description: Antrag Kostenübernahme package_name: de.medizininformatikinitiative.kerndatensatz.mtb derivation: constraint name: MII_PR_MTB_Antrag_Kostenuebernahme type: Claim elements: patient: {mustSupport: true, index: 5} insurance: mustSupport: true index: 21 elements: sequence: short: Priorität der Versicherung _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Prioritaet der Versicherung} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Insurance Priority} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Prioritaet der Versicherung. In der Regel 1 fuer die Hauptkrankenversicherung und fortlaufend fuer weitere freiwillige Zusatzversicherungen. Wird vsl. selten relevant sein.} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Insurance priority. Usually 1 for main health insurance and sequential for additional voluntary supplementary insurances. Will rarely be relevant.} mustSupport: true index: 22 focal: short: Versicherung relevant für diesen Antrag _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Versicherung relevant fuer diesen Antrag} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Insurance relevant for this application} mustSupport: true pattern: {type: Boolean, value: true} index: 23 coverage: short: Versicherung relevant für diesen Antrag _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Versicherung relevant fuer diesen Antrag} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Insurance relevant for this application} mustSupport: true index: 24 claimResponse: {mustSupport: true, index: 25} meta: mustSupport: true index: 0 elements: profile: {mustSupport: true, index: 1} use: short: Art des Kostenerstattungsantrags (claim, predetermination, preauthorization) _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Art des Kostenerstattungsantrags - claim oder predetermination oder preauthorization} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Type of cost reimbursement application - claim or predetermination or preauthorization} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: 'folgt den Definitionen wie im amerikanischen Gesundsheitswesen gebraeuchlich. claim: Erstattungsantrag nach erfolgter Therapie; predetermination: unverbindliche Anfrage insb. zu Anteilen der Kostenuebernahme; preauthorization: Anfrage nach moeglicher Erstattung fuer zukuenftige Therapie'} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: 'Follows definitions common in the American healthcare system. claim: reimbursement request after therapy; predetermination: non-binding inquiry esp. regarding coverage portions; preauthorization: inquiry about possible reimbursement for future therapy'} mustSupport: true index: 4 type: short: Kategorie des Antragstellers _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Kategorie des Antragstellers} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Applicant Category} binding: {strength: required, valueSet: 'https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/ValueSet/mii-vs-mtb-antrag-kostenuebernahme'} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Kategorie des Antragstellers - z.B. stationaer - ambulant - Apotheke} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Category of the applicant - e.g. inpatient - outpatient - pharmacy} mustSupport: true index: 3 created: short: Antragsdatum _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Antragsdatum} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Application Date} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Datum der Antragstellung} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Date of the application} mustSupport: true index: 6 related: mustSupport: true index: 9 elements: claim: short: 'bei Folgeantrag/Widerspruch: Verweis auf ursprünglichen Erstantrag' _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Verweis auf urspruenglichen Erstantrag der zu diesem Folgeantrag oder Widerspruch fuehrt} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Reference to original initial application that led to this follow-up application or objection} refers: ['https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme'] type: Reference mustSupport: true _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: 'bei Folgeantrag/Widerspruch: Verweis auf urspruenglichen Erstantrag'} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: 'for follow-up application/objection: Reference to original initial application'} index: 10 relationship: mustSupport: true index: 11 elements: coding: short: Antragsstadium _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Antragsstadium} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Application Stage} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Stadium des Antrags auf Kostenuebernahme - Erstantrag oder Widerspruch oder Folgeantrag oder Unbekannt. Bei Widerspruch oder Folgeantrag ist der Verweis auf den Erstantrag erforderlich} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Stage of the cost coverage application - initial application or objection or follow-up application or unknown. For objection or follow-up application reference to the initial application is required} mustSupport: true index: 12 elements: system: pattern: {type: Uri, value: 'https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/CodeSystem/mii-cs-mtb-antrag-kostenuebernahme-antragsstadium'} index: 13 code: {mustSupport: true, index: 14} required: [code] required: [coding] priority: short: Priorität des Antrags _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Prioritaet des Antrags} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Application Priority} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Prioritaet des Antrags. Pflichtfeld in FHIR aber nicht in der MII-Logik relevant} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Priority of the application. Required field in FHIR but not relevant in MII logic} mustSupport: true pattern: type: CodeableConcept value: coding: - {code: normal, system: 'http://terminology.hl7.org/CodeSystem/processpriority'} index: 8 status: short: Antrag _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Antrag} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Application} pattern: {type: Code, value: active} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: 'Status der FHIR-Ressource - statisch auf #active gesetzt'} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: 'Status of the FHIR resource - statically set to #active'} mustSupport: true index: 2 prescription: short: Therapieempfehlung _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Verweis auf die Therapieempfehlung des MTB die zu diesem Antrag fuehrt} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Reference to the MTB therapy recommendation that led to this application} refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest'] type: Reference mustSupport: true _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Therapieempfehlung} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Therapy Recommendation} index: 15 provider: short: Antragstellende Einrichtung / Klinik / Person _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Antragstellende Einrichtung / Klinik / Person} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Applicant Institution / Clinic / Person} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Einrichtung die den Antrag stellt. In der Regel die Klinik die den Patienten behandelt} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Institution submitting the application. Usually the clinic treating the patient} mustSupport: true index: 7 careTeam: index: 16 slicing: rules: open ordered: false description: Slice für Antragsstellung ZPM discriminator: - {path: sequence, type: type} min: 1 slices: ZPMBeteiligung: match: {} schema: short: Antragstellung ZPM _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Verweis auf entsprechendes Feld in NGS Bericht und/oder IHC - Verweis auf KDS Molekular-Pathologischer Befundbericht} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Reference to corresponding field in NGS report and/or IHC - Reference to KDS Molecular Pathology Report} mustSupport: true _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Antragstellung ZPM} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: ZPM Application} _required: true index: 17 elements: sequence: short: interne Variable der beteiligten Einrichtung _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: interne Variable der beteiligten Einrichtung} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: internal variable of the participating institution} mustSupport: true pattern: {type: PositiveInt, value: 1} index: 18 provider: short: Verweis auf ZPM _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Verweis auf Antragstellendes ZPM z.B. ZPM ID} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Reference to the applicant ZPM e.g. ZPM ID} refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference mustSupport: true _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Verweis auf ZPM} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Reference to ZPM} index: 19 responsible: short: Beteiliung ZPM - Ja/Nein _short: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Beteiligung ZPM - Ja/Nein} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: ZPM Participation - Yes/No} _definition: extension: - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: de-DE} - {url: content, valueString: Beteiligung des ZPM - Ja/Nein} - url: http://hl7.org/fhir/StructureDefinition/translation extension: - {url: lang, valueCode: en} - {url: content, valueString: Participation of the ZPM - Yes/No} mustSupport: true index: 20 required: [responsible] package_version: 2026.0.1 class: profile kind: resource url: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme base: http://hl7.org/fhir/StructureDefinition/Claim version: 2026.0.1 required: [careTeam]