臺灣社政領域基礎實作指引
0.0.1 - ci-build

臺灣社政領域基礎實作指引, published by 衛生福利部社會及家庭署. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/sfaassn2025-source/base/ and changes regularly. See the Directory of published versions

Resource Profile: 補助申請或核付明細-Claim TWSS Base

Official URL: https://sfaa.gov.tw/base/StructureDefinition/Claim-twss-base Version: 0.0.1
Draft as of 2026-10-20 Computable Name: ClaimTWSSBase

補助申請或核付明細-Claim TWSS Base Profile 表達衛生福利部社會及家庭署業務中的補助申請或核付明細。因 TW Core 0.3.2 尚未提供 Claim Profile，故繼承原生 Claim，並於設定社福欄位後補回適用的 TW Core 0.3.2 共通交換規則。

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Claim, Pre-determination or Pre-authorization
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier This element must be supported. 0..* Identifier Business Identifier for claim
Claim.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType This element must be supported. 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use This element must be supported. This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
Claim.billablePeriod This element must be supported. This element is included in summaries. 0..1 Period Relevant time frame for the claim
Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date
Claim.enterer This element must be supported. 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
Claim.insurer This element must be supported. This element is included in summaries. 0..1 Reference(機構資料-Organization TWSS Base) Target
Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Party responsible for the claim
Claim.priority This element must be supported. This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.prescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.careTeam This element must be supported. 0..* BackboneElement Members of the care team
Claim.careTeam.modifierExtension This element is a modifier element. 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
Claim.careTeam.provider 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Practitioner or organization
Claim.Slices for supportingInfo This element must be supported. 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code

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.supportingInfo:All Slices Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base | 個案服務案件-EpisodeOfCare TWSS Base | 健康與障礙狀況-Condition TWSS Base | 補助資格或補助案件-Coverage TWSS Base | 共用公文-DocumentReference TWSS Base)
Claim.Slices for supportingInfo.supportingInfo:serviceCase This element must be supported. 0..* BackboneElement 服務案件
Claim.Slices for supportingInfo.supportingInfo:serviceCase.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:serviceCase.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:serviceCase.value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:documentsComplete This element must be supported. 0..1 BackboneElement 申請人證件備齊日
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.timing[x] 0..1 date When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicationChannel This element must be supported. 0..1 BackboneElement 申請管道
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
Claim.Slices for supportingInfo.supportingInfo:applicant This element must be supported. 0..1 BackboneElement 申請人
Claim.Slices for supportingInfo.supportingInfo:applicant.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicant.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicant.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicant.value[x] 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:bankAccount This element must be supported. 0..1 BackboneElement 申請人銀行帳戶
Claim.Slices for supportingInfo.supportingInfo:bankAccount.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:bankAccount.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:bankAccount.value[x] 0..1 string Data to be provided
Claim.diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)
Claim.insurance This element must be supported. This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
Claim.item This element must be supported. 0..* BackboneElement Product or service provided
Claim.item.modifierExtension This element is a modifier element. 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
Claim.item.productOrService This element must be supported. 1..1 CodeableConcept 申請補助項目
Binding: TWSS-申請補助別值集 (required)
Claim.item.serviced[x] This element must be supported. 0..1 Date or dates of service or product delivery
Claim.item.serviced[x].servicedDate date
Claim.item.serviced[x].servicedPeriod Period
Claim.item.factor This element must be supported. 0..1 decimal 補助比率
Claim.item.net This element must be supported. 0..1 Money Total item cost
Claim.total This element must be supported. 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​code Base required TWSS-補助申請管道值集 📦0.0.1 This IG
Claim.supportingInfo:applicant.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base required TWSS-申請補助別值集 📦0.0.1 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim 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 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-4 error Claim If 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-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Claim, Pre-determination or Pre-authorization
Claim.identifier This element must be supported. 0..* Identifier Business Identifier for claim
Claim.status This element must be supported. 1..1 code active | cancelled | draft | entered-in-error
Claim.type This element must be supported. 1..1 CodeableConcept Category or discipline
Claim.use This element must be supported. 1..1 code claim | preauthorization | predetermination
Claim.patient This element must be supported. 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
Claim.billablePeriod This element must be supported. 0..1 Period Relevant time frame for the claim
Claim.created This element must be supported. 1..1 dateTime Resource creation date
Claim.enterer This element must be supported. 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
Claim.insurer This element must be supported. 0..1 Reference(機構資料-Organization TWSS Base) Target
Claim.provider This element must be supported. 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Party responsible for the claim
Claim.priority This element must be supported. 1..1 CodeableConcept Desired processing ugency
Claim.prescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
Claim.referral 0..0 Treatment referral
Claim.careTeam This element must be supported. 0..* BackboneElement Members of the care team
Claim.careTeam.provider 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Practitioner or organization
Claim.Slices for supportingInfo This element must be supported. 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
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.supportingInfo:All Slices Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base | 個案服務案件-EpisodeOfCare TWSS Base | 健康與障礙狀況-Condition TWSS Base | 補助資格或補助案件-Coverage TWSS Base | 共用公文-DocumentReference TWSS Base)
Claim.Slices for supportingInfo.supportingInfo:serviceCase This element must be supported. 0..* BackboneElement 服務案件
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 服務案件 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:documentsComplete This element must be supported. 0..1 BackboneElement 申請人證件備齊日
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.timing[x] 0..1 date When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicationChannel This element must be supported. 0..1 BackboneElement 申請管道
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請管道 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
Claim.Slices for supportingInfo.supportingInfo:applicant This element must be supported. 0..1 BackboneElement 申請人
Claim.Slices for supportingInfo.supportingInfo:applicant.category
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請人 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.value[x] 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:bankAccount This element must be supported. 0..1 BackboneElement 申請人銀行帳戶
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.value[x] 0..1 string Data to be provided
Claim.diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
Claim.insurance This element must be supported. 1..* BackboneElement Patient insurance information
Claim.insurance.coverage 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
Claim.item This element must be supported. 0..* BackboneElement Product or service provided
Claim.item.productOrService This element must be supported. 1..1 CodeableConcept 申請補助項目
Binding: TWSS-申請補助別值集 (required)
Claim.item.serviced[x] This element must be supported. 0..1 date, Period Date or dates of service or product delivery
Claim.item.factor This element must be supported. 0..1 decimal 補助比率
Claim.item.net This element must be supported. 0..1 Money Total item cost
Claim.total This element must be supported. 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.supportingInfo:applicationChannel.​code Base required TWSS-補助申請管道值集 📦0.0.1 This IG
Claim.item.productOrService Base required TWSS-申請補助別值集 📦0.0.1 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Claim, Pre-determination or Pre-authorization
Claim.id This element is included in summaries. 0..1 id Logical id of this artifact
Claim.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Claim.implicitRules This element is a modifier element. 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: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages 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
Claim.contained 0..* Resource Contained, inline Resources
Claim.extension 0..* Extension Additional content defined by implementations
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier This element must be supported. 0..* Identifier Business Identifier for claim
Claim.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType This element must be supported. 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use This element must be supported. This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
Claim.billablePeriod This element must be supported. This element is included in summaries. 0..1 Period Relevant time frame for the claim
Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date
Claim.enterer This element must be supported. 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
Claim.insurer This element must be supported. This element is included in summaries. 0..1 Reference(機構資料-Organization TWSS Base) Target
Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Party responsible for the claim
Claim.priority This element must be supported. This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related 0..* BackboneElement Prior or corollary claims
Claim.related.id 0..1 string Unique id for inter-element referencing
Claim.related.extension 0..* Extension Additional content defined by implementations
Claim.related.modifierExtension This element is a modifier element. 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
Claim.related.relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference 0..1 Identifier File or case reference
Claim.prescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
Claim.payee.id 0..1 string Unique id for inter-element referencing
Claim.payee.extension 0..* Extension Additional content defined by implementations
Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
Claim.facility 0..1 Reference(Location) Servicing facility
Claim.careTeam This element must be supported. 0..* BackboneElement Members of the care team
Claim.careTeam.id 0..1 string Unique id for inter-element referencing
Claim.careTeam.extension 0..* Extension Additional content defined by implementations
Claim.careTeam.modifierExtension This element is a modifier element. 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
Claim.careTeam.provider 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Practitioner or organization
Claim.careTeam.responsible 0..1 boolean Indicator of the lead practitioner
Claim.careTeam.role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.Slices for supportingInfo This element must be supported. 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code

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.supportingInfo:All Slices Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:All Slices.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base | 個案服務案件-EpisodeOfCare TWSS Base | 健康與障礙狀況-Condition TWSS Base | 補助資格或補助案件-Coverage TWSS Base | 共用公文-DocumentReference TWSS Base)
Claim.Slices for supportingInfo.supportingInfo:All Slices.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:serviceCase This element must be supported. 0..* BackboneElement 服務案件
Claim.Slices for supportingInfo.supportingInfo:serviceCase.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:serviceCase.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:serviceCase.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:serviceCase.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 服務案件 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:serviceCase.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:serviceCase.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:serviceCase.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:serviceCase.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:serviceCase.value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:serviceCase.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete This element must be supported. 0..1 BackboneElement 申請人證件備齊日
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.timing[x] 0..1 date When it occurred
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueReference Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:applicationChannel This element must be supported. 0..1 BackboneElement 申請管道
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請管道 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueReference Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:applicant This element must be supported. 0..1 BackboneElement 申請人
Claim.Slices for supportingInfo.supportingInfo:applicant.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicant.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:applicant.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicant.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicant.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicant.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicant.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請人 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:applicant.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:applicant.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:applicant.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicant.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:applicant.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:applicant.value[x] 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:applicant.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:bankAccount This element must be supported. 0..1 BackboneElement 申請人銀行帳戶
Claim.Slices for supportingInfo.supportingInfo:bankAccount.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:bankAccount.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:bankAccount.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:bankAccount.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:bankAccount.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:bankAccount.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:bankAccount.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:bankAccount.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:bankAccount.value[x] 0..1 string Data to be provided
Claim.Slices for supportingInfo.supportingInfo:bankAccount.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
Claim.diagnosis.id 0..1 string Unique id for inter-element referencing
Claim.diagnosis.extension 0..* Extension Additional content defined by implementations
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)
Claim.diagnosis.type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure 0..* BackboneElement Clinical procedures performed
Claim.procedure.id 0..1 string Unique id for inter-element referencing
Claim.procedure.extension 0..* Extension Additional content defined by implementations
Claim.procedure.modifierExtension This element is a modifier element. 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
Claim.procedure.type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date 0..1 dateTime When the procedure was performed
Claim.procedure.procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept CodeableConcept
Claim.procedure.procedure[x].procedureReference Reference(Procedure)
Claim.procedure.udi 0..* Reference(Device) Unique device identifier
Claim.insurance This element must be supported. This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.id 0..1 string Unique id for inter-element referencing
Claim.insurance.extension 0..* Extension Additional content defined by implementations
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal 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
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
Claim.insurance.businessArrangement 0..1 string Additional provider contract number
Claim.insurance.preAuthRef 0..* string Prior authorization reference number
Claim.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results
Claim.accident 0..1 BackboneElement Details of the event
Claim.accident.id 0..1 string Unique id for inter-element referencing
Claim.accident.extension 0..* Extension Additional content defined by implementations
Claim.accident.modifierExtension This element is a modifier element. 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
Claim.accident.type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x] 0..1 Where the event occurred
Claim.accident.location[x].locationAddress Address
Claim.accident.location[x].locationReference Reference(Location)
Claim.item This element must be supported. 0..* BackboneElement Product or service provided
Claim.item.id 0..1 string Unique id for inter-element referencing
Claim.item.extension 0..* Extension Additional content defined by implementations
Claim.item.modifierExtension This element is a modifier element. 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
Claim.item.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.item.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.item.procedureSequence 0..* positiveInt Applicable procedures
Claim.item.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.item.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService This element must be supported. 1..1 CodeableConcept 申請補助項目
Binding: TWSS-申請補助別值集 (required)
Claim.item.modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (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.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x] This element must be supported. 0..1 Date or dates of service or product delivery
Claim.item.serviced[x].servicedDate date
Claim.item.serviced[x].servicedPeriod Period
Claim.item.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept CodeableConcept
Claim.item.location[x].locationAddress Address
Claim.item.location[x].locationReference Reference(Location)
Claim.item.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.unitPrice 0..1 Money Fee, charge or cost per item
Claim.item.factor This element must be supported. 0..1 decimal 補助比率
Claim.item.net This element must be supported. 0..1 Money Total item cost
Claim.item.udi 0..* Reference(Device) Unique device identifier
Claim.item.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.item.detail 0..* BackboneElement Product or service provided
Claim.item.detail.id 0..1 string Unique id for inter-element referencing
Claim.item.detail.extension 0..* Extension Additional content defined by implementations
Claim.item.detail.modifierExtension This element is a modifier element. 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
Claim.item.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.item.detail.factor 0..1 decimal Price scaling factor
Claim.item.detail.net 0..1 Money Total item cost
Claim.item.detail.udi 0..* Reference(Device) Unique device identifier
Claim.item.detail.subDetail 0..* BackboneElement Product or service provided
Claim.item.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension This element is a modifier element. 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
Claim.item.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (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: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.item.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.item.detail.subDetail.net 0..1 Money Total item cost
Claim.item.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.total This element must be supported. 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​code Base required TWSS-補助申請管道值集 📦0.0.1 This IG
Claim.supportingInfo:applicationChannel.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicant.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicant.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicant.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.4
Claim.item.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base required TWSS-申請補助別值集 📦0.0.1 This IG
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim 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 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-4 error Claim If 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-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
sqty-1 error Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity The comparator is not used on a SimpleQuantity comparator.empty()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Claim, Pre-determination or Pre-authorization
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier This element must be supported. 0..* Identifier Business Identifier for claim
Claim.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType This element must be supported. 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use This element must be supported. This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
Claim.billablePeriod This element must be supported. This element is included in summaries. 0..1 Period Relevant time frame for the claim
Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date
Claim.enterer This element must be supported. 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
Claim.insurer This element must be supported. This element is included in summaries. 0..1 Reference(機構資料-Organization TWSS Base) Target
Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Party responsible for the claim
Claim.priority This element must be supported. This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.prescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.careTeam This element must be supported. 0..* BackboneElement Members of the care team
Claim.careTeam.modifierExtension This element is a modifier element. 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
Claim.careTeam.provider 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Practitioner or organization
Claim.Slices for supportingInfo This element must be supported. 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code

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.supportingInfo:All Slices Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base | 個案服務案件-EpisodeOfCare TWSS Base | 健康與障礙狀況-Condition TWSS Base | 補助資格或補助案件-Coverage TWSS Base | 共用公文-DocumentReference TWSS Base)
Claim.Slices for supportingInfo.supportingInfo:serviceCase This element must be supported. 0..* BackboneElement 服務案件
Claim.Slices for supportingInfo.supportingInfo:serviceCase.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:serviceCase.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:serviceCase.value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:documentsComplete This element must be supported. 0..1 BackboneElement 申請人證件備齊日
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.timing[x] 0..1 date When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicationChannel This element must be supported. 0..1 BackboneElement 申請管道
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
Claim.Slices for supportingInfo.supportingInfo:applicant This element must be supported. 0..1 BackboneElement 申請人
Claim.Slices for supportingInfo.supportingInfo:applicant.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicant.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicant.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicant.value[x] 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:bankAccount This element must be supported. 0..1 BackboneElement 申請人銀行帳戶
Claim.Slices for supportingInfo.supportingInfo:bankAccount.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:bankAccount.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:bankAccount.value[x] 0..1 string Data to be provided
Claim.diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)
Claim.insurance This element must be supported. This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
Claim.item This element must be supported. 0..* BackboneElement Product or service provided
Claim.item.modifierExtension This element is a modifier element. 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
Claim.item.productOrService This element must be supported. 1..1 CodeableConcept 申請補助項目
Binding: TWSS-申請補助別值集 (required)
Claim.item.serviced[x] This element must be supported. 0..1 Date or dates of service or product delivery
Claim.item.serviced[x].servicedDate date
Claim.item.serviced[x].servicedPeriod Period
Claim.item.factor This element must be supported. 0..1 decimal 補助比率
Claim.item.net This element must be supported. 0..1 Money Total item cost
Claim.total This element must be supported. 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​code Base required TWSS-補助申請管道值集 📦0.0.1 This IG
Claim.supportingInfo:applicant.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base required TWSS-申請補助別值集 📦0.0.1 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim 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 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-4 error Claim If 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-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Claim, Pre-determination or Pre-authorization
Claim.identifier This element must be supported. 0..* Identifier Business Identifier for claim
Claim.status This element must be supported. 1..1 code active | cancelled | draft | entered-in-error
Claim.type This element must be supported. 1..1 CodeableConcept Category or discipline
Claim.subType This element must be supported. 0..1 CodeableConcept More granular claim type
Claim.use This element must be supported. 1..1 code claim | preauthorization | predetermination
Claim.patient This element must be supported. 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
Claim.billablePeriod This element must be supported. 0..1 Period Relevant time frame for the claim
Claim.created This element must be supported. 1..1 dateTime Resource creation date
Claim.enterer This element must be supported. 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
Claim.insurer This element must be supported. 0..1 Reference(機構資料-Organization TWSS Base) Target
Claim.provider This element must be supported. 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Party responsible for the claim
Claim.priority This element must be supported. 1..1 CodeableConcept Desired processing ugency
Claim.prescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
Claim.referral 0..0 Treatment referral
Claim.careTeam This element must be supported. 0..* BackboneElement Members of the care team
Claim.careTeam.provider 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Practitioner or organization
Claim.Slices for supportingInfo This element must be supported. 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
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.supportingInfo:All Slices Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base | 個案服務案件-EpisodeOfCare TWSS Base | 健康與障礙狀況-Condition TWSS Base | 補助資格或補助案件-Coverage TWSS Base | 共用公文-DocumentReference TWSS Base)
Claim.Slices for supportingInfo.supportingInfo:serviceCase This element must be supported. 0..* BackboneElement 服務案件
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 服務案件 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:documentsComplete This element must be supported. 0..1 BackboneElement 申請人證件備齊日
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.timing[x] 0..1 date When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicationChannel This element must be supported. 0..1 BackboneElement 申請管道
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請管道 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
Claim.Slices for supportingInfo.supportingInfo:applicant This element must be supported. 0..1 BackboneElement 申請人
Claim.Slices for supportingInfo.supportingInfo:applicant.category
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請人 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.value[x] 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:bankAccount This element must be supported. 0..1 BackboneElement 申請人銀行帳戶
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.code 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.display 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.value[x] 0..1 string Data to be provided
Claim.diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
Claim.insurance This element must be supported. 1..* BackboneElement Patient insurance information
Claim.insurance.coverage 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
Claim.item This element must be supported. 0..* BackboneElement Product or service provided
Claim.item.productOrService This element must be supported. 1..1 CodeableConcept 申請補助項目
Binding: TWSS-申請補助別值集 (required)
Claim.item.serviced[x] This element must be supported. 0..1 date, Period Date or dates of service or product delivery
Claim.item.factor This element must be supported. 0..1 decimal 補助比率
Claim.item.net This element must be supported. 0..1 Money Total item cost
Claim.total This element must be supported. 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.supportingInfo:applicationChannel.​code Base required TWSS-補助申請管道值集 📦0.0.1 This IG
Claim.item.productOrService Base required TWSS-申請補助別值集 📦0.0.1 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Claim, Pre-determination or Pre-authorization
Claim.id This element is included in summaries. 0..1 id Logical id of this artifact
Claim.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Claim.implicitRules This element is a modifier element. 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: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages 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
Claim.contained 0..* Resource Contained, inline Resources
Claim.extension 0..* Extension Additional content defined by implementations
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier This element must be supported. 0..* Identifier Business Identifier for claim
Claim.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType This element must be supported. 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use This element must be supported. This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
Claim.billablePeriod This element must be supported. This element is included in summaries. 0..1 Period Relevant time frame for the claim
Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date
Claim.enterer This element must be supported. 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
Claim.insurer This element must be supported. This element is included in summaries. 0..1 Reference(機構資料-Organization TWSS Base) Target
Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Party responsible for the claim
Claim.priority This element must be supported. This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related 0..* BackboneElement Prior or corollary claims
Claim.related.id 0..1 string Unique id for inter-element referencing
Claim.related.extension 0..* Extension Additional content defined by implementations
Claim.related.modifierExtension This element is a modifier element. 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
Claim.related.relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference 0..1 Identifier File or case reference
Claim.prescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription This element must be supported. 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
Claim.payee.id 0..1 string Unique id for inter-element referencing
Claim.payee.extension 0..* Extension Additional content defined by implementations
Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
Claim.facility 0..1 Reference(Location) Servicing facility
Claim.careTeam This element must be supported. 0..* BackboneElement Members of the care team
Claim.careTeam.id 0..1 string Unique id for inter-element referencing
Claim.careTeam.extension 0..* Extension Additional content defined by implementations
Claim.careTeam.modifierExtension This element is a modifier element. 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
Claim.careTeam.provider 1..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base | 機構資料-Organization TWSS Base) Practitioner or organization
Claim.careTeam.responsible 0..1 boolean Indicator of the lead practitioner
Claim.careTeam.role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.Slices for supportingInfo This element must be supported. 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code

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.supportingInfo:All Slices Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:All Slices.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base | 個案服務案件-EpisodeOfCare TWSS Base | 健康與障礙狀況-Condition TWSS Base | 補助資格或補助案件-Coverage TWSS Base | 共用公文-DocumentReference TWSS Base)
Claim.Slices for supportingInfo.supportingInfo:All Slices.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:serviceCase This element must be supported. 0..* BackboneElement 服務案件
Claim.Slices for supportingInfo.supportingInfo:serviceCase.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:serviceCase.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:serviceCase.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:serviceCase.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 服務案件 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:serviceCase.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:serviceCase.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:serviceCase.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:serviceCase.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:serviceCase.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:serviceCase.value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:serviceCase.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete This element must be supported. 0..1 BackboneElement 申請人證件備齊日
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.timing[x] 0..1 date When it occurred
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.value[x].valueReference Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:documentsComplete.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:applicationChannel This element must be supported. 0..1 BackboneElement 申請管道
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請管道 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x] 0..1 Data to be provided
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueBoolean boolean
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueString string
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueQuantity Quantity
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueAttachment Attachment
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.value[x].valueReference Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:applicationChannel.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:applicant This element must be supported. 0..1 BackboneElement 申請人
Claim.Slices for supportingInfo.supportingInfo:applicant.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicant.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:applicant.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:applicant.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:applicant.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:applicant.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicant.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請人 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:applicant.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:applicant.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:applicant.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:applicant.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:applicant.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:applicant.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:applicant.value[x] 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Data to be provided
Claim.Slices for supportingInfo.supportingInfo:applicant.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:bankAccount This element must be supported. 0..1 BackboneElement 申請人銀行帳戶
Claim.Slices for supportingInfo.supportingInfo:bankAccount.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:bankAccount.extension 0..* Extension Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:bankAccount.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:bankAccount.sequence 1..1 positiveInt Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding This element is included in summaries. 0..* Coding Code defined by a terminology system
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.id 0..1 string Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.system This element is included in summaries. 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶 (extensions allowed)
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user
Claim.Slices for supportingInfo.supportingInfo:bankAccount.category.text This element is included in summaries. 0..1 string Plain text representation of the concept
Claim.Slices for supportingInfo.supportingInfo:bankAccount.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:bankAccount.timing[x] 0..1 When it occurred
Claim.Slices for supportingInfo.supportingInfo:bankAccount.timing[x].timingDate date
Claim.Slices for supportingInfo.supportingInfo:bankAccount.timing[x].timingPeriod Period
Claim.Slices for supportingInfo.supportingInfo:bankAccount.value[x] 0..1 string Data to be provided
Claim.Slices for supportingInfo.supportingInfo:bankAccount.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
Claim.diagnosis.id 0..1 string Unique id for inter-element referencing
Claim.diagnosis.extension 0..* Extension Additional content defined by implementations
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)
Claim.diagnosis.type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure 0..* BackboneElement Clinical procedures performed
Claim.procedure.id 0..1 string Unique id for inter-element referencing
Claim.procedure.extension 0..* Extension Additional content defined by implementations
Claim.procedure.modifierExtension This element is a modifier element. 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
Claim.procedure.type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date 0..1 dateTime When the procedure was performed
Claim.procedure.procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept CodeableConcept
Claim.procedure.procedure[x].procedureReference Reference(Procedure)
Claim.procedure.udi 0..* Reference(Device) Unique device identifier
Claim.insurance This element must be supported. This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.id 0..1 string Unique id for inter-element referencing
Claim.insurance.extension 0..* Extension Additional content defined by implementations
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal 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
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
Claim.insurance.businessArrangement 0..1 string Additional provider contract number
Claim.insurance.preAuthRef 0..* string Prior authorization reference number
Claim.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results
Claim.accident 0..1 BackboneElement Details of the event
Claim.accident.id 0..1 string Unique id for inter-element referencing
Claim.accident.extension 0..* Extension Additional content defined by implementations
Claim.accident.modifierExtension This element is a modifier element. 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
Claim.accident.type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x] 0..1 Where the event occurred
Claim.accident.location[x].locationAddress Address
Claim.accident.location[x].locationReference Reference(Location)
Claim.item This element must be supported. 0..* BackboneElement Product or service provided
Claim.item.id 0..1 string Unique id for inter-element referencing
Claim.item.extension 0..* Extension Additional content defined by implementations
Claim.item.modifierExtension This element is a modifier element. 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
Claim.item.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.item.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.item.procedureSequence 0..* positiveInt Applicable procedures
Claim.item.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.item.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService This element must be supported. 1..1 CodeableConcept 申請補助項目
Binding: TWSS-申請補助別值集 (required)
Claim.item.modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (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.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x] This element must be supported. 0..1 Date or dates of service or product delivery
Claim.item.serviced[x].servicedDate date
Claim.item.serviced[x].servicedPeriod Period
Claim.item.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept CodeableConcept
Claim.item.location[x].locationAddress Address
Claim.item.location[x].locationReference Reference(Location)
Claim.item.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.unitPrice 0..1 Money Fee, charge or cost per item
Claim.item.factor This element must be supported. 0..1 decimal 補助比率
Claim.item.net This element must be supported. 0..1 Money Total item cost
Claim.item.udi 0..* Reference(Device) Unique device identifier
Claim.item.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.item.detail 0..* BackboneElement Product or service provided
Claim.item.detail.id 0..1 string Unique id for inter-element referencing
Claim.item.detail.extension 0..* Extension Additional content defined by implementations
Claim.item.detail.modifierExtension This element is a modifier element. 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
Claim.item.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.item.detail.factor 0..1 decimal Price scaling factor
Claim.item.detail.net 0..1 Money Total item cost
Claim.item.detail.udi 0..* Reference(Device) Unique device identifier
Claim.item.detail.subDetail 0..* BackboneElement Product or service provided
Claim.item.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension This element is a modifier element. 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
Claim.item.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (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: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.item.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.item.detail.subDetail.net 0..1 Money Total item cost
Claim.item.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.total This element must be supported. 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:serviceCase.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:documentsComplete.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicationChannel.​code Base required TWSS-補助申請管道值集 📦0.0.1 This IG
Claim.supportingInfo:applicationChannel.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicant.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicant.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:applicant.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo:bankAccount.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.4
Claim.item.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base required TWSS-申請補助別值集 📦0.0.1 This IG
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim 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 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-4 error Claim If 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-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
sqty-1 error Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity The comparator is not used on a SimpleQuantity comparator.empty()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

建議應該支援以下查詢參數：

此 Profile 使用 FHIR R4 Claim Resource；伺服端建議（SHOULD）支援以下 FHIR 原生查詢參數： 完整定義請參考 FHIR R4 Claim 原生查詢參數。

查詢參數 類型 查詢範例
_content string GET [base]/_content=[value]
_filter special GET [base]/_filter=[value]
_id token GET [base]/Claim/[id]
_lastUpdated date GET [base]/_lastUpdated=[value]
_profile uri GET [base]/_profile=[value]
_query token GET [base]/_query=[value]
_security token GET [base]/_security=[value]
_source uri GET [base]/_source=[value]
_tag token GET [base]/_tag=[value]
_text string GET [base]/_text=[value]
care-team reference GET [base]/care-team=[value]
created date GET [base]/created=[value]
detail-udi reference GET [base]/detail-udi=[value]
encounter reference GET [base]/encounter=[value]
enterer reference GET [base]/enterer=[value]
facility reference GET [base]/facility=[value]
identifier token GET [base]/identifier=[value]
insurer reference GET [base]/insurer=[value]
item-udi reference GET [base]/item-udi=[value]
patient reference GET [base]/patient=[value]
payee reference GET [base]/payee=[value]
priority token GET [base]/priority=[value]
procedure-udi reference GET [base]/procedure-udi=[value]
provider reference GET [base]/provider=[value]
status token GET [base]/status=[value]
subdetail-udi reference GET [base]/subdetail-udi=[value]
use token GET [base]/use=[value]