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

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Resource Profile: MOPEDClaim

MOPED Profil der Claim Ressource für die Leistungsabrechnungsanfrage.

Usage:

• Refer to this Resource Profile: MOPEDClaim and MOPEDClaimResponse

Formal Views of Profile Content

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

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

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
DiagnosisRelatedNode		0..1	code	"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: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required)
PunkteBelagsdauerausreisserUntenLeistungskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Leistungskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
PunkteBelagsdauerausreisserUntenTageskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Tageskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
ZusatzpunkteBelagsdauerausreisserNachOben		0..1	unsignedInt	Zusatzpunkte Belagsdauerausreißer nach oben URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
ZusatzpunkteIntensiv		0..1	unsignedInt	Zusatzpunkte Intensiv URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
ZusatzpunkteMehrfachleistungen		0..1	unsignedInt	Zusatzpunkte Mehrfachleistungen URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
PunkteSpeziellerBereicheTageweise		0..1	unsignedInt	Punkte spezieller Bereiche (tageweise) URL: http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
LeistungskomponenteLeistungspunkte		0..1	unsignedInt	Leistungskomponente/Leistungspunkte URL: http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
TageskomponenteKontaktpunkte		0..1	unsignedInt	Tageskomponente/Kontaktpunkte URL: http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
TotalPoints		0..1	unsignedInt	Punkte total URL: http://example.org/StructureDefinition/totalPoints
ErrorWarning		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
Fondsrelevanz		0..1	code	Fondsrelevanz URL: http://example.org/StructureDefinition/moped-ext-fondsrelevanz Binding: http://tbd.at/MOPED-Fondsrelevanz (required)
Plausibilitaetskennzeichen		0..1	string	Plausibilitaetskennzeichen URL: http://example.org/StructureDefinition/Plausibilitaetskennzeichen
SVAbrechnungsquartal		0..1	(Complex)	Abrechnungsquartal der Sozialversicherung URL: http://example.org/StructureDefinition/SVAbrechnungsquartal
AccountRef		0..1	Reference(MOPEDAccount)	Account Referenz URL: http://example.org/StructureDefinition/moped-ext-AccountRef
patient		1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
related
claim		0..1	Reference(MOPEDClaim)	Reference to the related claim
Slices for encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments Slice: Unordered, Open by
encounter:MopedEncounter		0..1	Reference(MOPEDEncounter)	Generelle Informationen zu Aufnahme und Entlassung des Patienten
encounter:TransferEncounter		0..*	Reference(MOPEDTransferEncounter)	Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
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: http://tbd.at/MOPED-LKFAbrechnungsGruppe (required)
diagnosis
onAdmission		0..1	CodeableConcept	Present on admission
procedure
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
AbrechnungsRelevanz		0..1	code	Medizinische Leistung - Abrechnungsrelevanz URL: http://example.org/StructureDefinition/moped-ext-AbrechnungsRelevanz Binding: Abrechnungsrelevanz der medizinischen Leistung (required)
insurance
coverage		1..1	Reference(MOPEDCoverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Claim.diagnosisRelatedGroup	required	http://tbd.at/MOPED-LKFAbrechnungsGruppe http://tbd.at/MOPED-LKFAbrechnungsGruppe

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
DiagnosisRelatedNode		0..1	code	"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: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required)
PunkteBelagsdauerausreisserUntenLeistungskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Leistungskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
PunkteBelagsdauerausreisserUntenTageskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Tageskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
ZusatzpunkteBelagsdauerausreisserNachOben		0..1	unsignedInt	Zusatzpunkte Belagsdauerausreißer nach oben URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
ZusatzpunkteIntensiv		0..1	unsignedInt	Zusatzpunkte Intensiv URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
ZusatzpunkteMehrfachleistungen		0..1	unsignedInt	Zusatzpunkte Mehrfachleistungen URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
PunkteSpeziellerBereicheTageweise		0..1	unsignedInt	Punkte spezieller Bereiche (tageweise) URL: http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
LeistungskomponenteLeistungspunkte		0..1	unsignedInt	Leistungskomponente/Leistungspunkte URL: http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
TageskomponenteKontaktpunkte		0..1	unsignedInt	Tageskomponente/Kontaktpunkte URL: http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
TotalPoints		0..1	unsignedInt	Punkte total URL: http://example.org/StructureDefinition/totalPoints
ErrorWarning		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
Fondsrelevanz		0..1	code	Fondsrelevanz URL: http://example.org/StructureDefinition/moped-ext-fondsrelevanz Binding: http://tbd.at/MOPED-Fondsrelevanz (required)
Plausibilitaetskennzeichen		0..1	string	Plausibilitaetskennzeichen URL: http://example.org/StructureDefinition/Plausibilitaetskennzeichen
SVAbrechnungsquartal		0..1	(Complex)	Abrechnungsquartal der Sozialversicherung URL: http://example.org/StructureDefinition/SVAbrechnungsquartal
AccountRef		0..1	Reference(MOPEDAccount)	Account Referenz URL: http://example.org/StructureDefinition/moped-ext-AccountRef
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
created	Σ	1..1	dateTime	Resource creation date
Slices for encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments Slice: Unordered, Open by
encounter:MopedEncounter		0..1	Reference(MOPEDEncounter)	Generelle Informationen zu Aufnahme und Entlassung des Patienten
encounter:TransferEncounter		0..*	Reference(MOPEDTransferEncounter)	Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
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: http://tbd.at/MOPED-LKFAbrechnungsGruppe (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
Claim.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
Claim.diagnosisRelatedGroup	required	http://tbd.at/MOPED-LKFAbrechnungsGruppe http://tbd.at/MOPED-LKFAbrechnungsGruppe

Constraints

Id	Grade	Path(s)	Details	Requirements
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().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-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()

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
DiagnosisRelatedNode		0..1	code	"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: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required)
PunkteBelagsdauerausreisserUntenLeistungskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Leistungskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
PunkteBelagsdauerausreisserUntenTageskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Tageskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
ZusatzpunkteBelagsdauerausreisserNachOben		0..1	unsignedInt	Zusatzpunkte Belagsdauerausreißer nach oben URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
ZusatzpunkteIntensiv		0..1	unsignedInt	Zusatzpunkte Intensiv URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
ZusatzpunkteMehrfachleistungen		0..1	unsignedInt	Zusatzpunkte Mehrfachleistungen URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
PunkteSpeziellerBereicheTageweise		0..1	unsignedInt	Punkte spezieller Bereiche (tageweise) URL: http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
LeistungskomponenteLeistungspunkte		0..1	unsignedInt	Leistungskomponente/Leistungspunkte URL: http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
TageskomponenteKontaktpunkte		0..1	unsignedInt	Tageskomponente/Kontaktpunkte URL: http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
TotalPoints		0..1	unsignedInt	Punkte total URL: http://example.org/StructureDefinition/totalPoints
ErrorWarning		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
Fondsrelevanz		0..1	code	Fondsrelevanz URL: http://example.org/StructureDefinition/moped-ext-fondsrelevanz Binding: http://tbd.at/MOPED-Fondsrelevanz (required)
Plausibilitaetskennzeichen		0..1	string	Plausibilitaetskennzeichen URL: http://example.org/StructureDefinition/Plausibilitaetskennzeichen
SVAbrechnungsquartal		0..1	(Complex)	Abrechnungsquartal der Sozialversicherung URL: http://example.org/StructureDefinition/SVAbrechnungsquartal
AccountRef		0..1	Reference(MOPEDAccount)	Account Referenz URL: http://example.org/StructureDefinition/moped-ext-AccountRef
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for claim
traceNumber		0..*	Identifier	Number for tracking
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Author of the claim
insurer	Σ	0..1	Reference(Organization)	Target
provider	Σ	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
priority	Σ	0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: FundsReservationCodes (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(MOPEDClaim)	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: ClaimPayeeTypeCodes (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
Slices for encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments Slice: Unordered, Open by
encounter:MopedEncounter		0..1	Reference(MOPEDEncounter)	Generelle Informationen zu Aufnahme und Entlassung des Patienten
encounter:TransferEncounter		0..*	Reference(MOPEDTransferEncounter)	Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
facility		0..1	Reference(Location | Organization)	Servicing facility
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: http://tbd.at/MOPED-LKFAbrechnungsGruppe (required)
event		0..*	BackboneElement	Event 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
type		1..1	CodeableConcept	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
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.
specialty		0..1	CodeableConcept	Practitioner or provider specialization Binding: ExampleProviderQualificationCodes (example)
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)
valueIdentifier			Identifier
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis 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	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
AbrechnungsRelevanz		0..1	code	Medizinische Leistung - Abrechnungsrelevanz URL: http://example.org/StructureDefinition/moped-ext-AbrechnungsRelevanz Binding: Abrechnungsrelevanz der medizinischen Leistung (required)
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
procedure[x]		1..1		Specific clinical procedure Binding: ICD10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
insurance	Σ	0..*	BackboneElement	Patient insurance 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	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	Σ	1..1	Reference(MOPEDCoverage)	Insurance information
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	Details of the event
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	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
patientPaid		0..1	Money	Paid by the patient
item		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
traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
request		0..*	Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)	Request or Referral for Service
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)
patientPaid		0..1	Money	Paid by the patient
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..*	BackboneElement	Anatomical location
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
site		1..*	CodeableReference(BodyStructure)	Location Binding: OralSiteCodes (example)
subSite		0..*	CodeableConcept	Sub-location Binding: SurfaceCodes (example)
encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
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
traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.
patientPaid		0..1	Money	Paid by the patient
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
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
traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.
patientPaid		0..1	Money	Paid by the patient
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Claim.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
Claim.subType	example	ExampleClaimSubTypeCodes http://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard
Claim.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
Claim.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
Claim.fundsReserve	example	FundsReservationCodes http://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes http://hl7.org/fhir/ValueSet/related-claim-relationship from the FHIR Standard
Claim.payee.type	example	ClaimPayeeTypeCodes http://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard
Claim.diagnosisRelatedGroup	required	http://tbd.at/MOPED-LKFAbrechnungsGruppe http://tbd.at/MOPED-LKFAbrechnungsGruppe
Claim.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
Claim.careTeam.role	example	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard
Claim.careTeam.specialty	example	ExampleProviderQualificationCodes http://hl7.org/fhir/ValueSet/provider-qualification from the FHIR Standard
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason from the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard
Claim.diagnosis.type	example	ExampleDiagnosisTypeCodes http://hl7.org/fhir/ValueSet/ex-diagnosistype from the FHIR Standard
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission from the FHIR Standard
Claim.procedure.type	example	ExampleProcedureTypeCodes http://hl7.org/fhir/ValueSet/ex-procedure-type from the FHIR Standard
Claim.procedure.procedure[x]	example	ICD10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures from the FHIR Standard
Claim.accident.type	extensible	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Claim.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place from the FHIR Standard
Claim.item.bodySite.site	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth from the FHIR Standard
Claim.item.bodySite.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface from the FHIR Standard
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Claim.item.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Claim.item.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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().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-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()

This structure is derived from Claim

Summary

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)
• MOPEDClaim (http://example.org/StructureDefinition/MOPEDClaim)
• MOPEDEncounter (http://example.org/StructureDefinition/MOPEDEncounter)
• MOPEDTransferEncounter (http://example.org/StructureDefinition/MOPEDTransferEncounter)
• MOPEDCoverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/note
• http://example.org/StructureDefinition/moped-ext-diagnosisRelatedNode
• http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
• http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
• http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
• http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
• http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
• http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
• http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
• http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
• http://example.org/StructureDefinition/totalPoints
• http://example.org/StructureDefinition/moped-ext-ErrorWarning
• http://example.org/StructureDefinition/moped-ext-fondsrelevanz
• http://example.org/StructureDefinition/Plausibilitaetskennzeichen
• http://example.org/StructureDefinition/SVAbrechnungsquartal
• http://example.org/StructureDefinition/moped-ext-AccountRef
• http://example.org/StructureDefinition/moped-ext-AbrechnungsRelevanz

Slices

This structure defines the following Slices:

• There is a slice with no discriminator at Claim.encounter

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
DiagnosisRelatedNode		0..1	code	"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: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required)
PunkteBelagsdauerausreisserUntenLeistungskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Leistungskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
PunkteBelagsdauerausreisserUntenTageskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Tageskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
ZusatzpunkteBelagsdauerausreisserNachOben		0..1	unsignedInt	Zusatzpunkte Belagsdauerausreißer nach oben URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
ZusatzpunkteIntensiv		0..1	unsignedInt	Zusatzpunkte Intensiv URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
ZusatzpunkteMehrfachleistungen		0..1	unsignedInt	Zusatzpunkte Mehrfachleistungen URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
PunkteSpeziellerBereicheTageweise		0..1	unsignedInt	Punkte spezieller Bereiche (tageweise) URL: http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
LeistungskomponenteLeistungspunkte		0..1	unsignedInt	Leistungskomponente/Leistungspunkte URL: http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
TageskomponenteKontaktpunkte		0..1	unsignedInt	Tageskomponente/Kontaktpunkte URL: http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
TotalPoints		0..1	unsignedInt	Punkte total URL: http://example.org/StructureDefinition/totalPoints
ErrorWarning		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
Fondsrelevanz		0..1	code	Fondsrelevanz URL: http://example.org/StructureDefinition/moped-ext-fondsrelevanz Binding: http://tbd.at/MOPED-Fondsrelevanz (required)
Plausibilitaetskennzeichen		0..1	string	Plausibilitaetskennzeichen URL: http://example.org/StructureDefinition/Plausibilitaetskennzeichen
SVAbrechnungsquartal		0..1	(Complex)	Abrechnungsquartal der Sozialversicherung URL: http://example.org/StructureDefinition/SVAbrechnungsquartal
AccountRef		0..1	Reference(MOPEDAccount)	Account Referenz URL: http://example.org/StructureDefinition/moped-ext-AccountRef
patient		1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
related
claim		0..1	Reference(MOPEDClaim)	Reference to the related claim
Slices for encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments Slice: Unordered, Open by
encounter:MopedEncounter		0..1	Reference(MOPEDEncounter)	Generelle Informationen zu Aufnahme und Entlassung des Patienten
encounter:TransferEncounter		0..*	Reference(MOPEDTransferEncounter)	Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
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: http://tbd.at/MOPED-LKFAbrechnungsGruppe (required)
diagnosis
onAdmission		0..1	CodeableConcept	Present on admission
procedure
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
AbrechnungsRelevanz		0..1	code	Medizinische Leistung - Abrechnungsrelevanz URL: http://example.org/StructureDefinition/moped-ext-AbrechnungsRelevanz Binding: Abrechnungsrelevanz der medizinischen Leistung (required)
insurance
coverage		1..1	Reference(MOPEDCoverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Claim.diagnosisRelatedGroup	required	http://tbd.at/MOPED-LKFAbrechnungsGruppe http://tbd.at/MOPED-LKFAbrechnungsGruppe

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
DiagnosisRelatedNode		0..1	code	"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: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required)
PunkteBelagsdauerausreisserUntenLeistungskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Leistungskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
PunkteBelagsdauerausreisserUntenTageskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Tageskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
ZusatzpunkteBelagsdauerausreisserNachOben		0..1	unsignedInt	Zusatzpunkte Belagsdauerausreißer nach oben URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
ZusatzpunkteIntensiv		0..1	unsignedInt	Zusatzpunkte Intensiv URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
ZusatzpunkteMehrfachleistungen		0..1	unsignedInt	Zusatzpunkte Mehrfachleistungen URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
PunkteSpeziellerBereicheTageweise		0..1	unsignedInt	Punkte spezieller Bereiche (tageweise) URL: http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
LeistungskomponenteLeistungspunkte		0..1	unsignedInt	Leistungskomponente/Leistungspunkte URL: http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
TageskomponenteKontaktpunkte		0..1	unsignedInt	Tageskomponente/Kontaktpunkte URL: http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
TotalPoints		0..1	unsignedInt	Punkte total URL: http://example.org/StructureDefinition/totalPoints
ErrorWarning		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
Fondsrelevanz		0..1	code	Fondsrelevanz URL: http://example.org/StructureDefinition/moped-ext-fondsrelevanz Binding: http://tbd.at/MOPED-Fondsrelevanz (required)
Plausibilitaetskennzeichen		0..1	string	Plausibilitaetskennzeichen URL: http://example.org/StructureDefinition/Plausibilitaetskennzeichen
SVAbrechnungsquartal		0..1	(Complex)	Abrechnungsquartal der Sozialversicherung URL: http://example.org/StructureDefinition/SVAbrechnungsquartal
AccountRef		0..1	Reference(MOPEDAccount)	Account Referenz URL: http://example.org/StructureDefinition/moped-ext-AccountRef
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
created	Σ	1..1	dateTime	Resource creation date
Slices for encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments Slice: Unordered, Open by
encounter:MopedEncounter		0..1	Reference(MOPEDEncounter)	Generelle Informationen zu Aufnahme und Entlassung des Patienten
encounter:TransferEncounter		0..*	Reference(MOPEDTransferEncounter)	Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
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: http://tbd.at/MOPED-LKFAbrechnungsGruppe (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
Claim.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
Claim.diagnosisRelatedGroup	required	http://tbd.at/MOPED-LKFAbrechnungsGruppe http://tbd.at/MOPED-LKFAbrechnungsGruppe

Constraints

Id	Grade	Path(s)	Details	Requirements
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().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-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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
DiagnosisRelatedNode		0..1	code	"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: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required)
PunkteBelagsdauerausreisserUntenLeistungskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Leistungskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
PunkteBelagsdauerausreisserUntenTageskomponente		0..1	unsignedInt	Punkte Belagsdauerausreisser unten - Tageskomponente URL: http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
ZusatzpunkteBelagsdauerausreisserNachOben		0..1	unsignedInt	Zusatzpunkte Belagsdauerausreißer nach oben URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
ZusatzpunkteIntensiv		0..1	unsignedInt	Zusatzpunkte Intensiv URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
ZusatzpunkteMehrfachleistungen		0..1	unsignedInt	Zusatzpunkte Mehrfachleistungen URL: http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
PunkteSpeziellerBereicheTageweise		0..1	unsignedInt	Punkte spezieller Bereiche (tageweise) URL: http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
LeistungskomponenteLeistungspunkte		0..1	unsignedInt	Leistungskomponente/Leistungspunkte URL: http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
TageskomponenteKontaktpunkte		0..1	unsignedInt	Tageskomponente/Kontaktpunkte URL: http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
TotalPoints		0..1	unsignedInt	Punkte total URL: http://example.org/StructureDefinition/totalPoints
ErrorWarning		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-ErrorWarning
Fondsrelevanz		0..1	code	Fondsrelevanz URL: http://example.org/StructureDefinition/moped-ext-fondsrelevanz Binding: http://tbd.at/MOPED-Fondsrelevanz (required)
Plausibilitaetskennzeichen		0..1	string	Plausibilitaetskennzeichen URL: http://example.org/StructureDefinition/Plausibilitaetskennzeichen
SVAbrechnungsquartal		0..1	(Complex)	Abrechnungsquartal der Sozialversicherung URL: http://example.org/StructureDefinition/SVAbrechnungsquartal
AccountRef		0..1	Reference(MOPEDAccount)	Account Referenz URL: http://example.org/StructureDefinition/moped-ext-AccountRef
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for claim
traceNumber		0..*	Identifier	Number for tracking
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Author of the claim
insurer	Σ	0..1	Reference(Organization)	Target
provider	Σ	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
priority	Σ	0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: FundsReservationCodes (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(MOPEDClaim)	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: ClaimPayeeTypeCodes (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
Slices for encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments Slice: Unordered, Open by
encounter:MopedEncounter		0..1	Reference(MOPEDEncounter)	Generelle Informationen zu Aufnahme und Entlassung des Patienten
encounter:TransferEncounter		0..*	Reference(MOPEDTransferEncounter)	Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
facility		0..1	Reference(Location | Organization)	Servicing facility
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: http://tbd.at/MOPED-LKFAbrechnungsGruppe (required)
event		0..*	BackboneElement	Event 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
type		1..1	CodeableConcept	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
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.
specialty		0..1	CodeableConcept	Practitioner or provider specialization Binding: ExampleProviderQualificationCodes (example)
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)
valueIdentifier			Identifier
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis 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	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
AbrechnungsRelevanz		0..1	code	Medizinische Leistung - Abrechnungsrelevanz URL: http://example.org/StructureDefinition/moped-ext-AbrechnungsRelevanz Binding: Abrechnungsrelevanz der medizinischen Leistung (required)
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
procedure[x]		1..1		Specific clinical procedure Binding: ICD10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
insurance	Σ	0..*	BackboneElement	Patient insurance 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	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	Σ	1..1	Reference(MOPEDCoverage)	Insurance information
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	Details of the event
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	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
patientPaid		0..1	Money	Paid by the patient
item		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
traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
request		0..*	Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)	Request or Referral for Service
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)
patientPaid		0..1	Money	Paid by the patient
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..*	BackboneElement	Anatomical location
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
site		1..*	CodeableReference(BodyStructure)	Location Binding: OralSiteCodes (example)
subSite		0..*	CodeableConcept	Sub-location Binding: SurfaceCodes (example)
encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
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
traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.
patientPaid		0..1	Money	Paid by the patient
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
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
traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.
patientPaid		0..1	Money	Paid by the patient
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Claim.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
Claim.subType	example	ExampleClaimSubTypeCodes http://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard
Claim.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
Claim.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
Claim.fundsReserve	example	FundsReservationCodes http://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes http://hl7.org/fhir/ValueSet/related-claim-relationship from the FHIR Standard
Claim.payee.type	example	ClaimPayeeTypeCodes http://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard
Claim.diagnosisRelatedGroup	required	http://tbd.at/MOPED-LKFAbrechnungsGruppe http://tbd.at/MOPED-LKFAbrechnungsGruppe
Claim.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
Claim.careTeam.role	example	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard
Claim.careTeam.specialty	example	ExampleProviderQualificationCodes http://hl7.org/fhir/ValueSet/provider-qualification from the FHIR Standard
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason from the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard
Claim.diagnosis.type	example	ExampleDiagnosisTypeCodes http://hl7.org/fhir/ValueSet/ex-diagnosistype from the FHIR Standard
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission from the FHIR Standard
Claim.procedure.type	example	ExampleProcedureTypeCodes http://hl7.org/fhir/ValueSet/ex-procedure-type from the FHIR Standard
Claim.procedure.procedure[x]	example	ICD10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures from the FHIR Standard
Claim.accident.type	extensible	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Claim.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place from the FHIR Standard
Claim.item.bodySite.site	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth from the FHIR Standard
Claim.item.bodySite.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface from the FHIR Standard
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Claim.item.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Claim.item.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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().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-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()

This structure is derived from Claim

Summary

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)
• MOPEDClaim (http://example.org/StructureDefinition/MOPEDClaim)
• MOPEDEncounter (http://example.org/StructureDefinition/MOPEDEncounter)
• MOPEDTransferEncounter (http://example.org/StructureDefinition/MOPEDTransferEncounter)
• MOPEDCoverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/note
• http://example.org/StructureDefinition/moped-ext-diagnosisRelatedNode
• http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Leistungskomponente
• http://example.org/StructureDefinition/Punkte-Belagsdauerausreisser-unten-Tageskomponente
• http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Belagsdauerausreisser-nach-oben
• http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Intensiv
• http://example.org/StructureDefinition/moped-ext-Zusatzpunkte-Mehrfachleistungen
• http://example.org/StructureDefinition/Punkte-spezieller-Bereiche-tageweise
• http://example.org/StructureDefinition/Leistungskomponente-Leistungspunkte
• http://example.org/StructureDefinition/Tageskomponente-Kontaktpunkte
• http://example.org/StructureDefinition/totalPoints
• http://example.org/StructureDefinition/moped-ext-ErrorWarning
• http://example.org/StructureDefinition/moped-ext-fondsrelevanz
• http://example.org/StructureDefinition/Plausibilitaetskennzeichen
• http://example.org/StructureDefinition/SVAbrechnungsquartal
• http://example.org/StructureDefinition/moped-ext-AccountRef
• http://example.org/StructureDefinition/moped-ext-AbrechnungsRelevanz

Slices

This structure defines the following Slices:

• There is a slice with no discriminator at Claim.encounter