description: 此事前審查回覆-ClaimResponse TWPAS Profile說明本IG如何進一步定義FHIR的ClaimResponse Resource以呈現癌藥事前審查回覆之內容
package_name: tw.gov.mohw.nhi.pas
derivation: constraint
name: ClaimResponseTWPAS
type: ClaimResponse
elements:
  patient:
    type: Reference
    refers: ['https://nhicore.nhi.gov.tw/pas/StructureDefinition/Patient-twpas']
    index: 3
  request:
    type: Reference
    mustSupport: true
    refers: ['https://nhicore.nhi.gov.tw/pas/StructureDefinition/Claim-twpas']
    index: 6
  use:
    pattern: {type: code, value: preauthorization}
    type: code
    index: 2
  item:
    elements:
      adjudication:
        elements:
          category:
            short: 【因FHIR設計而需必填】
            index: 8
            elements:
              coding:
                elements:
                  system: {index: 9}
                  code: {index: 10}
          reason:
            short: 受理審查案件核定註記。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件
            binding: {strength: required, valueSet: 'https://nhicore.nhi.gov.tw/pas/ValueSet/nhi-approve-claim-comment'}
            mustSupport: true
            index: 11
          value: {short: 核定數量。, mustSupport: true, index: 12}
        required: [reason, value]
      detail:
        elements:
          detailSequence: {short: 請填寫對應的Claim.item.sequence, index: 13}
          adjudication:
            type: BackboneElement
            index: 14
            elements:
              category:
                short: 【因FHIR設計而需必填】
                index: 15
                elements:
                  coding:
                    elements:
                      system: {index: 16}
                      code: {index: 17}
              reason:
                short: 個別醫令核定註記。0:審核中 | 1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 | 6:不予同意:對應手術亦不支付 | 7:改核:如審查核定意見
                binding: {strength: required, valueSet: 'https://nhicore.nhi.gov.tw/pas/ValueSet/nhi-approve-item-comment'}
                mustSupport: true
                index: 18
            required: [reason]
  type:
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: institutional, system: 'http://terminology.hl7.org/CodeSystem/claim-type'}
    type: CodeableConcept
    index: 1
  created: {short: 核定日期或受理日期，即為案件受理狀態(disposition)之異動日期，依據其狀態不同而有不同日期，例如案件受理狀態為已受理，此日期則為受理日期；若為審畢結果則為核定日期。, mustSupport: true, index: 4}
  disposition:
    short: 案件受理狀態。待處理 | 處理中 | 處理中(等待附件檔) | 處理中(檔案檢核中) | 處理中(等待檢查申報資料) | 資料檢核失敗 | 檔案傳送失敗 | 附件檔轉檔失敗 | 影像檔轉檔失敗 | 電子病歷檔轉檔失敗 | 申請檔案檢核失敗 | 申請檔案未備齊 | 已受理 | 審查中 | 審畢結果
    binding: {strength: required, valueSet: 'https://nhicore.nhi.gov.tw/pas/ValueSet/nhi-acceptance-status'}
    mustSupport: true
    index: 7
  insurer:
    type: Reference
    refers: ['https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/Organization-govt-twcore']
    index: 5
  status:
    pattern: {type: code, value: active}
    type: code
    index: 0
package_version: 1.0.4
class: profile
kind: resource
url: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 1.0.4
required: [disposition, request]