# Ví dụ: Kết quả BHYT — Từ chối một phần (thuốc ngoài danh mục) - Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam v0.5.0

## Ví dụ ClaimResponse: Ví dụ: Kết quả BHYT — Từ chối một phần (thuốc ngoài danh mục)

Profile: [Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile](StructureDefinition-vn-core-claim-response.md)

**identifier**: Mã phản hồi XML1 của Cổng tiếp nhận BHYT/XML1-20260322-000042

**status**: Active

**type**: Institutional

**use**: Claim

**patient**: [Nguyễn Văn An](Patient-ExamplePatientNguyenVanAn.md)

**created**: 2026-03-22

**insurer**: [Bảo hiểm xã hội Việt Nam](Organization-ExampleOrganizationBHXH.md)

**request**: [Claim: extension = ,,Phí dịch vụ (FFS); identifier = Mã liên kết hồ sơ BHYT: VNMALK#LK-2026-000101; status = active; type = Institutional; subType = KCB đúng cơ sở nơi đăng ký KCB BHYT ban đầu; use = claim; created = 2026-03-17; priority = Normal](Claim-ExampleClaimBHYT.md)

**outcome**: Partial Processing

> **item****itemSequence**: 1
> **adjudication****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 150000 | Vietnamese đồng |


> **adjudication****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 150000 | Vietnamese đồng |


> **adjudication****category**: CoPay

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 30000 | Vietnamese đồng |


> **adjudication****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 120000 | Vietnamese đồng |



> **item****itemSequence**: 2
> **adjudication****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 850000 | Vietnamese đồng |


> **adjudication****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 850000 | Vietnamese đồng |


> **adjudication****category**: CoPay

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 170000 | Vietnamese đồng |


> **adjudication****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 680000 | Vietnamese đồng |



> **item****itemSequence**: 3
> **adjudication****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 3200000 | Vietnamese đồng |


> **adjudication****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 2400000 | Vietnamese đồng |


> **adjudication****category**: CoPay

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 480000 | Vietnamese đồng |


> **adjudication****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 1920000 | Vietnamese đồng |



> **total****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 4200000 | Vietnamese đồng |


> **total****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 3400000 | Vietnamese đồng |


> **total****category**: CoPay

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 680000 | Vietnamese đồng |


> **total****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 2720000 | Vietnamese đồng |


> **payment****type**: Partial

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 2720000 | Vietnamese đồng |


### Errors

| | | |
| :--- | :--- | :--- |
| - | **ItemSequence** | **Code** |
| * | 3 | Chi phí không đúng quy định pháp luật |



## Resource Content

```json
{
  "resourceType" : "ClaimResponse",
  "id" : "ExampleClaimResponsePartialDeny",
  "meta" : {
    "profile" : ["http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim-response"]
  },
  "identifier" : [{
    "type" : {
      "coding" : [{
        "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs",
        "code" : "BHYT_XML1_ID"
      }]
    },
    "system" : "http://fhir.hl7.org.vn/core/sid/bhyt-gateway-response-id",
    "value" : "XML1-20260322-000042"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional",
      "display" : "Institutional"
    }]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/ExamplePatientNguyenVanAn",
    "display" : "Nguyễn Văn An"
  },
  "created" : "2026-03-22",
  "insurer" : {
    "reference" : "Organization/ExampleOrganizationBHXH",
    "display" : "Bảo hiểm xã hội Việt Nam"
  },
  "request" : {
    "reference" : "Claim/ExampleClaimBHYT"
  },
  "outcome" : "partial",
  "item" : [{
    "itemSequence" : 1,
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        }]
      },
      "amount" : {
        "value" : 150000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible",
          "display" : "Eligible Amount"
        }]
      },
      "amount" : {
        "value" : 150000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "copay",
          "display" : "CoPay"
        }]
      },
      "amount" : {
        "value" : 30000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        }]
      },
      "amount" : {
        "value" : 120000,
        "currency" : "VND"
      }
    }]
  },
  {
    "itemSequence" : 2,
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        }]
      },
      "amount" : {
        "value" : 850000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible",
          "display" : "Eligible Amount"
        }]
      },
      "amount" : {
        "value" : 850000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "copay",
          "display" : "CoPay"
        }]
      },
      "amount" : {
        "value" : 170000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        }]
      },
      "amount" : {
        "value" : 680000,
        "currency" : "VND"
      }
    }]
  },
  {
    "itemSequence" : 3,
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        }]
      },
      "amount" : {
        "value" : 3200000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible",
          "display" : "Eligible Amount"
        }]
      },
      "amount" : {
        "value" : 2400000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "copay",
          "display" : "CoPay"
        }]
      },
      "amount" : {
        "value" : 480000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        }]
      },
      "amount" : {
        "value" : 1920000,
        "currency" : "VND"
      }
    }]
  }],
  "total" : [{
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "submitted",
        "display" : "Submitted Amount"
      }]
    },
    "amount" : {
      "value" : 4200000,
      "currency" : "VND"
    }
  },
  {
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "eligible",
        "display" : "Eligible Amount"
      }]
    },
    "amount" : {
      "value" : 3400000,
      "currency" : "VND"
    }
  },
  {
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "copay",
        "display" : "CoPay"
      }]
    },
    "amount" : {
      "value" : 680000,
      "currency" : "VND"
    }
  },
  {
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "benefit",
        "display" : "Benefit Amount"
      }]
    },
    "amount" : {
      "value" : 2720000,
      "currency" : "VND"
    }
  }],
  "payment" : {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
        "code" : "partial",
        "display" : "Partial"
      }]
    },
    "amount" : {
      "value" : 2720000,
      "currency" : "VND"
    }
  },
  "error" : [{
    "itemSequence" : 3,
    "code" : {
      "coding" : [{
        "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-review-issue-cs",
        "code" : "LEGAL_NON_COMPLIANT_COST",
        "display" : "Chi phí không đúng quy định pháp luật"
      }]
    }
  }]
}

```
