HL7 Vietnam VN Core FHIR Implementation Guide

Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam
0.5.0 - Draft for Community Review

Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam - Local Development build (v0.5.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Hồ sơ tài nguyên: Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile

URL chính thức: http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim | Phiên bản: 0.5.0 | Làm nổi bật phần thay đổi?
| Computable Name: VNCoreClaim
Bản quyền/Pháp lý: Căn cứ pháp lý Việt Nam: Luật 25/2008/QH12 ngày 14/11/2008; Luật 51/2024/QH15 ngày 27/11/2024; NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025; NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective); QĐ 3176/QĐ-BYT ngày 29/10/2024; QĐ 697/QĐ-BYT ngày 19/03/2026.

Profile Claim cho Việt Nam. Dùng cho yêu cầu thanh toán chi phí khám chữa bệnh BHYT. Mapping từ chuẩn dữ liệu đầu ra phục vụ BHXH hiện hành (QĐ 130 → QĐ 4750 → QĐ 3176). Bảng kê chi phí theo QĐ 697/QĐ-BYT (19/3/2026) — 12 danh mục, 14 mã. Căn cứ:

- QĐ 130/QĐ-BYT (2023) — Chuẩn dữ liệu đầu ra phục vụ BHXH
- QĐ 4750/QĐ-BYT (2023) — Sửa đổi QĐ 130
- QĐ 3176/QĐ-BYT (29/10/2024) — Sửa đổi QĐ 4750
- QĐ 697/QĐ-BYT (19/3/2026) — Mẫu bảng kê chi phí KCB (thay QĐ 6556)
- NĐ 188/2025/NĐ-CP — ban hành 01/07/2025, hiệu lực 15/08/2025 — Hướng dẫn thi hành Luật BHYT, Điều 15 về giá trị sử dụng thẻ và Điều 22 về nhiều thẻ BHYT
- NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) — Xử phạt vi phạm hành chính trong lĩnh vực y tế khi hồ sơ/chứng từ BHYT sai quy định
- Luật BHYT 2008 sửa đổi 2014
- Luật 25/2008/QH12 ngày 14/11/2008 về BHYT; Luật 51/2024/QH15 ngày 27/11/2024 sửa đổi Luật BHYT Nguồn TVPL: NĐ 188/2025/NĐ-CP https://thuvienphapluat.vn/van-ban/Bao-hiem/Nghi-dinh-188-2025-ND-CP-huong-dan-Luat-Bao-hiem-y-te-641049.aspx; NĐ 90/2026/NĐ-CP https://thuvienphapluat.vn/van-ban/Vi-pham-hanh-chinh/Nghi-dinh-sua-doi-Nghi-dinh-117-2020-ND-CP-xu-phat-vi-pham-hanh-chinh-trong-linh-vuc-y-te-639959.aspx

Usages:

- Refer to this Profile: Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile and Quyết toán BHYT VN Core — VN Core Payment Reconciliation Profile
- Examples for this Profile: Claim/ExampleClaimBHYT, Claim/ExampleClaimMultiService and Claim/ExampleClaimSelfPay
- CapabilityStatements using this Profile: VN Core BHYT Gateway Client CapabilityStatement, VN Core BHYT Gateway Server CapabilityStatement and VN Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Các dạng xem hình thức của nội dung hồ sơ

Mô tả profile, differential, snapshot và các biểu diễn liên quan.

- Bảng phần tử chính
- Bảng Differential
- Bảng Snapshot
- Thống kê/Tham chiếu
- Tất cả

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:costSummary | S | 0..1 | (Complex) | Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
extension:paymentPeriod |  | 0..1 | (Complex) | Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod |  | 0..1 | CodeableConcept | Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S | 1..* | Identifier | Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system
identifier:MALK | S | 1..1 | Identifier | Mã liên kết hồ sơ (MA_LK)
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MA_LK
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value | S Σ | 1..1 | string | Giá trị MA_LK Example General: 123456
status | ?!S Σ | 1..1 | code | Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 1..1 | CodeableConcept | Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType | S | 0..1 | CodeableConcept | Mã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible)
use | S Σ | 1..1 | code | Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Bệnh nhân (XML 3176: MA_BN)
created | S Σ | 1..1 | dateTime | Ngày tạo yêu cầu
insurer | S Σ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan BHXH thanh toán
provider | S Σ | 1..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) | Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
priority | Σ | 1..1 | CodeableConcept | Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
diagnosis | S | 1..* | BackboneElement | Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 |  | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
diagnosis[x]:diagnosisCodeableConcept | S | 0..1 | CodeableConcept | Mã bệnh ICD-10 VN (QĐ 4469/QĐ-BYT) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type | S | 0..* | CodeableConcept | Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
procedure |  | 0..* | BackboneElement | Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
Slices for procedure[x] |  | 1..1 |  | Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure[x]:procedureCodeableConcept |  | 0..1 | CodeableConcept | Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance | S Σ | 1..* | BackboneElement | Thông tin BHYT (XML 3176: MA_THE)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | S Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | S Σ | 1..1 | Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) | Thẻ BHYT (Coverage)
accident |  | 0..1 | BackboneElement | Thông tin tai nạn thương tích
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | Loại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item | S | 1..* | BackboneElement | Chi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:department |  | 0..1 | CodeableConcept | Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup |  | 0..1 | CodeableConcept | Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope |  | 0..1 | CodeableConcept | Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo |  | 0..1 | (Complex) | BHYT: phạm vi, tỷ lệ TT, mức hưởng URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:paymentSource |  | 0..1 | CodeableConcept | Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit |  | 0..1 | boolean | Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo |  | 0..1 | string | Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod |  | 0..1 | string | Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Item instance identifier
category | S | 0..1 | CodeableConcept | Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService | S | 1..1 | CodeableConcept | Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Số lượng
unitPrice |  | 0..1 | Money | Đơn giá
net | S | 0..1 | Money | Thành tiền
total | S | 0..1 | Money | Tổng chi phí (XML 3176: T_TONGCHI)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.identifier:MALK.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:MALK.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.subType | Base | extensible | Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet | 📦0.5.0 | This IG
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | Base | extensible | Mã chẩn đoán — VN Core Condition Code ValueSet | 📦0.5.0 | This IG
Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept | Base | extensible | Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet | 📦0.5.0 | This IG
Claim.accident.type | Base | extensible | Mã tai nạn thương tích — Vietnam Accident Type ValueSet | 📦0.5.0 | This IG
Claim.item.category | Base | extensible | Danh mục chi phí KCB — Vietnam Cost Category ValueSet | 📦0.5.0 | This IG
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
vn-claim-coverage-not-expired | warning | Claim | Cảnh báo: thẻ BHYT focal có thể đã hết hạn tại thời điểm tạo Claim — per NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ15 | `insurance.where(focal = true).coverage.resolve().period.end.all($this >= %resource.created)`
vn-claim-single-focal-insurance | error | Claim | Phải có đúng 1 thẻ BHYT chính (focal=true). Các thẻ bổ trợ dùng focal=false — per QĐ 697/QĐ-BYT ngày 19/03/2026 cột 13, NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ22; sai hồ sơ/chứng từ BHYT có thể bị xử phạt theo NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) | `insurance.where(focal = true).count() = 1`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
meta |  | 0..1 | Meta | Metadata about the resource
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:costSummary | S | 0..1 | (Complex) | Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
extension:paymentPeriod |  | 0..1 | (Complex) | Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod |  | 0..1 | CodeableConcept | Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible)
Slices for identifier | S | 1..* | Identifier | Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system
identifier:MALK | S | 1..1 | Identifier | Mã liên kết hồ sơ (MA_LK)
type |  | 0..1 | CodeableConcept | Description of identifier Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MA_LK
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value | S | 1..1 | string | Giá trị MA_LK
status | S | 1..1 | code | Trạng thái yêu cầu thanh toán
type | S | 1..1 | CodeableConcept | Loại yêu cầu: institutional (nội trú), professional (ngoại trú)
subType | S | 0..1 | CodeableConcept | Mã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible)
use | S | 1..1 | code | Mục đích: claim (thanh toán) | preauthorization | predetermination
patient | S | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Bệnh nhân (XML 3176: MA_BN)
created | S | 1..1 | dateTime | Ngày tạo yêu cầu
insurer | S | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan BHXH thanh toán
provider | S | 1..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) | Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
priority |  | 1..1 | CodeableConcept | Mức ưu tiên xử lý
diagnosis | S | 1..* | BackboneElement | Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Slice: Unordered, Open by type:$this
diagnosis[x]:diagnosisCodeableConcept | S | 0..1 | CodeableConcept | Mã bệnh ICD-10 VN (QĐ 4469/QĐ-BYT) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type | S | 0..* | CodeableConcept | Loại chẩn đoán (chính/phụ)
procedure |  | 0..* | BackboneElement | Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
Slices for procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Slice: Unordered, Open by type:$this
procedure[x]:procedureCodeableConcept |  | 0..1 | CodeableConcept | Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance | S | 1..* | BackboneElement | Thông tin BHYT (XML 3176: MA_THE)
focal | S | 1..1 | boolean | Coverage to be used for adjudication
coverage | S | 1..1 | Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) | Thẻ BHYT (Coverage)
accident |  | 0..1 | BackboneElement | Thông tin tai nạn thương tích
type |  | 0..1 | CodeableConcept | Loại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item | S | 1..* | BackboneElement | Chi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:department |  | 0..1 | CodeableConcept | Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup |  | 0..1 | CodeableConcept | Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope |  | 0..1 | CodeableConcept | Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo |  | 0..1 | (Complex) | BHYT: phạm vi, tỷ lệ TT, mức hưởng URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:paymentSource |  | 0..1 | CodeableConcept | Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit |  | 0..1 | boolean | Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo |  | 0..1 | string | Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod |  | 0..1 | string | Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method
sequence | S | 1..1 | positiveInt | Item instance identifier
category | S | 0..1 | CodeableConcept | Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService | S | 1..1 | CodeableConcept | Mã dịch vụ/thuốc/TBYT
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Số lượng
unitPrice |  | 0..1 | Money | Đơn giá
net | S | 0..1 | Money | Thành tiền
total | S | 0..1 | Money | Tổng chi phí (XML 3176: T_TONGCHI)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.subType | Base | extensible | Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet | 📦0.5.0 | This IG
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | Base | extensible | Mã chẩn đoán — VN Core Condition Code ValueSet | 📦0.5.0 | This IG
Claim.procedure.procedure[x]:procedureCodeableConcept | Base | extensible | Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet | 📦0.5.0 | This IG
Claim.accident.type | Base | extensible | Mã tai nạn thương tích — Vietnam Accident Type ValueSet | 📦0.5.0 | This IG
Claim.item.category | Base | extensible | Danh mục chi phí KCB — Vietnam Cost Category ValueSet | 📦0.5.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
vn-claim-coverage-not-expired | warning | Claim | Cảnh báo: thẻ BHYT focal có thể đã hết hạn tại thời điểm tạo Claim — per NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ15 | `insurance.where(focal = true).coverage.resolve().period.end.all($this >= %resource.created)`
vn-claim-single-focal-insurance | error | Claim | Phải có đúng 1 thẻ BHYT chính (focal=true). Các thẻ bổ trợ dùng focal=false — per QĐ 697/QĐ-BYT ngày 19/03/2026 cột 13, NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ22; sai hồ sơ/chứng từ BHYT có thể bị xử phạt theo NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) | `insurance.where(focal = true).count() = 1`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:costSummary | S | 0..1 | (Complex) | Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
extension:paymentPeriod |  | 0..1 | (Complex) | Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod |  | 0..1 | CodeableConcept | Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S | 1..* | Identifier | Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system
identifier:MALK | S | 1..1 | Identifier | Mã liên kết hồ sơ (MA_LK)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MA_LK
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value | S Σ | 1..1 | string | Giá trị MA_LK Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
status | ?!S Σ | 1..1 | code | Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 1..1 | CodeableConcept | Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType | S | 0..1 | CodeableConcept | Mã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible)
use | S Σ | 1..1 | code | Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Bệnh nhân (XML 3176: MA_BN)
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
created | S Σ | 1..1 | dateTime | Ngày tạo yêu cầu
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | S Σ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan BHXH thanh toán
provider | S Σ | 1..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) | Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
priority | Σ | 1..1 | CodeableConcept | Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(Location) | Servicing facility
careTeam |  | 0..* | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo |  | 0..* | BackboneElement | Supporting information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis | S | 1..* | BackboneElement | Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 |  | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
diagnosis[x]:diagnosisCodeableConcept | S | 0..1 | CodeableConcept | Mã bệnh ICD-10 VN (QĐ 4469/QĐ-BYT) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type | S | 0..* | CodeableConcept | Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure |  | 0..* | BackboneElement | Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
Slices for procedure[x] |  | 1..1 |  | Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure[x]:procedureCodeableConcept |  | 0..1 | CodeableConcept | Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | S Σ | 1..* | BackboneElement | Thông tin BHYT (XML 3176: MA_THE)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | S Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | S Σ | 1..1 | Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) | Thẻ BHYT (Coverage)
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident |  | 0..1 | BackboneElement | Thông tin tai nạn thương tích
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | Loại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
location[x] |  | 0..1 |  | Where the event occurred
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
item | S | 1..* | BackboneElement | Chi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:department |  | 0..1 | CodeableConcept | Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup |  | 0..1 | CodeableConcept | Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope |  | 0..1 | CodeableConcept | Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo |  | 0..1 | (Complex) | BHYT: phạm vi, tỷ lệ TT, mức hưởng URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:paymentSource |  | 0..1 | CodeableConcept | Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit |  | 0..1 | boolean | Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo |  | 0..1 | string | Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod |  | 0..1 | string | Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Item instance identifier
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category | S | 0..1 | CodeableConcept | Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService | S | 1..1 | CodeableConcept | Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] |  | 0..1 |  | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Số lượng
unitPrice |  | 0..1 | Money | Đơn giá
factor |  | 0..1 | decimal | Price scaling factor
net | S | 0..1 | Money | Thành tiền
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total | S | 0..1 | Money | Tổng chi phí (XML 3176: T_TONGCHI)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Claim.identifier:MALK.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:MALK.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.subType | Base | extensible | Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet | 📦0.5.0 | This IG
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | example | Claim Care Team Role Codes | 📍4.0.1 | FHIR Std.
Claim.careTeam.qualification | Base | example | Example Provider Qualification Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | Base | extensible | Mã chẩn đoán — VN Core Condition Code ValueSet | 📦0.5.0 | This IG
Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.type | Base | example | Example Procedure Type Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept | Base | extensible | Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet | 📦0.5.0 | This IG
Claim.accident.type | Base | extensible | Mã tai nạn thương tích — Vietnam Accident Type ValueSet | 📦0.5.0 | This IG
Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.category | Base | extensible | Danh mục chi phí KCB — Vietnam Cost Category ValueSet | 📦0.5.0 | This IG
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std.
Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
vn-claim-coverage-not-expired | warning | Claim | Cảnh báo: thẻ BHYT focal có thể đã hết hạn tại thời điểm tạo Claim — per NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ15 | `insurance.where(focal = true).coverage.resolve().period.end.all($this >= %resource.created)`
vn-claim-single-focal-insurance | error | Claim | Phải có đúng 1 thẻ BHYT chính (focal=true). Các thẻ bổ trợ dùng focal=false — per QĐ 697/QĐ-BYT ngày 19/03/2026 cột 13, NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ22; sai hồ sơ/chứng từ BHYT có thể bị xử phạt theo NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) | `insurance.where(focal = true).count() = 1`

Summary

Mandatory: 6 elements
Must-Support: 25 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- Bệnh nhân VN Core — VN Core Patient Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)
- Cơ sở y tế VN Core — VN Core Organization Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization)
- Nhân viên y tế VN Core — VN Core Practitioner Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner)
- Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role)
- Thẻ BHYT VN Core — VN Core Coverage Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)

Extensions

This structure refers to these extensions:

- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the values of Claim.identifier
- The element 1 is sliced based on the values of Claim.diagnosis.diagnosis[x]
- The element 1 is sliced based on the values of Claim.procedure.procedure[x]

Dạng xem phần tử chính

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:costSummary | S | 0..1 | (Complex) | Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
extension:paymentPeriod |  | 0..1 | (Complex) | Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod |  | 0..1 | CodeableConcept | Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S | 1..* | Identifier | Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system
identifier:MALK | S | 1..1 | Identifier | Mã liên kết hồ sơ (MA_LK)
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MA_LK
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value | S Σ | 1..1 | string | Giá trị MA_LK Example General: 123456
status | ?!S Σ | 1..1 | code | Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 1..1 | CodeableConcept | Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType | S | 0..1 | CodeableConcept | Mã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible)
use | S Σ | 1..1 | code | Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Bệnh nhân (XML 3176: MA_BN)
created | S Σ | 1..1 | dateTime | Ngày tạo yêu cầu
insurer | S Σ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan BHXH thanh toán
provider | S Σ | 1..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) | Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
priority | Σ | 1..1 | CodeableConcept | Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
diagnosis | S | 1..* | BackboneElement | Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 |  | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
diagnosis[x]:diagnosisCodeableConcept | S | 0..1 | CodeableConcept | Mã bệnh ICD-10 VN (QĐ 4469/QĐ-BYT) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type | S | 0..* | CodeableConcept | Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
procedure |  | 0..* | BackboneElement | Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
Slices for procedure[x] |  | 1..1 |  | Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure[x]:procedureCodeableConcept |  | 0..1 | CodeableConcept | Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance | S Σ | 1..* | BackboneElement | Thông tin BHYT (XML 3176: MA_THE)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | S Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | S Σ | 1..1 | Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) | Thẻ BHYT (Coverage)
accident |  | 0..1 | BackboneElement | Thông tin tai nạn thương tích
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | Loại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item | S | 1..* | BackboneElement | Chi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:department |  | 0..1 | CodeableConcept | Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup |  | 0..1 | CodeableConcept | Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope |  | 0..1 | CodeableConcept | Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo |  | 0..1 | (Complex) | BHYT: phạm vi, tỷ lệ TT, mức hưởng URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:paymentSource |  | 0..1 | CodeableConcept | Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit |  | 0..1 | boolean | Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo |  | 0..1 | string | Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod |  | 0..1 | string | Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Item instance identifier
category | S | 0..1 | CodeableConcept | Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService | S | 1..1 | CodeableConcept | Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Số lượng
unitPrice |  | 0..1 | Money | Đơn giá
net | S | 0..1 | Money | Thành tiền
total | S | 0..1 | Money | Tổng chi phí (XML 3176: T_TONGCHI)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.identifier:MALK.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:MALK.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.subType | Base | extensible | Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet | 📦0.5.0 | This IG
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | Base | extensible | Mã chẩn đoán — VN Core Condition Code ValueSet | 📦0.5.0 | This IG
Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept | Base | extensible | Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet | 📦0.5.0 | This IG
Claim.accident.type | Base | extensible | Mã tai nạn thương tích — Vietnam Accident Type ValueSet | 📦0.5.0 | This IG
Claim.item.category | Base | extensible | Danh mục chi phí KCB — Vietnam Cost Category ValueSet | 📦0.5.0 | This IG
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
vn-claim-coverage-not-expired | warning | Claim | Cảnh báo: thẻ BHYT focal có thể đã hết hạn tại thời điểm tạo Claim — per NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ15 | `insurance.where(focal = true).coverage.resolve().period.end.all($this >= %resource.created)`
vn-claim-single-focal-insurance | error | Claim | Phải có đúng 1 thẻ BHYT chính (focal=true). Các thẻ bổ trợ dùng focal=false — per QĐ 697/QĐ-BYT ngày 19/03/2026 cột 13, NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ22; sai hồ sơ/chứng từ BHYT có thể bị xử phạt theo NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) | `insurance.where(focal = true).count() = 1`

Dạng xem Differential

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
meta |  | 0..1 | Meta | Metadata about the resource
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:costSummary | S | 0..1 | (Complex) | Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
extension:paymentPeriod |  | 0..1 | (Complex) | Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod |  | 0..1 | CodeableConcept | Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible)
Slices for identifier | S | 1..* | Identifier | Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system
identifier:MALK | S | 1..1 | Identifier | Mã liên kết hồ sơ (MA_LK)
type |  | 0..1 | CodeableConcept | Description of identifier Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MA_LK
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value | S | 1..1 | string | Giá trị MA_LK
status | S | 1..1 | code | Trạng thái yêu cầu thanh toán
type | S | 1..1 | CodeableConcept | Loại yêu cầu: institutional (nội trú), professional (ngoại trú)
subType | S | 0..1 | CodeableConcept | Mã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible)
use | S | 1..1 | code | Mục đích: claim (thanh toán) | preauthorization | predetermination
patient | S | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Bệnh nhân (XML 3176: MA_BN)
created | S | 1..1 | dateTime | Ngày tạo yêu cầu
insurer | S | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan BHXH thanh toán
provider | S | 1..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) | Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
priority |  | 1..1 | CodeableConcept | Mức ưu tiên xử lý
diagnosis | S | 1..* | BackboneElement | Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Slice: Unordered, Open by type:$this
diagnosis[x]:diagnosisCodeableConcept | S | 0..1 | CodeableConcept | Mã bệnh ICD-10 VN (QĐ 4469/QĐ-BYT) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type | S | 0..* | CodeableConcept | Loại chẩn đoán (chính/phụ)
procedure |  | 0..* | BackboneElement | Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
Slices for procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Slice: Unordered, Open by type:$this
procedure[x]:procedureCodeableConcept |  | 0..1 | CodeableConcept | Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance | S | 1..* | BackboneElement | Thông tin BHYT (XML 3176: MA_THE)
focal | S | 1..1 | boolean | Coverage to be used for adjudication
coverage | S | 1..1 | Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) | Thẻ BHYT (Coverage)
accident |  | 0..1 | BackboneElement | Thông tin tai nạn thương tích
type |  | 0..1 | CodeableConcept | Loại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item | S | 1..* | BackboneElement | Chi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:department |  | 0..1 | CodeableConcept | Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup |  | 0..1 | CodeableConcept | Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope |  | 0..1 | CodeableConcept | Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo |  | 0..1 | (Complex) | BHYT: phạm vi, tỷ lệ TT, mức hưởng URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:paymentSource |  | 0..1 | CodeableConcept | Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit |  | 0..1 | boolean | Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo |  | 0..1 | string | Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod |  | 0..1 | string | Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method
sequence | S | 1..1 | positiveInt | Item instance identifier
category | S | 0..1 | CodeableConcept | Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService | S | 1..1 | CodeableConcept | Mã dịch vụ/thuốc/TBYT
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Số lượng
unitPrice |  | 0..1 | Money | Đơn giá
net | S | 0..1 | Money | Thành tiền
total | S | 0..1 | Money | Tổng chi phí (XML 3176: T_TONGCHI)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.subType | Base | extensible | Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet | 📦0.5.0 | This IG
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | Base | extensible | Mã chẩn đoán — VN Core Condition Code ValueSet | 📦0.5.0 | This IG
Claim.procedure.procedure[x]:procedureCodeableConcept | Base | extensible | Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet | 📦0.5.0 | This IG
Claim.accident.type | Base | extensible | Mã tai nạn thương tích — Vietnam Accident Type ValueSet | 📦0.5.0 | This IG
Claim.item.category | Base | extensible | Danh mục chi phí KCB — Vietnam Cost Category ValueSet | 📦0.5.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
vn-claim-coverage-not-expired | warning | Claim | Cảnh báo: thẻ BHYT focal có thể đã hết hạn tại thời điểm tạo Claim — per NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ15 | `insurance.where(focal = true).coverage.resolve().period.end.all($this >= %resource.created)`
vn-claim-single-focal-insurance | error | Claim | Phải có đúng 1 thẻ BHYT chính (focal=true). Các thẻ bổ trợ dùng focal=false — per QĐ 697/QĐ-BYT ngày 19/03/2026 cột 13, NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ22; sai hồ sơ/chứng từ BHYT có thể bị xử phạt theo NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) | `insurance.where(focal = true).count() = 1`

Dạng xem SnapshotView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:costSummary | S | 0..1 | (Complex) | Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
extension:paymentPeriod |  | 0..1 | (Complex) | Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod |  | 0..1 | CodeableConcept | Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S | 1..* | Identifier | Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system
identifier:MALK | S | 1..1 | Identifier | Mã liên kết hồ sơ (MA_LK)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MA_LK
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value | S Σ | 1..1 | string | Giá trị MA_LK Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
status | ?!S Σ | 1..1 | code | Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 1..1 | CodeableConcept | Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType | S | 0..1 | CodeableConcept | Mã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible)
use | S Σ | 1..1 | code | Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(Bệnh nhân VN Core — VN Core Patient Profile) | Bệnh nhân (XML 3176: MA_BN)
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
created | S Σ | 1..1 | dateTime | Ngày tạo yêu cầu
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | S Σ | 0..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile) | Cơ quan BHXH thanh toán
provider | S Σ | 1..1 | Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile) | Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
priority | Σ | 1..1 | CodeableConcept | Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(Location) | Servicing facility
careTeam |  | 0..* | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo |  | 0..* | BackboneElement | Supporting information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis | S | 1..* | BackboneElement | Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 |  | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
diagnosis[x]:diagnosisCodeableConcept | S | 0..1 | CodeableConcept | Mã bệnh ICD-10 VN (QĐ 4469/QĐ-BYT) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type | S | 0..* | CodeableConcept | Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure |  | 0..* | BackboneElement | Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
Slices for procedure[x] |  | 1..1 |  | Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure[x]:procedureCodeableConcept |  | 0..1 | CodeableConcept | Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | S Σ | 1..* | BackboneElement | Thông tin BHYT (XML 3176: MA_THE)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | S Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | S Σ | 1..1 | Reference(Thẻ BHYT VN Core — VN Core Coverage Profile) | Thẻ BHYT (Coverage)
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident |  | 0..1 | BackboneElement | Thông tin tai nạn thương tích
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | Loại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
location[x] |  | 0..1 |  | Where the event occurred
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
item | S | 1..* | BackboneElement | Chi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:department |  | 0..1 | CodeableConcept | Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup |  | 0..1 | CodeableConcept | Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope |  | 0..1 | CodeableConcept | Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo |  | 0..1 | (Complex) | BHYT: phạm vi, tỷ lệ TT, mức hưởng URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:paymentSource |  | 0..1 | CodeableConcept | Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit |  | 0..1 | boolean | Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo |  | 0..1 | string | Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod |  | 0..1 | string | Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Item instance identifier
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category | S | 0..1 | CodeableConcept | Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService | S | 1..1 | CodeableConcept | Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] |  | 0..1 |  | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Số lượng
unitPrice |  | 0..1 | Money | Đơn giá
factor |  | 0..1 | decimal | Price scaling factor
net | S | 0..1 | Money | Thành tiền
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total | S | 0..1 | Money | Tổng chi phí (XML 3176: T_TONGCHI)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Claim.identifier:MALK.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:MALK.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.subType | Base | extensible | Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet | 📦0.5.0 | This IG
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | example | Claim Care Team Role Codes | 📍4.0.1 | FHIR Std.
Claim.careTeam.qualification | Base | example | Example Provider Qualification Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | Base | extensible | Mã chẩn đoán — VN Core Condition Code ValueSet | 📦0.5.0 | This IG
Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.type | Base | example | Example Procedure Type Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept | Base | extensible | Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet | 📦0.5.0 | This IG
Claim.accident.type | Base | extensible | Mã tai nạn thương tích — Vietnam Accident Type ValueSet | 📦0.5.0 | This IG
Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.category | Base | extensible | Danh mục chi phí KCB — Vietnam Cost Category ValueSet | 📦0.5.0 | This IG
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std.
Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
vn-claim-coverage-not-expired | warning | Claim | Cảnh báo: thẻ BHYT focal có thể đã hết hạn tại thời điểm tạo Claim — per NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ15 | `insurance.where(focal = true).coverage.resolve().period.end.all($this >= %resource.created)`
vn-claim-single-focal-insurance | error | Claim | Phải có đúng 1 thẻ BHYT chính (focal=true). Các thẻ bổ trợ dùng focal=false — per QĐ 697/QĐ-BYT ngày 19/03/2026 cột 13, NĐ 188/2025/NĐ-CP ban hành 01/07/2025, hiệu lực 15/08/2025, Đ22; sai hồ sơ/chứng từ BHYT có thể bị xử phạt theo NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — future-effective) | `insurance.where(focal = true).count() = 1`

Summary

Mandatory: 6 elements
Must-Support: 25 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- Bệnh nhân VN Core — VN Core Patient Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)
- Cơ sở y tế VN Core — VN Core Organization Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization)
- Nhân viên y tế VN Core — VN Core Practitioner Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner)
- Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role)
- Thẻ BHYT VN Core — VN Core Coverage Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)

Extensions

This structure refers to these extensions:

- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
- http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the values of Claim.identifier
- The element 1 is sliced based on the values of Claim.diagnosis.diagnosis[x]
- The element 1 is sliced based on the values of Claim.procedure.procedure[x]

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