description: 此自主審查報備-ClaimResponse TWPAS Profile說明本IG如何進一步定義FHIR的ClaimResponse Resource以呈現自主審查報備之內容。 \r\n  \r\n現行開放自主事前審查項目僅有心臟及肝臟移植，若醫院要自主事前審查需向健保署申請，通過後，健保署會於署內系統維護，具有此資格之院所才可填報自主審查報備。
package_name: tw.gov.mohw.nhi.pas
derivation: constraint
name: ClaimResponseSelfAssessmentTWPAS
type: ClaimResponse
elements:
  status:
    pattern: {type: code, value: active}
    type: code
    index: 0
  type:
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: institutional, system: 'http://terminology.hl7.org/CodeSystem/claim-type'}
    type: CodeableConcept
    index: 1
  use:
    pattern: {type: code, value: preauthorization}
    type: code
    index: 2
  patient:
    type: Reference
    refers: ['https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/Patient-twpas']
    index: 3
  created: {short: 核定日期。若申請案件類別為3時須填寫。YYYY-MM-DD，西元年月日。, mustSupport: true, index: 4}
  insurer:
    type: Reference
    refers: ['https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/Organization-govt-twcore']
    index: 5
  disposition: {mustSupport: true, index: 6}
  item:
    elements:
      adjudication:
        elements:
          category:
            short: 【因FHIR設計而需必填】
            index: 7
            elements:
              coding:
                elements:
                  system: {index: 8}
                  code: {index: 9}
          reason:
            short: 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件
            binding: {strength: required, valueSet: 'https://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-approve-claim-comment'}
            mustSupport: true
            index: 10
          value: {short: 核定數量，若申請案件類別為3時須填寫。, mustSupport: true, index: 11}
        required: [reason, value]
      detail:
        elements:
          detailSequence: {short: 請填寫對應的Claim.item.sequence, index: 12}
          adjudication:
            type: BackboneElement
            index: 13
            elements:
              category:
                short: 【因FHIR設計而需必填】
                index: 14
                elements:
                  coding:
                    elements:
                      system: {index: 15}
                      code: {index: 16}
              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://twcore.mohw.gov.tw/ig/pas/ValueSet/nhi-approve-item-comment'}
                index: 17
            required: [reason]
package_version: 1.0.2
class: profile
kind: resource
url: https://twcore.mohw.gov.tw/ig/pas/StructureDefinition/ClaimResponse-self-assessment-twpas
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 1.0.2