Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build

Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: MOPEDClaimResponse

Official URL: http://example.org/StructureDefinition/MOPEDClaimResponse Version: 0.1.0
Draft as of 2025-02-10 Responsible: Example Publisher Computable Name: MOPEDClaimResponse

MOPED Profil der ClaimResponse Ressource für die Leistungsabrechnungsantwort.

Usage:

  • This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... ErrorWarning 0..* (Complex) Error/Warning
URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... DiagnosisRelatedNode 0..1 Coding "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen.
URL: http://example.org/StructureDefinition/moped-ext-diagnosisRelatedNode
Binding: LKF Abrechnungsknoten (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... LKFPunkte 0..* (Complex) LKF Punkte
URL: http://example.org/StructureDefinition/lkfPunkte
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... LDFPunktewertNetto 0..1 decimal LDF-Punktewert Netto
URL: http://example.org/StructureDefinition/moped-ext-LDFPunktewertNetto
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... LDFBetragNetto 0..1 decimal LDF-Betrag Netto
URL: http://example.org/StructureDefinition/moped-ext-LDFBetragNetto
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... PatientenanteilAngehoerige 0..1 Money Patientenanteil für Angehoerige
URL: http://example.org/StructureDefinition/moped-ext-PatientenanteilAngehoerige
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... Patientenanteil 0..1 Money Patientenanteil Netto
URL: http://example.org/StructureDefinition/moped-ext-Patientenanteil
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... Beihilfenaequivalent 0..1 unsignedInt Beihilfenaequivalent
URL: http://example.org/StructureDefinition/moped-ext-Beihilfenaequivalent
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... ForderungsbetragAuslaenderverrechnungRegress 0..1 Money Forderungsbetrag für Auslaenderverrechnung oder Regress
URL: http://example.org/StructureDefinition/moped-ext-ForderungsbetragAuslaenderverrechnungRegress
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... RechnungsnummerKHLGF 0..1 string Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds
URL: http://example.org/StructureDefinition/moped-ext-RechnungsnummerKHLGF
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... Note 0..* Annotation A recorded sex or gender property for the individual
URL: http://hl7.org/fhir/StructureDefinition/note
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... Sonderleistungsnummer 0..1 Coding Sonderleistungsnummer
URL: http://example.org/StructureDefinition/moped-ext-Sonderleistungsnummer
Binding: Nummer für Sonderleistung (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... AnzahlSonderleistungen 0..1 unsignedInt Anzahl Sonderleistungen
URL: http://example.org/StructureDefinition/moped-ext-AnzahlSonderleistungen
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... PunkteLDFPauschale 0..1 decimal Punkte LDF Pauschale
URL: http://example.org/StructureDefinition/moped-ext-PunkteLDFPauschale
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... KonstenmeldungARK 0..1 Coding Kostenmeldung für (A/R/K)
URL: http://example.org/StructureDefinition/moped-ext-KonstenmeldungARK
Binding: Kostenmeldung für (A/R/K) (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
Required Pattern: active
... type Σ 1..1 CodeableConcept More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


ele-1: All FHIR elements must have a @value or children
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.


ele-1: All FHIR elements must have a @value or children
Required Pattern: claim
... patient Σ 1..1 Reference(HL7® AT Core Patient Profile) The recipient of the products and services
ele-1: All FHIR elements must have a @value or children
... created Σ 1..1 dateTime Response creation date
ele-1: All FHIR elements must have a @value or children
... insurer Σ 1..1 Reference(HL7® AT Core Organization Profile) Party responsible for reimbursement
ele-1: All FHIR elements must have a @value or children
... requestor 1..1 Reference(HL7® AT Core Organization Profile) Party responsible for the claim
ele-1: All FHIR elements must have a @value or children
... request Σ 1..1 Reference(MOPEDClaim) Id of resource triggering adjudication
ele-1: All FHIR elements must have a @value or children
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.


ele-1: All FHIR elements must have a @value or children
... diagnosisRelatedGroup 0..1 CodeableConcept "Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart.
Binding: LKF Abrechnungsgruppe (required)
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ClaimResponse.statusrequiredPattern: active
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
ClaimResponse.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
ClaimResponse.userequiredPattern: claim
http://hl7.org/fhir/ValueSet/claim-use|5.0.0
from the FHIR Standard
ClaimResponse.outcomerequiredClaimProcessingCodes
http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0
from the FHIR Standard
ClaimResponse.diagnosisRelatedGrouprequiredLKFAbrechnungsGruppe
http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimResponseIf 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimResponseIf 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-5errorClaimResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimResponseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron