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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: 補助審核或核付結果-ClaimResponse TWSS Base

補助審核或核付結果-ClaimResponse TWSS Base Profile 表達衛生福利部社會及家庭署業務中的補助審核或核付結果。因 TW Core 0.3.2 尚未提供 ClaimResponse Profile，故繼承原生 ClaimResponse，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:

• Refer to this Profile: 個案服務計畫-CarePlan TWSS Base, 共用公文-DocumentReference TWSS Base and 資料建立與修改歷程-Provenance TWSS Base
• Examples for this Profile: ClaimResponse/claimresponse-min
• CapabilityStatements using this Profile: TWSS Base IG 用戶端能力聲明 and TWSS Base IG 伺服端能力聲明

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.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:paymentStatus	S This element must be supported.	0..1	CodeableConceptTW	補助撥款狀況 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status Binding: TWSS-補助撥款狀況值集 (required)
ClaimResponse.Slices for extension.extension:subsidyMonth	S This element must be supported.	0..1	integer	補助月分 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
ClaimResponse.Slices for extension.extension:subsidyPeriod	S This element must be supported.	0..1	(Complex)	實際補助期間 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	0..*	Identifier	核定文號
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ClaimResponse.subType	S This element must be supported.	0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(個案資料-Patient TWSS Base)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	審核日期
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(機構資料-Organization TWSS Base)	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..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
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(補助申請或核付明細-Claim TWSS Base)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition	S This element must be supported.	0..1	string	Disposition Message
ClaimResponse.preAuthRef	S This element must be supported.	0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定起領日
ClaimResponse.preAuthPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定結束日
ClaimResponse.payeeType	S This element must be supported.	0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ClaimResponse.item	S This element must be supported. C	0..*	BackboneElement	Adjudication for claim line items Constraints: TWSSClaimResponseAdjudicationConsistency
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.Slices for adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category.coding.code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for adjudication.adjudication:All Slices				Content/Rules for all slices
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Type of adjudication information Binding: TWSS-補助裁決類別值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.reason	S This element must be supported.	0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.amount	S This element must be supported.	0..1	Money	核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit	S This element must be supported.	0..1	BackboneElement	通過的補助申請及其核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason		1..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-補助核定結果值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.coding	S This element must be supported. Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.amount		1..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial	S This element must be supported.	0..1	BackboneElement	不符原因
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-不符原因值集 (example)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination	S This element must be supported.	0..1	BackboneElement	註銷原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension	S This element must be supported.	0..1	BackboneElement	停發原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.amount		0..1	Money	Monetary amount
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment	S This element must be supported.	0..1	BackboneElement	Payment Details
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number	S This element must be supported.	0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	審核意見說明
ClaimResponse.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(補助資格或補助案件-Coverage TWSS Base)	Insurance information
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	required	TWSS-補助裁決類別值集	📦0.0.1	This IG
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​reason	Base	required	TWSS-補助核定結果值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:eligibilityDenial.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:eligibilityDenial.​reason	Base	example	TWSS-不符原因值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:benefitTermination.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitTermination.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
TWSSClaimResponseAdjudicationConsistency	error	ClaimResponse.item	同一補助申請項目不可同時為通過核定與資格不符。	adjudication.where(category.coding.where(code = 'benefit').exists()).exists() implies adjudication.where(category.coding.where(code = 'eligibility-denial').exists()).empty()
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	ClaimResponse	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	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	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 ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:paymentStatus	S This element must be supported.	0..1	CodeableConceptTW	補助撥款狀況 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status Binding: TWSS-補助撥款狀況值集 (required)
ClaimResponse.Slices for extension.extension:subsidyMonth	S This element must be supported.	0..1	integer	補助月分 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
ClaimResponse.Slices for extension.extension:subsidyPeriod	S This element must be supported.	0..1	(Complex)	實際補助期間 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period
ClaimResponse.identifier	S This element must be supported.	0..*	Identifier	核定文號
ClaimResponse.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error
ClaimResponse.type	S This element must be supported.	1..1	CodeableConcept	More granular claim type
ClaimResponse.subType	S This element must be supported.	0..1	CodeableConcept	More granular claim type
ClaimResponse.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination
ClaimResponse.patient	S This element must be supported.	1..1	Reference(個案資料-Patient TWSS Base)	The recipient of the products and services
ClaimResponse.created	S This element must be supported.	1..1	dateTime	審核日期
ClaimResponse.insurer	S This element must be supported.	1..1	Reference(機構資料-Organization TWSS Base)	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..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
ClaimResponse.request	S This element must be supported.	1..1	Reference(補助申請或核付明細-Claim TWSS Base)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported.	1..1	code	queued | complete | error | partial
ClaimResponse.disposition	S This element must be supported.	0..1	string	Disposition Message
ClaimResponse.preAuthRef	S This element must be supported.	0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	S This element must be supported.	0..1	dateTime	核定起領日
ClaimResponse.preAuthPeriod.end	S This element must be supported.	0..1	dateTime	核定結束日
ClaimResponse.payeeType	S This element must be supported.	0..1	CodeableConcept	Party to be paid any benefits payable
ClaimResponse.item	S This element must be supported. C	0..*	BackboneElement	Adjudication for claim line items Constraints: TWSSClaimResponseAdjudicationConsistency
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.Slices for adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category.coding.code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for adjudication.adjudication:All Slices				Content/Rules for all slices
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Type of adjudication information Binding: TWSS-補助裁決類別值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.reason	S This element must be supported.	0..1	CodeableConcept	Explanation of adjudication outcome
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.amount	S This element must be supported.	0..1	Money	核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit	S This element must be supported.	0..1	BackboneElement	通過的補助申請及其核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/adjudication (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: benefit (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason		1..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-補助核定結果值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.coding	S This element must be supported.	1..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.amount		1..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial	S This element must be supported.	0..1	BackboneElement	不符原因
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: eligibility-denial (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-不符原因值集 (example)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.text	S This element must be supported.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination	S This element must be supported.	0..1	BackboneElement	註銷原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-termination (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.text	S This element must be supported.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension	S This element must be supported.	0..1	BackboneElement	停發原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-suspension (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.text	S This element must be supported.	1..1	string	Plain text representation of the concept
ClaimResponse.total	S This element must be supported.	0..*	BackboneElement	Adjudication totals
ClaimResponse.payment	S This element must be supported.	0..1	BackboneElement	Payment Details
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.number	S This element must be supported.	0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	審核意見說明
ClaimResponse.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.coverage		1..1	Reference(補助資格或補助案件-Coverage TWSS Base)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.item.adjudication.​category	Base	required	TWSS-補助裁決類別值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:approvedBenefit.​reason	Base	required	TWSS-補助核定結果值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:eligibilityDenial.​reason	Base	example	TWSS-不符原因值集	📦0.0.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
TWSSClaimResponseAdjudicationConsistency	error	ClaimResponse.item	同一補助申請項目不可同時為通過核定與資格不符。	adjudication.where(category.coding.where(code = 'benefit').exists()).exists() implies adjudication.where(category.coding.where(code = 'eligibility-denial').exists()).empty()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.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
ClaimResponse.contained		0..*	Resource	Contained, inline Resources
ClaimResponse.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:paymentStatus	S This element must be supported.	0..1	CodeableConceptTW	補助撥款狀況 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status Binding: TWSS-補助撥款狀況值集 (required)
ClaimResponse.Slices for extension.extension:subsidyMonth	S This element must be supported.	0..1	integer	補助月分 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
ClaimResponse.Slices for extension.extension:subsidyPeriod	S This element must be supported.	0..1	(Complex)	實際補助期間 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	0..*	Identifier	核定文號
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ClaimResponse.subType	S This element must be supported.	0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(個案資料-Patient TWSS Base)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	審核日期
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(機構資料-Organization TWSS Base)	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..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
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(補助申請或核付明細-Claim TWSS Base)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition	S This element must be supported.	0..1	string	Disposition Message
ClaimResponse.preAuthRef	S This element must be supported.	0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.preAuthPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.preAuthPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定起領日
ClaimResponse.preAuthPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定結束日
ClaimResponse.payeeType	S This element must be supported.	0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ClaimResponse.item	S This element must be supported. C	0..*	BackboneElement	Adjudication for claim line items Constraints: TWSSClaimResponseAdjudicationConsistency
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.Slices for adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category.coding.code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for adjudication.adjudication:All Slices				Content/Rules for all slices
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Type of adjudication information Binding: TWSS-補助裁決類別值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.reason	S This element must be supported.	0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.amount	S This element must be supported.	0..1	Money	核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit	S This element must be supported.	0..1	BackboneElement	通過的補助申請及其核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/adjudication (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: benefit (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason		1..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-補助核定結果值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.coding	S This element must be supported. Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.amount		1..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial	S This element must be supported.	0..1	BackboneElement	不符原因
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: eligibility-denial (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-不符原因值集 (example)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination	S This element must be supported.	0..1	BackboneElement	註銷原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-termination (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension	S This element must be supported.	0..1	BackboneElement	停發原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-suspension (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		0..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.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.
ClaimResponse.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate			date
ClaimResponse.addItem.serviced[x].servicedPeriod			Period
ClaimResponse.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept			CodeableConcept
ClaimResponse.addItem.location[x].locationAddress			Address
ClaimResponse.addItem.location[x].locationReference			Reference(Location)
ClaimResponse.addItem.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment	S This element must be supported.	0..1	BackboneElement	Payment Details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ClaimResponse.payment.date		0..1	date	Expected date of payment
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
ClaimResponse.form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number	S This element must be supported.	0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	審核意見說明
ClaimResponse.processNote.language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(補助資格或補助案件-Coverage TWSS Base)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		0..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		0..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	required	TWSS-補助裁決類別值集	📦0.0.1	This IG
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​reason	Base	required	TWSS-補助核定結果值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:eligibilityDenial.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:eligibilityDenial.​reason	Base	example	TWSS-不符原因值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:benefitTermination.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitTermination.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
TWSSClaimResponseAdjudicationConsistency	error	ClaimResponse.item	同一補助申請項目不可同時為通過核定與資格不符。	adjudication.where(category.coding.where(code = 'benefit').exists()).exists() implies adjudication.where(category.coding.where(code = 'eligibility-denial').exists()).empty()
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	ClaimResponse	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	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	ClaimResponse.addItem.quantity, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from ClaimResponse

Summary

Mandatory: 1 element(9 nested mandatory elements)
Must-Support: 41 elements

Structures

This structure refers to these other structures:

• 個案資料-Patient TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Patient-twss-base)
• 機構資料-Organization TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Organization-twss-base)
• 人員資料-Practitioner TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Practitioner-twss-base)
• 人員角色-PractitionerRole TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/PractitionerRole-twss-base)
• 補助申請或核付明細-Claim TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Claim-twss-base)
• 補助資格或補助案件-Coverage TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Coverage-twss-base)

Extensions

This structure refers to these extensions:

• https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status
• https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
• https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.item.adjudication

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:paymentStatus	S This element must be supported.	0..1	CodeableConceptTW	補助撥款狀況 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status Binding: TWSS-補助撥款狀況值集 (required)
ClaimResponse.Slices for extension.extension:subsidyMonth	S This element must be supported.	0..1	integer	補助月分 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
ClaimResponse.Slices for extension.extension:subsidyPeriod	S This element must be supported.	0..1	(Complex)	實際補助期間 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	0..*	Identifier	核定文號
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ClaimResponse.subType	S This element must be supported.	0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(個案資料-Patient TWSS Base)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	審核日期
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(機構資料-Organization TWSS Base)	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..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
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(補助申請或核付明細-Claim TWSS Base)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition	S This element must be supported.	0..1	string	Disposition Message
ClaimResponse.preAuthRef	S This element must be supported.	0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定起領日
ClaimResponse.preAuthPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定結束日
ClaimResponse.payeeType	S This element must be supported.	0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ClaimResponse.item	S This element must be supported. C	0..*	BackboneElement	Adjudication for claim line items Constraints: TWSSClaimResponseAdjudicationConsistency
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.Slices for adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category.coding.code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for adjudication.adjudication:All Slices				Content/Rules for all slices
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Type of adjudication information Binding: TWSS-補助裁決類別值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.reason	S This element must be supported.	0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.amount	S This element must be supported.	0..1	Money	核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit	S This element must be supported.	0..1	BackboneElement	通過的補助申請及其核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason		1..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-補助核定結果值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.coding	S This element must be supported. Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.amount		1..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial	S This element must be supported.	0..1	BackboneElement	不符原因
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-不符原因值集 (example)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination	S This element must be supported.	0..1	BackboneElement	註銷原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension	S This element must be supported.	0..1	BackboneElement	停發原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.amount		0..1	Money	Monetary amount
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment	S This element must be supported.	0..1	BackboneElement	Payment Details
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number	S This element must be supported.	0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	審核意見說明
ClaimResponse.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(補助資格或補助案件-Coverage TWSS Base)	Insurance information
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	required	TWSS-補助裁決類別值集	📦0.0.1	This IG
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​reason	Base	required	TWSS-補助核定結果值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:eligibilityDenial.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:eligibilityDenial.​reason	Base	example	TWSS-不符原因值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:benefitTermination.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitTermination.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
TWSSClaimResponseAdjudicationConsistency	error	ClaimResponse.item	同一補助申請項目不可同時為通過核定與資格不符。	adjudication.where(category.coding.where(code = 'benefit').exists()).exists() implies adjudication.where(category.coding.where(code = 'eligibility-denial').exists()).empty()
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	ClaimResponse	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	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	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 ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:paymentStatus	S This element must be supported.	0..1	CodeableConceptTW	補助撥款狀況 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status Binding: TWSS-補助撥款狀況值集 (required)
ClaimResponse.Slices for extension.extension:subsidyMonth	S This element must be supported.	0..1	integer	補助月分 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
ClaimResponse.Slices for extension.extension:subsidyPeriod	S This element must be supported.	0..1	(Complex)	實際補助期間 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period
ClaimResponse.identifier	S This element must be supported.	0..*	Identifier	核定文號
ClaimResponse.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error
ClaimResponse.type	S This element must be supported.	1..1	CodeableConcept	More granular claim type
ClaimResponse.subType	S This element must be supported.	0..1	CodeableConcept	More granular claim type
ClaimResponse.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination
ClaimResponse.patient	S This element must be supported.	1..1	Reference(個案資料-Patient TWSS Base)	The recipient of the products and services
ClaimResponse.created	S This element must be supported.	1..1	dateTime	審核日期
ClaimResponse.insurer	S This element must be supported.	1..1	Reference(機構資料-Organization TWSS Base)	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..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
ClaimResponse.request	S This element must be supported.	1..1	Reference(補助申請或核付明細-Claim TWSS Base)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported.	1..1	code	queued | complete | error | partial
ClaimResponse.disposition	S This element must be supported.	0..1	string	Disposition Message
ClaimResponse.preAuthRef	S This element must be supported.	0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	S This element must be supported.	0..1	dateTime	核定起領日
ClaimResponse.preAuthPeriod.end	S This element must be supported.	0..1	dateTime	核定結束日
ClaimResponse.payeeType	S This element must be supported.	0..1	CodeableConcept	Party to be paid any benefits payable
ClaimResponse.item	S This element must be supported. C	0..*	BackboneElement	Adjudication for claim line items Constraints: TWSSClaimResponseAdjudicationConsistency
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.Slices for adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category.coding.code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for adjudication.adjudication:All Slices				Content/Rules for all slices
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Type of adjudication information Binding: TWSS-補助裁決類別值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.reason	S This element must be supported.	0..1	CodeableConcept	Explanation of adjudication outcome
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.amount	S This element must be supported.	0..1	Money	核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit	S This element must be supported.	0..1	BackboneElement	通過的補助申請及其核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/adjudication (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: benefit (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason		1..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-補助核定結果值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.coding	S This element must be supported.	1..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.amount		1..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial	S This element must be supported.	0..1	BackboneElement	不符原因
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: eligibility-denial (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-不符原因值集 (example)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.text	S This element must be supported.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination	S This element must be supported.	0..1	BackboneElement	註銷原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-termination (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.text	S This element must be supported.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension	S This element must be supported.	0..1	BackboneElement	停發原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.system		0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.code		1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-suspension (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.text	S This element must be supported.	1..1	string	Plain text representation of the concept
ClaimResponse.total	S This element must be supported.	0..*	BackboneElement	Adjudication totals
ClaimResponse.payment	S This element must be supported.	0..1	BackboneElement	Payment Details
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.number	S This element must be supported.	0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	審核意見說明
ClaimResponse.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.coverage		1..1	Reference(補助資格或補助案件-Coverage TWSS Base)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.item.adjudication.​category	Base	required	TWSS-補助裁決類別值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:approvedBenefit.​reason	Base	required	TWSS-補助核定結果值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:eligibilityDenial.​reason	Base	example	TWSS-不符原因值集	📦0.0.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
TWSSClaimResponseAdjudicationConsistency	error	ClaimResponse.item	同一補助申請項目不可同時為通過核定與資格不符。	adjudication.where(category.coding.where(code = 'benefit').exists()).exists() implies adjudication.where(category.coding.where(code = 'eligibility-denial').exists()).empty()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.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
ClaimResponse.contained		0..*	Resource	Contained, inline Resources
ClaimResponse.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:paymentStatus	S This element must be supported.	0..1	CodeableConceptTW	補助撥款狀況 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status Binding: TWSS-補助撥款狀況值集 (required)
ClaimResponse.Slices for extension.extension:subsidyMonth	S This element must be supported.	0..1	integer	補助月分 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
ClaimResponse.Slices for extension.extension:subsidyPeriod	S This element must be supported.	0..1	(Complex)	實際補助期間 URL: https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	0..*	Identifier	核定文號
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ClaimResponse.subType	S This element must be supported.	0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(個案資料-Patient TWSS Base)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	審核日期
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(機構資料-Organization TWSS Base)	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..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
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(補助申請或核付明細-Claim TWSS Base)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition	S This element must be supported.	0..1	string	Disposition Message
ClaimResponse.preAuthRef	S This element must be supported.	0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.preAuthPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.preAuthPeriod.start	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定起領日
ClaimResponse.preAuthPeriod.end	S This element must be supported. Σ This element is included in summaries. C	0..1	dateTime	核定結束日
ClaimResponse.payeeType	S This element must be supported.	0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ClaimResponse.item	S This element must be supported. C	0..*	BackboneElement	Adjudication for claim line items Constraints: TWSSClaimResponseAdjudicationConsistency
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.Slices for adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category.coding.code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.Slices for adjudication.adjudication:All Slices				Content/Rules for all slices
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.category	S This element must be supported.	1..1	CodeableConcept	Type of adjudication information Binding: TWSS-補助裁決類別值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.reason	S This element must be supported.	0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.amount	S This element must be supported.	0..1	Money	核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:All Slices.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit	S This element must be supported.	0..1	BackboneElement	通過的補助申請及其核定補助金額
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/adjudication (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: benefit (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason		1..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-補助核定結果值集 (required)
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.coding	S This element must be supported. Σ This element is included in summaries.	1..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.reason.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.amount		1..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:approvedBenefit.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial	S This element must be supported.	0..1	BackboneElement	不符原因
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: eligibility-denial (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: TWSS-不符原因值集 (example)
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.reason.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:eligibilityDenial.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination	S This element must be supported.	0..1	BackboneElement	註銷原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-termination (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitTermination.value		0..1	decimal	Non-monetary value
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension	S This element must be supported.	0..1	BackboneElement	停發原因
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://sfaa.gov.tw/base/CodeSystem/twss-claim-adjudication-category (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system Required Pattern: benefit-suspension (extensions allowed)
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.reason.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	Plain text representation of the concept
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.amount		0..1	Money	Monetary amount
ClaimResponse.item.Slices for adjudication.adjudication:benefitSuspension.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		0..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.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.
ClaimResponse.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate			date
ClaimResponse.addItem.serviced[x].servicedPeriod			Period
ClaimResponse.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept			CodeableConcept
ClaimResponse.addItem.location[x].locationAddress			Address
ClaimResponse.addItem.location[x].locationReference			Reference(Location)
ClaimResponse.addItem.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment	S This element must be supported.	0..1	BackboneElement	Payment Details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ClaimResponse.payment.date		0..1	date	Expected date of payment
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
ClaimResponse.form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number	S This element must be supported.	0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	審核意見說明
ClaimResponse.processNote.language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(補助資格或補助案件-Coverage TWSS Base)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		0..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		0..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	required	TWSS-補助裁決類別值集	📦0.0.1	This IG
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:approvedBenefit.​reason	Base	required	TWSS-補助核定結果值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:eligibilityDenial.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:eligibilityDenial.​reason	Base	example	TWSS-不符原因值集	📦0.0.1	This IG
ClaimResponse.item.adjudication:benefitTermination.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitTermination.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication:benefitSuspension.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
TWSSClaimResponseAdjudicationConsistency	error	ClaimResponse.item	同一補助申請項目不可同時為通過核定與資格不符。	adjudication.where(category.coding.where(code = 'benefit').exists()).exists() implies adjudication.where(category.coding.where(code = 'eligibility-denial').exists()).empty()
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	ClaimResponse	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	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	ClaimResponse.addItem.quantity, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from ClaimResponse

Summary

Mandatory: 1 element(9 nested mandatory elements)
Must-Support: 41 elements

Structures

This structure refers to these other structures:

• 個案資料-Patient TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Patient-twss-base)
• 機構資料-Organization TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Organization-twss-base)
• 人員資料-Practitioner TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Practitioner-twss-base)
• 人員角色-PractitionerRole TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/PractitionerRole-twss-base)
• 補助申請或核付明細-Claim TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Claim-twss-base)
• 補助資格或補助案件-Coverage TWSS Base (https://sfaa.gov.tw/base/StructureDefinition/Coverage-twss-base)

Extensions

This structure refers to these extensions:

• https://sfaa.gov.tw/base/StructureDefinition/twss-claim-payment-status
• https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-month
• https://sfaa.gov.tw/base/StructureDefinition/twss-claim-subsidy-period

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.item.adjudication