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

This is the set of resources that conform to both Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim) and Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim).

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C0..*Claim, Pre-determination or Pre-authorization
Constraints: vn-claim-single-focal-insurance, vn-claim-coverage-not-expired
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..*IdentifierĐịnh danh hồ sơ thanh toán, bao gồm MA_LK
... status ?!SΣ1..1codeTrạng thái yêu cầu thanh toán
Binding: ?? (required): A code specifying the state of the resource instance.
... type SΣ1..1CodeableConceptLoại yêu cầu: institutional (nội trú), professional (ngoại trú)
Binding: ?? (extensible): The type or discipline-style of the claim.
... subType S0..1CodeableConceptMã đối tượng đến KCB (MA_DOITUONG_KCB per QĐ 3276/QĐ-BYT)
Binding: ?? (extensible)
... use SΣ1..1codeMục đích: claim (thanh toán) | preauthorization | predetermination
Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ1..1Reference(Bệnh nhân VN Core — VN Core Patient Profile | #sd+86-vn-core-patient-vn-core-patient)Bệnh nhân (XML 3176: MA_BN)
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created SΣ1..1dateTimeNgày tạo yêu cầu
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer SΣ0..1Reference(Cơ sở y tế VN Core — VN Core Organization Profile | #sd+90-vn-core-organization-vn-core-organization)Cơ quan BHXH thanh toán
... provider SΣ1..1Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile | #sd+90-vn-core-organization-vn-core-organization)Cơ sở KCB thực hiện (XML 3176: MA_CSKCB)
... priority Σ1..1CodeableConceptMức ưu tiên xử lý
Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..*BackboneElementPrior or corollary claims
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.
.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Treatment referral
... facility 0..1Reference(Location)Servicing facility
... careTeam 0..*BackboneElementMembers of the care team
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (example): Provider professional qualifications.
... supportingInfo 0..*BackboneElementSupporting information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodeableConceptExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.
... diagnosis S1..*BackboneElementChẩn đoán — ICD-10 VN (XML 3176: MA_BENH, MA_BENHKHAC)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence S1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ?? (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type S0..*CodeableConceptLoại chẩn đoán (chính/phụ)
Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ?? (example): Present on admission.
.... packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.
... procedure 0..*BackboneElementThủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: ?? (example): Example procedure type codes.
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: ?? (example): Example ICD10 Procedure codes.
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... insurance SΣ1..*BackboneElementThông tin BHYT (XML 3176: MA_THE)
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal SΣ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage SΣ1..1Reference(Thẻ BHYT VN Core — VN Core Coverage Profile | #sd+96-vn-core-coverage-vn-core-coverage)Thẻ BHYT (Coverage)
.... businessArrangement 0..1stringAdditional provider contract number
.... preAuthRef 0..*stringPrior authorization reference number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... accident 0..1BackboneElementThông tin tai nạn thương tích
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptLoại tai nạn (MA_TAI_NAN per QĐ 3176, Bảng 8)
Binding: ?? (extensible)
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item S1..*BackboneElementChi tiết chi phí — 12 nhóm per QĐ 697/QĐ-BYT (bắt buộc ít nhất 1 dòng)
.... extension 0..*ExtensionExtension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence S1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable careTeam members
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category S0..1CodeableConceptNhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697)
Binding: ?? (extensible)
.... productOrService S1..1CodeableConceptMã dịch vụ/thuốc/TBYT
Binding: ?? (example): Allowable service and product codes.
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??, ??Số lượng
.... unitPrice 0..1MoneyĐơn giá
.... factor 0..1decimalPrice scaling factor
.... net S0..1MoneyThành tiền
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
..... quantity 0..1??, ??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... udi 0..*Reference(Device)Unique device identifier
..... subDetail 0..*BackboneElementProduct or service provided
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
...... quantity 0..1??, ??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
... total S0..1MoneyTổng chi phí (XML 3176: T_TONGCHI)

doco Documentation for this format