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 2026-08-10 Computable Name: ClaimTWSSBase

補助申請或核付明細-Claim TWSS Base Profile 表達社家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: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Business Identifier for claim
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer S 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
... insurer SΣ 0..1 Reference(機構資料-Organization TWSS Base) Target
... provider SΣ 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
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... careTeam S 0..* BackboneElement Members of the care team
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... 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
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
.... supportingInfo:serviceCase S 0..* BackboneElement 服務案件
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
.... supportingInfo:documentsComplete S 0..1 BackboneElement 申請人證件備齊日
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... timing[x] 0..1 date When it occurred
.... supportingInfo:applicationChannel S 0..1 BackboneElement 申請管道
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
.... supportingInfo:applicant S 0..1 BackboneElement 申請人
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... 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
.... supportingInfo:bankAccount S 0..1 BackboneElement 申請人銀行帳戶
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... value[x] 0..1 string Data to be provided
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
... item S 0..* BackboneElement Product or service provided
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... productOrService S 1..1 CodeableConcept 申請補助項目
Binding: USCLSCodes (example): Allowable service and product codes.
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... factor S 0..1 decimal 補助比率
.... net S 0..1 Money Total item cost
... total S 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 example USCLS 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()

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... identifier S 0..* Identifier Business Identifier for claim
... status S 1..1 code active | cancelled | draft | entered-in-error
... type S 1..1 CodeableConcept Category or discipline
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
... billablePeriod S 0..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... enterer S 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
... insurer S 0..1 Reference(機構資料-Organization TWSS Base) Target
... provider S 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
... priority S 1..1 CodeableConcept Desired processing ugency
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
... referral 0..0 Treatment referral
... careTeam S 0..* BackboneElement Members of the care team
.... 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
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
.... supportingInfo:All Slices Content/Rules for all slices
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
.... supportingInfo:serviceCase S 0..* BackboneElement 服務案件
..... category
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case
....... display 0..1 string Representation defined by the system
Required Pattern: 服務案件
..... value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
.... supportingInfo:documentsComplete S 0..1 BackboneElement 申請人證件備齊日
..... category
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete
....... display 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日
..... timing[x] 0..1 date When it occurred
.... supportingInfo:applicationChannel S 0..1 BackboneElement 申請管道
..... category
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel
....... display 0..1 string Representation defined by the system
Required Pattern: 申請管道
..... code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
.... supportingInfo:applicant S 0..1 BackboneElement 申請人
..... category
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant
....... display 0..1 string Representation defined by the system
Required Pattern: 申請人
..... 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
.... supportingInfo:bankAccount S 0..1 BackboneElement 申請人銀行帳戶
..... category
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... code 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account
....... display 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶
..... value[x] 0..1 string Data to be provided
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
... insurance S 1..* BackboneElement Patient insurance information
.... coverage 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
... item S 0..* BackboneElement Product or service provided
.... productOrService S 1..1 CodeableConcept 申請補助項目
.... serviced[x] S 0..1 date, Period Date or dates of service or product delivery
.... factor S 0..1 decimal 補助比率
.... net S 0..1 Money Total item cost
... total S 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
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... 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
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Business Identifier for claim
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer S 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
... insurer SΣ 0..1 Reference(機構資料-Organization TWSS Base) Target
... provider SΣ 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
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... facility 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... 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
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:serviceCase S 0..* BackboneElement 服務案件
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 服務案件
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:documentsComplete S 0..1 BackboneElement 申請人證件備齊日
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 date When it occurred
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:applicationChannel S 0..1 BackboneElement 申請管道
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請管道
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:applicant S 0..1 BackboneElement 申請人
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請人
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... 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
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:bankAccount S 0..1 BackboneElement 申請人銀行帳戶
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 string Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... 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.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 CodeableConcept 申請補助項目
Binding: USCLSCodes (example): Allowable service and product codes.
.... 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.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal 補助比率
.... net S 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... 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.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... 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.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... 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.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... 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.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total S 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 v7.3
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 example USCLS Codes 📍4.0.1 FHIR Std.
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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Business Identifier for claim
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer S 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
... insurer SΣ 0..1 Reference(機構資料-Organization TWSS Base) Target
... provider SΣ 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
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... careTeam S 0..* BackboneElement Members of the care team
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... 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
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
.... supportingInfo:serviceCase S 0..* BackboneElement 服務案件
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
.... supportingInfo:documentsComplete S 0..1 BackboneElement 申請人證件備齊日
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... timing[x] 0..1 date When it occurred
.... supportingInfo:applicationChannel S 0..1 BackboneElement 申請管道
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
.... supportingInfo:applicant S 0..1 BackboneElement 申請人
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... 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
.... supportingInfo:bankAccount S 0..1 BackboneElement 申請人銀行帳戶
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... value[x] 0..1 string Data to be provided
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
... item S 0..* BackboneElement Product or service provided
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... productOrService S 1..1 CodeableConcept 申請補助項目
Binding: USCLSCodes (example): Allowable service and product codes.
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... factor S 0..1 decimal 補助比率
.... net S 0..1 Money Total item cost
... total S 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 example USCLS 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()

Differential View

This structure is derived from Claim

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

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... 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
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 0..* Identifier Business Identifier for claim
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(個案資料-Patient TWSS Base) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer S 0..1 Reference(人員資料-Practitioner TWSS Base | 人員角色-PractitionerRole TWSS Base) Author of the claim
... insurer SΣ 0..1 Reference(機構資料-Organization TWSS Base) Target
... provider SΣ 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
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... facility 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... 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
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... Slices for supportingInfo S 0..* BackboneElement Supporting information
Slice: Unordered, Open by value:category.coding.code
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:serviceCase S 0..* BackboneElement 服務案件
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: service-case
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 服務案件
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Reference(個案服務案件-EpisodeOfCare TWSS Base) Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:documentsComplete S 0..1 BackboneElement 申請人證件備齊日
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: documents-complete
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請人證件備齊日
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 date When it occurred
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:applicationChannel S 0..1 BackboneElement 申請管道
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: application-channel
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請管道
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConceptTW Type of information
Binding: TWSS-補助申請管道值集 (required)
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... 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)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:applicant S 0..1 BackboneElement 申請人
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: applicant
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請人
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... 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
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:bankAccount S 0..1 BackboneElement 申請人銀行帳戶
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-supporting-info-type
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Required Pattern: bank-account
....... display Σ 0..1 string Representation defined by the system
Required Pattern: 申請人銀行帳戶
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 string Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(補助資格或補助案件-Coverage TWSS Base) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... 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.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 CodeableConcept 申請補助項目
Binding: USCLSCodes (example): Allowable service and product codes.
.... 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.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal 補助比率
.... net S 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... 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.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... 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.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... 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.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... 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.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total S 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 v7.3
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 example USCLS Codes 📍4.0.1 FHIR Std.
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()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

建議應該支援以下查詢參數：

  1. 建議（SHOULD） 支援透過查詢參數 _id 查詢所有 Claim： (如何透過 token 查詢)
    GET [base]/Claim?_id=[id]
    GET [base]/Claim/[id]

  2. 建議（SHOULD） 支援透過查詢參數 identifier 查詢所有 Claim： (如何透過 token 查詢)
    GET [base]/Claim?identifier=[system]|[code]

  3. 建議（SHOULD） 支援透過查詢參數 patient 查詢所有 Claim： (如何透過 reference 查詢)
    GET [base]/Claim?patient={Type/}[id]

  4. 建議（SHOULD） 支援透過查詢參數 created 查詢所有 Claim： (如何透過 date 查詢)
    GET [base]/Claim?created={gt|lt|ge|le}[date]