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: MOPED VAERequest

Official URL: https://elga.moped.at/StructureDefinition/MopedVAERequest | Version: 0.1.0
Draft as of 2025-12-19 | Responsible: ELGA GmbH | Computable Name: MopedVAERequest

MOPED Profil für die Anfrage der Versichertenanspruchserklärung VAE.

Usages:

- Derived from this Profile: MOPED VAERequest für die initiale Anfrage der VAE and MOPED VAERequest für die Verlängerung der VAE
- Refer to this Profile: MOPED LKFRequest and MOPED VAERequest
- Examples for this Profile: Claim/PJ1VAERequest1 and Claim/PJ2VAERequest1

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Obligations | Actor
SHALL:handle | Moped Device Actor
SHALL:populate | Moped KH Actor
type | O Σ | 1..1 | CodeableConcept | Category or discipline Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
coding | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Request)
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAEREQ
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
subType | O | 1..1 | CodeableConcept | More granular claim type Binding: VAE Claim Subtype ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped KH Actor
patient | O Σ | 1..1 | Reference(MOPED Patient) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | Σ | 1..1 | dateTime | Resource creation date
insurer | O Σ | 1..1 | Reference(SV Organization) | Target
Obligations | Actor
SHALL:populate | Moped KH Actor
provider | O Σ | 1..1 | Reference(KH Organization) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
Slices for encounter |  | 1..* | Reference(Encounter) | Encounters associated with the listed treatments Slice: Unordered, Open by value:resolve().type
encounter:MopedEncounter | O | 1..1 | Reference(MOPED Encounter) | Generelle Informationen zu Aufnahme und Entlassung des Patienten
Obligations | Actor
SHALL:handle | Moped Device Actor
encounter:TransferEncounter | O | 0..* | Reference(MOPED TransferEncounter) | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
Obligations | Actor
SHALL:handle | Moped Device Actor
Slices for supportingInfo |  | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
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.
supportingInfo:Sonderklasse | O | 0..* | BackboneElement | KaOrg: Allgemeine Gebührenklasse/Sonderklasse
Obligations | Actor
SHALL:populate | Moped KH Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: KLAS
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | O | 1..1 | CodeableConcept | KaOrg: Verlegung Klasse Binding: Sonderklasse ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
Slices for timing[x] |  | 1..1 | Period | When it occurred Slice: Unordered, Closed by type:$this
timing[x]:timingPeriod | O | 1..1 | Period | KaOrg: Aufnahme-/Verlegungsdatum
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:VerdachtFremdverschulden |  | 1..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: FREVER
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value[x] | O | 1..1 | boolean | KaOrg: Fremdverschulden
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:Verlaengerungstage | O | 0..1 | BackboneElement | Supporting information
Obligations | Actor
SHALL:populate | Moped KH Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VERLAENG
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
Slices for value[x] |  | 0..1 |  | Data to be provided Slice: Unordered, Open by type:$this
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
valueIdentifier |  |  | Identifier |
value[x]:valueQuantity |  | 0..1 | Quantity | Data to be provided
value | O Σ | 1..1 | decimal | KaOrg: Anzahl der Verlängerungstage
Obligations | Actor
SHALL:populate | Moped KH Actor
comparator | ?!Σ | 0..1 | code | < | <= | >= | > | ad - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit | O Σ | 0..1 | string | Unit representation Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
system | O Σ C | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Obligations | Actor
SHALL:populate | Moped KH Actor
code | O Σ C | 0..1 | code | Coded form of the unit Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Claim.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
Claim.subType | Base | required | VAE Claim Subtype ValueSet | 📦0.1.0 | This IG
Claim.use | Base | required | Use | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​code | Base | required | Sonderklasse ValueSet | 📦0.1.0 | This IG
Claim.supportingInfo:VerdachtFremdverschulden.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  |  | Claim |
status | O | 1..1 | code | active | cancelled | draft | entered-in-error
Obligations | Actor
SHALL:handle | Moped Device Actor
SHALL:populate | Moped KH Actor
type | O | 1..1 | CodeableConcept | Category or discipline Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Request)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAEREQ
subType | O | 1..1 | CodeableConcept | More granular claim type Binding: VAE Claim Subtype ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
use | O | 1..1 | code | claim | preauthorization | predetermination Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped KH Actor
patient | O | 1..1 | Reference(MOPED Patient) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
billablePeriod |  |  |  |
start | O | 1..1 | dateTime | Starting time with inclusive boundary
Obligations | Actor
SHALL:populate | Moped KH Actor
insurer | O | 1..1 | Reference(SV Organization) | Target
Obligations | Actor
SHALL:populate | Moped KH Actor
provider | O | 1..1 | Reference(KH Organization) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
related |  |  |  |
claim | O | 0..1 | Reference(MOPED VAERequest) | Reference to the related claim
Obligations | Actor
SHALL:populate | Moped KH Actor
Slices for encounter |  | 1..* | Reference(Encounter) | Encounters associated with the listed treatments Slice: Unordered, Open by value:resolve().type
encounter:MopedEncounter | O | 1..1 | Reference(MOPED Encounter) | Generelle Informationen zu Aufnahme und Entlassung des Patienten
Obligations | Actor
SHALL:handle | Moped Device Actor
encounter:TransferEncounter | O | 0..* | Reference(MOPED TransferEncounter) | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
Obligations | Actor
SHALL:handle | Moped Device Actor
Slices for supportingInfo |  | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
code |  |  |  |
coding |  | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
supportingInfo:Sonderklasse | O | 0..* | BackboneElement | KaOrg: Allgemeine Gebührenklasse/Sonderklasse
Obligations | Actor
SHALL:populate | Moped KH Actor
category | O | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: KLAS
code | O | 1..1 | CodeableConcept | KaOrg: Verlegung Klasse Binding: Sonderklasse ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
Slices for timing[x] |  | 1..1 | Period | When it occurred Slice: Unordered, Open by type:$this
timing[x]:timingPeriod | O | 1..1 | Period | KaOrg: Aufnahme-/Verlegungsdatum
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:VerdachtFremdverschulden |  | 1..1 | BackboneElement | Supporting information
category | O | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: FREVER
value[x] | O | 1..1 | boolean | KaOrg: Fremdverschulden
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:Verlaengerungstage | O | 0..1 | BackboneElement | Supporting information
Obligations | Actor
SHALL:populate | Moped KH Actor
category | O | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VERLAENG
Slices for value[x] |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource), Identifier | Data to be provided Slice: Unordered, Open by type:$this
value[x]:valueQuantity |  | 0..1 | Quantity | Data to be provided
value | O | 1..1 | decimal | KaOrg: Anzahl der Verlängerungstage
Obligations | Actor
SHALL:populate | Moped KH Actor
unit | O | 0..1 | string | Unit representation Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
system | O | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Obligations | Actor
SHALL:populate | Moped KH Actor
code | O | 0..1 | code | Coded form of the unit Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
diagnosis |  |  |  |
diagnosis[x] | O | 1..1 | Reference(MOPED Condition) | Nature of illness or problem
Obligations | Actor
SHALL:populate | Moped KH Actor
insurance |  |  |  |
coverage | O | 1..1 | Reference(MOPED Coverage) | Insurance information
Obligations | Actor
SHALL:handle | Moped Device Actor
accident |  |  |  |
date | O | 1..1 | date | KaOrg: Ereignis-/Unfalldatum (echtes Unfalldatum)
Obligations | Actor
SHALL:populate | Moped KH Actor
type | O | 1..1 | CodeableConcept | KaOrg: Verdacht auf Arbeits-/Schülerunfall Binding: Verdacht auf Arbeits- oder Schuelerunfall ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
Claim.subType | Base | required | VAE Claim Subtype ValueSet | 📦0.1.0 | This IG
Claim.supportingInfo.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:Sonderklasse.​code | Base | required | Sonderklasse ValueSet | 📦0.1.0 | This IG
Claim.accident.type | Base | required | Verdacht auf Arbeits- oder Schuelerunfall ValueSet | 📦0.1.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for claim
traceNumber |  | 0..* | Identifier | Number for tracking
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Obligations | Actor
SHALL:handle | Moped Device Actor
SHALL:populate | Moped KH Actor
type | O Σ | 1..1 | CodeableConcept | Category or discipline Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Request)
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAEREQ
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
subType | O | 1..1 | CodeableConcept | More granular claim type Binding: VAE Claim Subtype ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped KH Actor
patient | O Σ | 1..1 | Reference(MOPED Patient) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
start | O Σ C | 1..1 | dateTime | Starting time with inclusive boundary
Obligations | Actor
SHALL:populate | Moped KH Actor
end | Σ C | 0..1 | dateTime | End time with inclusive boundary, if not ongoing
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | Author of the claim
insurer | O Σ | 1..1 | Reference(SV Organization) | Target
Obligations | Actor
SHALL:populate | Moped KH Actor
provider | O Σ | 1..1 | Reference(KH Organization) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
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 | O | 0..1 | Reference(MOPED VAERequest) | Reference to the related claim
Obligations | Actor
SHALL:populate | Moped KH Actor
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 |  | 1..* | Reference(Encounter) | Encounters associated with the listed treatments Slice: Unordered, Open by value:resolve().type
encounter:MopedEncounter | O | 1..1 | Reference(MOPED Encounter) | Generelle Informationen zu Aufnahme und Entlassung des Patienten
Obligations | Actor
SHALL:handle | Moped Device Actor
encounter:TransferEncounter | O | 0..* | Reference(MOPED TransferEncounter) | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
Obligations | Actor
SHALL:handle | Moped Device Actor
facility |  | 0..1 | Reference(Location | Organization) | Servicing facility
diagnosisRelatedGroup |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
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)
Slices for supportingInfo |  | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
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.
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
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.
supportingInfo:Sonderklasse | O | 0..* | BackboneElement | KaOrg: Allgemeine Gebührenklasse/Sonderklasse
Obligations | Actor
SHALL:populate | Moped KH Actor
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 | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: KLAS
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | O | 1..1 | CodeableConcept | KaOrg: Verlegung Klasse Binding: Sonderklasse ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
Slices for timing[x] |  | 1..1 | Period | When it occurred Slice: Unordered, Closed by type:$this
timing[x]:timingPeriod | O | 1..1 | Period | KaOrg: Aufnahme-/Verlegungsdatum
Obligations | Actor
SHALL:populate | Moped KH Actor
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.
supportingInfo:VerdachtFremdverschulden |  | 1..1 | 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 | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: FREVER
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] | O | 1..1 | boolean | KaOrg: Fremdverschulden
Obligations | Actor
SHALL:populate | Moped KH Actor
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:Verlaengerungstage | O | 0..1 | BackboneElement | Supporting information
Obligations | Actor
SHALL:populate | Moped KH Actor
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 | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VERLAENG
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
Slices for value[x] |  | 0..1 |  | Data to be provided Slice: Unordered, Open by type:$this
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
valueIdentifier |  |  | Identifier |
value[x]:valueQuantity |  | 0..1 | Quantity | Data to be provided
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
value | O Σ | 1..1 | decimal | KaOrg: Anzahl der Verlängerungstage
Obligations | Actor
SHALL:populate | Moped KH Actor
comparator | ?!Σ | 0..1 | code | < | <= | >= | > | ad - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit | O Σ | 0..1 | string | Unit representation Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
system | O Σ C | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Obligations | Actor
SHALL:populate | Moped KH Actor
code | O Σ C | 0..1 | code | Coded form of the unit Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
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] | O | 1..1 | Reference(MOPED Condition) | Nature of illness or problem
Obligations | Actor
SHALL:populate | Moped KH Actor
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
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 | O Σ | 1..1 | Reference(MOPED Coverage) | Insurance information
Obligations | Actor
SHALL:handle | Moped Device Actor
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 | O | 1..1 | date | KaOrg: Ereignis-/Unfalldatum (echtes Unfalldatum)
Obligations | Actor
SHALL:populate | Moped KH Actor
type | O | 1..1 | CodeableConcept | KaOrg: Verdacht auf Arbeits-/Schülerunfall Binding: Verdacht auf Arbeits- oder Schuelerunfall ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
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(5.0.0) | 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(5.0.0) | 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(5.0.0) | 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 | Status | Usage | ValueSet | Version | Source
Claim.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Claim.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
Claim.subType | Base | required | VAE Claim Subtype ValueSet | 📦0.1.0 | This IG
Claim.use | Base | required | Use | 📍5.0.0 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍5.0.0 | FHIR Std.
Claim.fundsReserve | Base | example | Funds Reservation Codes | 📍5.0.0 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍5.0.0 | FHIR Std.
Claim.payee.type | Base | example | Claim Payee Type Codes | 📍5.0.0 | FHIR Std.
Claim.diagnosisRelatedGroup | Base | example | Example Diagnosis Related Group Codes | 📍5.0.0 | FHIR Std.
Claim.event.type | Base | example | Dates Type Codes | 📍5.0.0 | FHIR Std.
Claim.careTeam.role | Base | example | Claim Care Team Role Codes | 📍5.0.0 | FHIR Std.
Claim.careTeam.specialty | Base | example | Example Provider Qualification Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​code | Base | required | Sonderklasse ValueSet | 📦0.1.0 | This IG
Claim.supportingInfo:Sonderklasse.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:Sonderklasse.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:VerdachtFremdverschulden.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:VerdachtFremdverschulden.​code | Base | example | Exception Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:VerdachtFremdverschulden.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:VerdachtFremdverschulden.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​code | Base | example | Exception Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:Verlaengerungstage.​value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍5.0.0 | FHIR Std.
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍5.0.0 | FHIR Std.
Claim.procedure.type | Base | example | Example Procedure Type Codes | 📍5.0.0 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍5.0.0 | FHIR Std.
Claim.accident.type | Base | required | Verdacht auf Arbeits- oder Schuelerunfall ValueSet | 📦0.1.0 | This IG
Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
Claim.item.category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍5.0.0 | FHIR Std.
Claim.item.bodySite.​site | Base | example | Oral Site Codes | 📍5.0.0 | FHIR Std.
Claim.item.bodySite.​subSite | Base | example | Surface Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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

Mandatory: 8 elements(6 nested mandatory elements)
Fixed: 1 element

Structures

This structure refers to these other structures:

- MOPED Patient (https://elga.moped.at/StructureDefinition/MopedPatient)
- SV Organization (https://elga.moped.at/StructureDefinition/SVOrganization)
- KH Organization (https://elga.moped.at/StructureDefinition/KHOrganization)
- MOPED VAERequest (https://elga.moped.at/StructureDefinition/MopedVAERequest)
- MOPED Encounter (https://elga.moped.at/StructureDefinition/MopedEncounter)
- MOPED TransferEncounter (https://elga.moped.at/StructureDefinition/MopedTransferEncounter)
- MOPED Condition (https://elga.moped.at/StructureDefinition/MopedCondition)
- MOPED Coverage (https://elga.moped.at/StructureDefinition/MopedCoverage)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.encounter
- The element 1 is sliced based on the value of Claim.supportingInfo
- The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]
- The element 1 is sliced based on the value of Claim.supportingInfo.value[x]

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Obligations | Actor
SHALL:handle | Moped Device Actor
SHALL:populate | Moped KH Actor
type | O Σ | 1..1 | CodeableConcept | Category or discipline Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
coding | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Request)
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAEREQ
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
subType | O | 1..1 | CodeableConcept | More granular claim type Binding: VAE Claim Subtype ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped KH Actor
patient | O Σ | 1..1 | Reference(MOPED Patient) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | Σ | 1..1 | dateTime | Resource creation date
insurer | O Σ | 1..1 | Reference(SV Organization) | Target
Obligations | Actor
SHALL:populate | Moped KH Actor
provider | O Σ | 1..1 | Reference(KH Organization) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
Slices for encounter |  | 1..* | Reference(Encounter) | Encounters associated with the listed treatments Slice: Unordered, Open by value:resolve().type
encounter:MopedEncounter | O | 1..1 | Reference(MOPED Encounter) | Generelle Informationen zu Aufnahme und Entlassung des Patienten
Obligations | Actor
SHALL:handle | Moped Device Actor
encounter:TransferEncounter | O | 0..* | Reference(MOPED TransferEncounter) | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
Obligations | Actor
SHALL:handle | Moped Device Actor
Slices for supportingInfo |  | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
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.
supportingInfo:Sonderklasse | O | 0..* | BackboneElement | KaOrg: Allgemeine Gebührenklasse/Sonderklasse
Obligations | Actor
SHALL:populate | Moped KH Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: KLAS
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | O | 1..1 | CodeableConcept | KaOrg: Verlegung Klasse Binding: Sonderklasse ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
Slices for timing[x] |  | 1..1 | Period | When it occurred Slice: Unordered, Closed by type:$this
timing[x]:timingPeriod | O | 1..1 | Period | KaOrg: Aufnahme-/Verlegungsdatum
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:VerdachtFremdverschulden |  | 1..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: FREVER
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value[x] | O | 1..1 | boolean | KaOrg: Fremdverschulden
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:Verlaengerungstage | O | 0..1 | BackboneElement | Supporting information
Obligations | Actor
SHALL:populate | Moped KH Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VERLAENG
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
Slices for value[x] |  | 0..1 |  | Data to be provided Slice: Unordered, Open by type:$this
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
valueIdentifier |  |  | Identifier |
value[x]:valueQuantity |  | 0..1 | Quantity | Data to be provided
value | O Σ | 1..1 | decimal | KaOrg: Anzahl der Verlängerungstage
Obligations | Actor
SHALL:populate | Moped KH Actor
comparator | ?!Σ | 0..1 | code | < | <= | >= | > | ad - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit | O Σ | 0..1 | string | Unit representation Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
system | O Σ C | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Obligations | Actor
SHALL:populate | Moped KH Actor
code | O Σ C | 0..1 | code | Coded form of the unit Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Claim.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
Claim.subType | Base | required | VAE Claim Subtype ValueSet | 📦0.1.0 | This IG
Claim.use | Base | required | Use | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​code | Base | required | Sonderklasse ValueSet | 📦0.1.0 | This IG
Claim.supportingInfo:VerdachtFremdverschulden.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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()`

Differential View

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  |  | Claim |
status | O | 1..1 | code | active | cancelled | draft | entered-in-error
Obligations | Actor
SHALL:handle | Moped Device Actor
SHALL:populate | Moped KH Actor
type | O | 1..1 | CodeableConcept | Category or discipline Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Request)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAEREQ
subType | O | 1..1 | CodeableConcept | More granular claim type Binding: VAE Claim Subtype ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
use | O | 1..1 | code | claim | preauthorization | predetermination Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped KH Actor
patient | O | 1..1 | Reference(MOPED Patient) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
billablePeriod |  |  |  |
start | O | 1..1 | dateTime | Starting time with inclusive boundary
Obligations | Actor
SHALL:populate | Moped KH Actor
insurer | O | 1..1 | Reference(SV Organization) | Target
Obligations | Actor
SHALL:populate | Moped KH Actor
provider | O | 1..1 | Reference(KH Organization) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
related |  |  |  |
claim | O | 0..1 | Reference(MOPED VAERequest) | Reference to the related claim
Obligations | Actor
SHALL:populate | Moped KH Actor
Slices for encounter |  | 1..* | Reference(Encounter) | Encounters associated with the listed treatments Slice: Unordered, Open by value:resolve().type
encounter:MopedEncounter | O | 1..1 | Reference(MOPED Encounter) | Generelle Informationen zu Aufnahme und Entlassung des Patienten
Obligations | Actor
SHALL:handle | Moped Device Actor
encounter:TransferEncounter | O | 0..* | Reference(MOPED TransferEncounter) | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
Obligations | Actor
SHALL:handle | Moped Device Actor
Slices for supportingInfo |  | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
code |  |  |  |
coding |  | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
supportingInfo:Sonderklasse | O | 0..* | BackboneElement | KaOrg: Allgemeine Gebührenklasse/Sonderklasse
Obligations | Actor
SHALL:populate | Moped KH Actor
category | O | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: KLAS
code | O | 1..1 | CodeableConcept | KaOrg: Verlegung Klasse Binding: Sonderklasse ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
Slices for timing[x] |  | 1..1 | Period | When it occurred Slice: Unordered, Open by type:$this
timing[x]:timingPeriod | O | 1..1 | Period | KaOrg: Aufnahme-/Verlegungsdatum
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:VerdachtFremdverschulden |  | 1..1 | BackboneElement | Supporting information
category | O | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: FREVER
value[x] | O | 1..1 | boolean | KaOrg: Fremdverschulden
Obligations | Actor
SHALL:populate | Moped KH Actor
supportingInfo:Verlaengerungstage | O | 0..1 | BackboneElement | Supporting information
Obligations | Actor
SHALL:populate | Moped KH Actor
category | O | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VERLAENG
Slices for value[x] |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource), Identifier | Data to be provided Slice: Unordered, Open by type:$this
value[x]:valueQuantity |  | 0..1 | Quantity | Data to be provided
value | O | 1..1 | decimal | KaOrg: Anzahl der Verlängerungstage
Obligations | Actor
SHALL:populate | Moped KH Actor
unit | O | 0..1 | string | Unit representation Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
system | O | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Obligations | Actor
SHALL:populate | Moped KH Actor
code | O | 0..1 | code | Coded form of the unit Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
diagnosis |  |  |  |
diagnosis[x] | O | 1..1 | Reference(MOPED Condition) | Nature of illness or problem
Obligations | Actor
SHALL:populate | Moped KH Actor
insurance |  |  |  |
coverage | O | 1..1 | Reference(MOPED Coverage) | Insurance information
Obligations | Actor
SHALL:handle | Moped Device Actor
accident |  |  |  |
date | O | 1..1 | date | KaOrg: Ereignis-/Unfalldatum (echtes Unfalldatum)
Obligations | Actor
SHALL:populate | Moped KH Actor
type | O | 1..1 | CodeableConcept | KaOrg: Verdacht auf Arbeits-/Schülerunfall Binding: Verdacht auf Arbeits- oder Schuelerunfall ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
Claim.subType | Base | required | VAE Claim Subtype ValueSet | 📦0.1.0 | This IG
Claim.supportingInfo.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:Sonderklasse.​code | Base | required | Sonderklasse ValueSet | 📦0.1.0 | This IG
Claim.accident.type | Base | required | Verdacht auf Arbeits- oder Schuelerunfall ValueSet | 📦0.1.0 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for claim
traceNumber |  | 0..* | Identifier | Number for tracking
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Obligations | Actor
SHALL:handle | Moped Device Actor
SHALL:populate | Moped KH Actor
type | O Σ | 1..1 | CodeableConcept | Category or discipline Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Request)
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAEREQ
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
subType | O | 1..1 | CodeableConcept | More granular claim type Binding: VAE Claim Subtype ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped KH Actor
patient | O Σ | 1..1 | Reference(MOPED Patient) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
start | O Σ C | 1..1 | dateTime | Starting time with inclusive boundary
Obligations | Actor
SHALL:populate | Moped KH Actor
end | Σ C | 0..1 | dateTime | End time with inclusive boundary, if not ongoing
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | Author of the claim
insurer | O Σ | 1..1 | Reference(SV Organization) | Target
Obligations | Actor
SHALL:populate | Moped KH Actor
provider | O Σ | 1..1 | Reference(KH Organization) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
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 | O | 0..1 | Reference(MOPED VAERequest) | Reference to the related claim
Obligations | Actor
SHALL:populate | Moped KH Actor
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 |  | 1..* | Reference(Encounter) | Encounters associated with the listed treatments Slice: Unordered, Open by value:resolve().type
encounter:MopedEncounter | O | 1..1 | Reference(MOPED Encounter) | Generelle Informationen zu Aufnahme und Entlassung des Patienten
Obligations | Actor
SHALL:handle | Moped Device Actor
encounter:TransferEncounter | O | 0..* | Reference(MOPED TransferEncounter) | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
Obligations | Actor
SHALL:handle | Moped Device Actor
facility |  | 0..1 | Reference(Location | Organization) | Servicing facility
diagnosisRelatedGroup |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
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)
Slices for supportingInfo |  | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
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.
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
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.
supportingInfo:Sonderklasse | O | 0..* | BackboneElement | KaOrg: Allgemeine Gebührenklasse/Sonderklasse
Obligations | Actor
SHALL:populate | Moped KH Actor
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 | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: KLAS
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code | O | 1..1 | CodeableConcept | KaOrg: Verlegung Klasse Binding: Sonderklasse ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
Slices for timing[x] |  | 1..1 | Period | When it occurred Slice: Unordered, Closed by type:$this
timing[x]:timingPeriod | O | 1..1 | Period | KaOrg: Aufnahme-/Verlegungsdatum
Obligations | Actor
SHALL:populate | Moped KH Actor
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.
supportingInfo:VerdachtFremdverschulden |  | 1..1 | 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 | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: FREVER
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] | O | 1..1 | boolean | KaOrg: Fremdverschulden
Obligations | Actor
SHALL:populate | Moped KH Actor
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:Verlaengerungstage | O | 0..1 | BackboneElement | Supporting information
Obligations | Actor
SHALL:populate | Moped KH Actor
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 | O | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following
Obligations | Actor
SHALL:populate | Moped KH Actor
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/ClaimSupportingInformationCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VERLAENG
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: MOPED VAESupportingInformationCategory (required)
text | Σ | 0..1 | string | Plain text representation of the concept
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
Slices for value[x] |  | 0..1 |  | Data to be provided Slice: Unordered, Open by type:$this
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
valueIdentifier |  |  | Identifier |
value[x]:valueQuantity |  | 0..1 | Quantity | Data to be provided
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
value | O Σ | 1..1 | decimal | KaOrg: Anzahl der Verlängerungstage
Obligations | Actor
SHALL:populate | Moped KH Actor
comparator | ?!Σ | 0..1 | code | < | <= | >= | > | ad - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit | O Σ | 0..1 | string | Unit representation Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
system | O Σ C | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org
Obligations | Actor
SHALL:populate | Moped KH Actor
code | O Σ C | 0..1 | code | Coded form of the unit Required Pattern: day
Obligations | Actor
SHALL:populate | Moped KH Actor
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] | O | 1..1 | Reference(MOPED Condition) | Nature of illness or problem
Obligations | Actor
SHALL:populate | Moped KH Actor
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
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 | O Σ | 1..1 | Reference(MOPED Coverage) | Insurance information
Obligations | Actor
SHALL:handle | Moped Device Actor
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 | O | 1..1 | date | KaOrg: Ereignis-/Unfalldatum (echtes Unfalldatum)
Obligations | Actor
SHALL:populate | Moped KH Actor
type | O | 1..1 | CodeableConcept | KaOrg: Verdacht auf Arbeits-/Schülerunfall Binding: Verdacht auf Arbeits- oder Schuelerunfall ValueSet (required)
Obligations | Actor
SHALL:populate | Moped KH Actor
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(5.0.0) | 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(5.0.0) | 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(5.0.0) | 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 | Status | Usage | ValueSet | Version | Source
Claim.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
Claim.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
Claim.subType | Base | required | VAE Claim Subtype ValueSet | 📦0.1.0 | This IG
Claim.use | Base | required | Use | 📍5.0.0 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍5.0.0 | FHIR Std.
Claim.fundsReserve | Base | example | Funds Reservation Codes | 📍5.0.0 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍5.0.0 | FHIR Std.
Claim.payee.type | Base | example | Claim Payee Type Codes | 📍5.0.0 | FHIR Std.
Claim.diagnosisRelatedGroup | Base | example | Example Diagnosis Related Group Codes | 📍5.0.0 | FHIR Std.
Claim.event.type | Base | example | Dates Type Codes | 📍5.0.0 | FHIR Std.
Claim.careTeam.role | Base | example | Claim Care Team Role Codes | 📍5.0.0 | FHIR Std.
Claim.careTeam.specialty | Base | example | Example Provider Qualification Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Sonderklasse.​code | Base | required | Sonderklasse ValueSet | 📦0.1.0 | This IG
Claim.supportingInfo:Sonderklasse.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:Sonderklasse.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:VerdachtFremdverschulden.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:VerdachtFremdverschulden.​code | Base | example | Exception Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:VerdachtFremdverschulden.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:VerdachtFremdverschulden.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​category | Base | example | Claim Information Category Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​code | Base | example | Exception Codes | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​code.coding | Base | required | MOPED VAESupportingInformationCategory | 📦0.1.0 | This IG
Claim.supportingInfo:Verlaengerungstage.​value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍5.0.0 | FHIR Std.
Claim.supportingInfo:Verlaengerungstage.​reason | Base | example | Missing Tooth Reason Codes | 📍5.0.0 | FHIR Std.
Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍5.0.0 | FHIR Std.
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍5.0.0 | FHIR Std.
Claim.procedure.type | Base | example | Example Procedure Type Codes | 📍5.0.0 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍5.0.0 | FHIR Std.
Claim.accident.type | Base | required | Verdacht auf Arbeits- oder Schuelerunfall ValueSet | 📦0.1.0 | This IG
Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
Claim.item.category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍5.0.0 | FHIR Std.
Claim.item.bodySite.​site | Base | example | Oral Site Codes | 📍5.0.0 | FHIR Std.
Claim.item.bodySite.​subSite | Base | example | Surface Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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

Mandatory: 8 elements(6 nested mandatory elements)
Fixed: 1 element

Structures

This structure refers to these other structures:

- MOPED Patient (https://elga.moped.at/StructureDefinition/MopedPatient)
- SV Organization (https://elga.moped.at/StructureDefinition/SVOrganization)
- KH Organization (https://elga.moped.at/StructureDefinition/KHOrganization)
- MOPED VAERequest (https://elga.moped.at/StructureDefinition/MopedVAERequest)
- MOPED Encounter (https://elga.moped.at/StructureDefinition/MopedEncounter)
- MOPED TransferEncounter (https://elga.moped.at/StructureDefinition/MopedTransferEncounter)
- MOPED Condition (https://elga.moped.at/StructureDefinition/MopedCondition)
- MOPED Coverage (https://elga.moped.at/StructureDefinition/MopedCoverage)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.encounter
- The element 1 is sliced based on the value of Claim.supportingInfo
- The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]
- The element 1 is sliced based on the value of Claim.supportingInfo.value[x]

Other representations of profile: CSV, Excel, Schematron