{
"description": "Übergabe von Informationen zum Kostenträger/ Krankenversicherungsverhältnis vom PVS an die VoS.",
"_filename": "74_PR_VoS_Kostentraeger.json",
"package_name": "kbv.ita.vos",
"date": "2021-07-08",
"derivation": "constraint",
"publisher": "Kassenärztliche Bundesvereinigung (KBV)",
"fhirVersion": "3.0.1",
"name": "74_PR_VoS_Kostentraeger",
"abstract": false,
"copyright": "Copyright © [2021], Kassenärztliche Bundesvereinigung (KBV). All rights reserved.",
"type": "Coverage",
"experimental": null,
"resourceType": "StructureDefinition",
"title": "74_PR_VoS_Kostentraeger",
"package_version": "1.20.0",
"status": "active",
"id": "4dbba243-d526-47fa-80a0-8526553086bd",
"kind": "resource",
"url": "https://fhir.kbv.de/StructureDefinition/74_PR_VoS_Kostentraeger",
"version": "1.20.0",
"differential": {
"element": [ {
"id": "Coverage",
"path": "Coverage",
"constraint": [ {
"key": "kbvcov-01",
"human": "Es muss entweder eine Versichertennummer (eGK, KVK, sonstige) oder aber eine SKT-Zusatzangabe existieren. Die Angabe von beidem ist nicht zulässig.",
"severity": "error",
"expression": "identifier.exists() xor extension('http://fhir.de/StructureDefinition/kbv/skt-zusatzangabe/0.2').exists()"
} ]
}, {
"id": "Coverage.extension",
"path": "Coverage.extension",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
}
}, {
"id": "Coverage.extension:einlesedatum-karte",
"max": "1",
"path": "Coverage.extension",
"type": [ {
"code": "Extension",
"profile": "http://fhir.de/StructureDefinition/gkv/einlesedatum-karte/0.2"
} ],
"sliceName": "einlesedatum-karte",
"mustSupport": true
}, {
"id": "Coverage.extension:einlesedatum-karte.valueDateTime:valueDateTime",
"path": "Coverage.extension.valueDateTime",
"sliceName": "valueDateTime",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfo-geschuetzt",
"max": "1",
"min": 1,
"path": "Coverage.extension",
"type": [ {
"code": "Extension",
"profile": "http://fhir.de/StructureDefinition/gkv/zusatzinfos-geschuetzt/0.2"
} ],
"sliceName": "gkv-zusatzinfo-geschuetzt",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfo-geschuetzt.extension:besonderePersonengruppe",
"min": 1,
"path": "Coverage.extension.extension",
"sliceName": "besonderePersonengruppe",
"definition": "Gibt die Zugehörigkeit des Versicherten zu einer besonderen Personengruppe\r\nan. \r\nSchlüsselverzeichnis:\r\n00 = keine Angabe\r\n04 = BSHG (Bundessozialhilfegesetz) § 264 SGB V, \r\n06 = BVG (Gesetz über die Versorgung der Opfer des Krieges), \r\n07 = SVA-Kennzeichnung für zwischenstaatliches Krankenversicherungsrecht: - Personen mit\r\nWohnsitz im Inland, Abrechnung nach Aufwand, \r\n08 = SVAKennzeichnung, Pauschal, \r\n09 = Empfänger von Gesundheitsleistungen nach §§ 4 und 6 des Asylbewerberleistungsgesetzes (AsylbLG)",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfo-geschuetzt.extension:besonderePersonengruppe.valueCode:valueCode",
"path": "Coverage.extension.extension.valueCode",
"sliceName": "valueCode",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfo-geschuetzt.extension:dmpKennzeichnung",
"min": 1,
"path": "Coverage.extension.extension",
"sliceName": "dmpKennzeichnung",
"definition": "Gibt die Teilnahme des Versicherten an einem Disease Management Program\r\nan. \r\nSchlüsselverzeichnis:\r\n00 = keine Angabe\r\n01 = Diabetes mellitus Typ 2, \r\n02 = Brustkrebs, \r\n03 = Koronare Herzkrankheit, \r\n04 = Diabetes mellitus Typ 1, \r\n05 = Asthma bronchiale, \r\n06 = COPD (chronic obstructive pulmonary disease) \r\n\r\nDas DMP-Kennzeichen findet derzeit aufgrund bilateraler vertraglicher\r\nVerpflichtungen von einzelnen Kostenträgern und Leistungserbringern noch\r\nVerwendung. Das DMP-Kennzeichen wird in diesem Zusammenhang als\r\nAngabe zum Nachweis von Wahltarifen nach § 53 SGB V bzw. der Angaben\r\nzum Nachweis von zusätzlichen Vertragsverhältnissen verwendet.",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfo-geschuetzt.extension:dmpKennzeichnung.valueCode:valueCode",
"path": "Coverage.extension.extension.valueCode",
"sliceName": "valueCode",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfos-allgemein",
"max": "1",
"min": 1,
"path": "Coverage.extension",
"type": [ {
"code": "Extension",
"profile": "http://fhir.de/StructureDefinition/gkv/zusatzinfos-allgemein/0.2"
} ],
"sliceName": "gkv-zusatzinfos-allgemein",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfos-allgemein.extension:versichertenart",
"min": 1,
"path": "Coverage.extension.extension",
"sliceName": "versichertenart",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfos-allgemein.extension:versichertenart.valueCode:valueCode",
"path": "Coverage.extension.extension.valueCode",
"sliceName": "valueCode",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfos-allgemein.extension:wop",
"path": "Coverage.extension.extension",
"sliceName": "wop",
"mustSupport": true
}, {
"id": "Coverage.extension:gkv-zusatzinfos-allgemein.extension:wop.valueCode:valueCode",
"path": "Coverage.extension.extension.valueCode",
"sliceName": "valueCode",
"mustSupport": true
}, {
"id": "Coverage.extension:SKT-Zusatzangabe",
"path": "Coverage.extension",
"type": [ {
"code": "Extension",
"profile": "http://fhir.de/StructureDefinition/kbv/skt-zusatzangabe/0.2"
} ],
"condition": [ "kbvcov-01" ],
"sliceName": "SKT-Zusatzangabe",
"mustSupport": true
}, {
"id": "Coverage.extension:SKT-Zusatzangabe.valueString:valueString",
"path": "Coverage.extension.valueString",
"sliceName": "valueString",
"definition": "Übermittlung gemäß KV-SpezifikaStammdatei der KBV",
"mustSupport": true
}, {
"id": "Coverage.identifier",
"max": "1",
"path": "Coverage.identifier",
"slicing": {
"rules": "closed",
"discriminator": [ {
"path": "system",
"type": "value"
} ]
}
}, {
"id": "Coverage.identifier:VersichertenID",
"max": "1",
"path": "Coverage.identifier",
"comment": "eGK - VersichertenNummer",
"condition": [ "kbvcov-01" ],
"sliceName": "VersichertenID"
}, {
"id": "Coverage.identifier:VersichertenID.use",
"max": "0",
"path": "Coverage.identifier.use"
}, {
"id": "Coverage.identifier:VersichertenID.type",
"max": "0",
"path": "Coverage.identifier.type"
}, {
"id": "Coverage.identifier:VersichertenID.system",
"min": 1,
"path": "Coverage.identifier.system",
"fixedUri": "http://fhir.de/NamingSystem/gkv/kvid-10",
"mustSupport": true
}, {
"id": "Coverage.identifier:VersichertenID.value",
"min": 1,
"path": "Coverage.identifier.value",
"mustSupport": true
}, {
"id": "Coverage.identifier:KVK-Versichertennummer",
"max": "1",
"path": "Coverage.identifier",
"comment": "KVK-VersichertenNummer",
"condition": [ "kbvcov-01" ],
"sliceName": "KVK-Versichertennummer"
}, {
"id": "Coverage.identifier:KVK-Versichertennummer.use",
"max": "0",
"path": "Coverage.identifier.use"
}, {
"id": "Coverage.identifier:KVK-Versichertennummer.type",
"max": "0",
"path": "Coverage.identifier.type"
}, {
"id": "Coverage.identifier:KVK-Versichertennummer.system",
"min": 1,
"path": "Coverage.identifier.system",
"fixedUri": "http://fhir.de/NamingSystem/gkv/kvk-versichertennummer",
"mustSupport": true
}, {
"id": "Coverage.identifier:KVK-Versichertennummer.value",
"min": 1,
"path": "Coverage.identifier.value",
"mustSupport": true
}, {
"id": "Coverage.status",
"path": "Coverage.status",
"mustSupport": true
}, {
"id": "Coverage.type",
"min": 1,
"path": "Coverage.type",
"mustSupport": true
}, {
"id": "Coverage.type.coding",
"max": "1",
"min": 1,
"path": "Coverage.type.coding"
}, {
"id": "Coverage.type.coding.system",
"min": 1,
"path": "Coverage.type.coding.system",
"mustSupport": true
}, {
"id": "Coverage.type.coding.code",
"min": 1,
"path": "Coverage.type.coding.code",
"mustSupport": true
}, {
"id": "Coverage.type.text",
"max": "0",
"path": "Coverage.type.text",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
} ]
}, {
"id": "Coverage.subscriber",
"path": "Coverage.subscriber",
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.kbv.de/StructureDefinition/74_PR_VoS_Patient"
} ],
"mustSupport": true
}, {
"id": "Coverage.subscriber.reference",
"min": 1,
"path": "Coverage.subscriber.reference",
"mustSupport": true
}, {
"id": "Coverage.subscriber.identifier",
"max": "0",
"path": "Coverage.subscriber.identifier"
}, {
"id": "Coverage.subscriber.display",
"max": "0",
"path": "Coverage.subscriber.display",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
} ]
}, {
"id": "Coverage.beneficiary",
"path": "Coverage.beneficiary",
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.kbv.de/StructureDefinition/74_PR_VoS_Patient"
} ],
"mustSupport": true
}, {
"id": "Coverage.beneficiary.reference",
"min": 1,
"path": "Coverage.beneficiary.reference",
"mustSupport": true
}, {
"id": "Coverage.beneficiary.identifier",
"max": "0",
"path": "Coverage.beneficiary.identifier"
}, {
"id": "Coverage.beneficiary.display",
"max": "0",
"path": "Coverage.beneficiary.display",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
} ]
}, {
"id": "Coverage.relationship",
"max": "0",
"path": "Coverage.relationship"
}, {
"id": "Coverage.period",
"path": "Coverage.period",
"mustSupport": true
}, {
"id": "Coverage.period.end",
"path": "Coverage.period.end",
"mustSupport": true
}, {
"id": "Coverage.payor",
"path": "Coverage.payor",
"mustSupport": true
}, {
"id": "Coverage.payor.reference",
"max": "0",
"path": "Coverage.payor.reference"
}, {
"id": "Coverage.payor.identifier",
"min": 1,
"path": "Coverage.payor.identifier",
"mustSupport": true
}, {
"id": "Coverage.payor.identifier.system",
"min": 1,
"path": "Coverage.payor.identifier.system",
"fixedUri": "http://fhir.de/NamingSystem/arge-ik/iknr",
"mustSupport": true
}, {
"id": "Coverage.payor.identifier.value",
"min": 1,
"path": "Coverage.payor.identifier.value",
"mustSupport": true
}, {
"id": "Coverage.contract",
"max": "0",
"path": "Coverage.contract"
} ]
},
"baseDefinition": "http://fhir.de/StructureDefinition/coverage-de-basis/0.2"
}