Intersection of http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim-response and http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim-response

This is the set of resources that conform to both Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim-response) and Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim-response).

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..*Response to a claim predetermination or preauthorization
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
... text 0..1NarrativeText 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..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S0..*IdentifierĐịnh danh kết quả xử lý, bao gồm mã phản hồi gateway nếu có
... status ?!SΣ1..1codeTrạng thái kết quả: active | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.
... type SΣ1..1CodeableConceptLoại: institutional (nội trú) | professional (ngoại trú)
Binding: ?? (extensible): The type or discipline-style of the claim.
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use SΣ1..1codeMục đích: claim | preauthorization | predetermination
Binding: ?? (required): Claim, preauthorization, predetermination.
... patient SΣ1..1Reference(Bệnh nhân VN Core — VN Core Patient Profile | #sd+86-vn-core-patient-vn-core-patient)Bệnh nhân
... created SΣ1..1dateTimeNgày tạo kết quả
... insurer SΣ1..1Reference(Cơ sở y tế VN Core — VN Core Organization Profile | #sd+90-vn-core-organization-vn-core-organization)Cơ quan BHXH giải quyết
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... request SΣ0..1Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile | #sd+95-vn-core-claim-vn-core-claim)Yêu cầu thanh toán gốc (VNCoreClaim)
... outcome SΣ1..1codeKết quả: queued | complete | error | partial
Binding: ?? (required): The result of the claim processing.
... disposition 0..1stringDisposition Message
... preAuthRef 0..1stringPreauthorization reference
... preAuthPeriod 0..1PeriodPreauthorization reference effective period
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: ?? (example): A code for the party to be reimbursed.
... item S0..*BackboneElementKết quả từng dòng chi phí
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence S1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication S1..*BackboneElementPhân bổ chi phí: đề nghị, đủ ĐK, cùng chi trả, BHYT thanh toán
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptLoại: submitted | eligible | copay | benefit
Binding: ?? (extensible)
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
..... amount S0..1MoneySố tiền (VND)
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*Subdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??, ??Count of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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.
..... quantity 0..1??, ??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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.
...... quantity 0..1??, ??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*Added items detail adjudication
... adjudication 0..*Header-level adjudication
... total SΣ0..*BackboneElementTổng adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category SΣ1..1CodeableConceptLoại tổng: submitted | eligible | copay | benefit hoặc category BHYT cục bộ
Binding: ?? (extensible)
.... amount SΣ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementThông tin thanh toán
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptPartial or complete payment
Binding: ?? (example): The type (partial, complete) of the payment.
.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: ?? (example): Payment Adjustment reason codes.
.... date 0..1dateExpected date of payment
.... amount 1..1MoneySố tiền BHXH thanh toán
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.
... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.
.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInsurance instance identifier
.... focal 1..1booleanCoverage to be used for adjudication
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... error S0..*BackboneElementNhóm issue giám định/từ chối hoặc yêu cầu điều chỉnh
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence S0..1positiveIntDòng chi phí liên quan nếu có
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code S1..1CodeableConceptNhóm issue/lý do BHYT
Binding: ?? (extensible)

doco Documentation for this format