profile

Official URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse Version: 2.1.0
Active as of 2025-01-22 Computable Name: BeMyCareNetEagreementClaimResponse

Claimresponse profile for use in the different eAgreement flows from MyCareNet.

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse C 0..* ClaimResponse Response to a claim predetermination or preauthorization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD
be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
.... profile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
... type SΣ 1..1 CodeableConcept More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


ele-1: All FHIR elements must have a @value or children
.... coding Σ 1..1 Coding Code defined by a terminology system
ele-1: All FHIR elements must have a @value or children
..... system Σ 1..1 uri Identity of the terminology system
ele-1: All FHIR elements must have a @value or children
..... code Σ 1..1 code Symbol in syntax defined by the system
ele-1: All FHIR elements must have a @value or children
... subType S 1..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.


ele-1: All FHIR elements must have a @value or children
.... coding Σ 1..1 Coding Code defined by a terminology system
ele-1: All FHIR elements must have a @value or children
..... system Σ 1..1 uri Identity of the terminology system
ele-1: All FHIR elements must have a @value or children
Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types
..... code Σ 1..1 code Symbol in syntax defined by the system
ele-1: All FHIR elements must have a @value or children
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.


ele-1: All FHIR elements must have a @value or children
... patient SΣ 1..1 Reference(BePatient) The recipient of the products and services
ele-1: All FHIR elements must have a @value or children
... created SΣ 1..1 dateTime Response creation date
ele-1: All FHIR elements must have a @value or children
... insurer SΣ 1..1 Reference(BeOrganization) Party responsible for reimbursement
ele-1: All FHIR elements must have a @value or children
... requestor S 1..1 Reference(BeOrganization | BePractitioner | BePractitionerRole) Party responsible for the claim
ele-1: All FHIR elements must have a @value or children
.... reference ΣC 1..1 string Literal reference, Relative, internal or absolute URL
ele-1: All FHIR elements must have a @value or children
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.


ele-1: All FHIR elements must have a @value or children
... preAuthRef S 1..1 string Preauthorization reference
ele-1: All FHIR elements must have a @value or children
... preAuthPeriod S 0..1 Period Preauthorization reference effective period
ele-1: All FHIR elements must have a @value or children
.... start ΣC 1..1 dateTime Starting time with inclusive boundary
ele-1: All FHIR elements must have a @value or children
... item 0..* BackboneElement Adjudication for claim line items
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... itemSequence 1..1 positiveInt Claim item instance identifier
ele-1: All FHIR elements must have a @value or children
.... adjudication S 1..1 BackboneElement Adjudication details
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


ele-1: All FHIR elements must have a @value or children
...... coding Σ 1..1 Coding Code defined by a terminology system
ele-1: All FHIR elements must have a @value or children
....... system Σ 1..1 uri Identity of the terminology system
ele-1: All FHIR elements must have a @value or children
Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values
....... code Σ 1..1 code Symbol in syntax defined by the system
ele-1: All FHIR elements must have a @value or children
... addItem S 0..* BackboneElement Insurer added line items
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... itemSequence S 1..1 positiveInt Item sequence number
ele-1: All FHIR elements must have a @value or children
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ValueSet product or service (extensible)
ele-1: All FHIR elements must have a @value or children
..... coding Σ 1..1 Coding Code defined by a terminology system
ele-1: All FHIR elements must have a @value or children
...... system Σ 1..1 uri Identity of the terminology system
ele-1: All FHIR elements must have a @value or children
...... code Σ 1..1 code Symbol in syntax defined by the system
ele-1: All FHIR elements must have a @value or children
.... adjudication S 1..* See adjudication (ClaimResponse) Added items adjudication
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
ClaimResponse.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
ClaimResponse.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
ClaimResponse.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
ClaimResponse.userequiredUse
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
ClaimResponse.outcomerequiredClaimProcessingCodes
http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
from the FHIR Standard
ClaimResponse.item.adjudication.categoryexampleAdjudicationValueCodes
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ClaimResponse.addItem.productOrServiceextensibleBeProductOrServiceNihdiEAgreement
https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice
from this IG

Constraints

IdGradePath(s)DetailsRequirements
be-rule-eagreementclaimresponse-1errorClaimResponsepreAuthPeriod start and end SHALL be YYYY-MM-DD
: (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10)
be-rule-eagreementclaimresponse-2errorClaimResponseCreated SHALL be YYYY-MM-DDThh:mm:ss+zz:zz
: ClaimResponse.created.toString().length()=25
dom-2errorClaimResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimResponseIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimResponseIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimResponseA resource should have narrative for robust management
: text.`div`.exists()
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()

 

Other representations of profile: CSV, Excel, Schematron