description: Antwort auf Antrag Kostenübernahme
package_name: de.medizininformatikinitiative.kerndatensatz.mtb
derivation: constraint
name: MII_PR_MTB_Antwort_Kostenuebernahme
type: ClaimResponse
elements:
  patient: {mustSupport: true, index: 8}
  request:
    short: Antrag
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Dazugehoeriger Antrag zur Kostenuebernahme}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Associated cost coverage application}
    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: Antrag}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Application}
    index: 11
  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: 7
  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: 6
  created:
    short: Datum der Zusage / des Widerspruchs
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Datum der Zusage / des Widerspruchs}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Date of approval / objection}
    mustSupport: true
    index: 9
  outcome:
    short: Ergebnis der Kostenübernahme
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Ergebnis der Kostenuebernahme}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Cost Coverage Outcome}
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: 'Ergebnis der Kostenuebernahme. Fuer den Fall der Sekundaerdatennutzung ist davon auszugehen dass die Kostenerstattung bereits erfolgt ist. Daher ist der Status auf #complete gesetzt.'}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: 'Cost coverage outcome. For secondary data use it is assumed that cost reimbursement has already occurred. Therefore the status is set to #complete.'}
    mustSupport: true
    pattern: {type: Code, value: complete}
    index: 12
  extension:
    mustSupport: true
    index: 2
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: null
      slices:
        Entscheidung:
          match: {url: null}
          schema:
            short: Entscheidung
            _definition:
              extension:
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: de-DE}
                - {url: content, valueString: Stadium der Antwort auf den Antrag zur Kostenuebernahme}
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: en}
                - {url: content, valueString: Stage of the response to the cost coverage application}
            type: Extension
            mustSupport: true
            _short:
              extension:
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: de-DE}
                - {url: content, valueString: Entscheidung}
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: en}
                - {url: content, valueString: Decision}
            url: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-antwort-kostenuebernahme-entscheidung
            index: 3
          min: 0
          max: 1
        Ablehnungsgrund:
          match: {url: null}
          schema:
            short: Ablehnungsgrund
            _definition:
              extension:
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: de-DE}
                - {url: content, valueString: Stadium der Antwort auf den Antrag zur Kostenuebernahme}
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: en}
                - {url: content, valueString: Stage of the response to the cost coverage application}
            type: Extension
            _short:
              extension:
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: de-DE}
                - {url: content, valueString: Ablehnungsgrund}
              - url: http://hl7.org/fhir/StructureDefinition/translation
                extension:
                - {url: lang, valueCode: en}
                - {url: content, valueString: Reason for Rejection}
            url: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-antwort-kostenuebernahme-ablehnungsgrund
            index: 4
          min: 0
          max: 1
  insurer: {mustSupport: true, index: 10}
  status:
    short: Status der FHIR-Ressource
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Status der FHIR-Ressource}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: FHIR Resource Status}
    _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 da retrospektive Datenerschliessung'}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: 'Status of the FHIR resource - statically set to #active due to retrospective data acquisition'}
    mustSupport: true
    pattern: {type: Code, value: active}
    index: 5
package_version: 2026.0.1
extensions:
  Entscheidung:
    min: 0
    short: Entscheidung
    index: 3
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Stadium der Antwort auf den Antrag zur Kostenuebernahme}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Stage of the response to the cost coverage application}
    type: Extension
    mustSupport: true
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Entscheidung}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Decision}
    max: 1
    url: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-antwort-kostenuebernahme-entscheidung
  Ablehnungsgrund:
    url: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-antwort-kostenuebernahme-ablehnungsgrund
    min: 0
    max: 1
    short: Ablehnungsgrund
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Stadium der Antwort auf den Antrag zur Kostenuebernahme}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Stage of the response to the cost coverage application}
    type: Extension
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: de-DE}
        - {url: content, valueString: Ablehnungsgrund}
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: en}
        - {url: content, valueString: Reason for Rejection}
    index: 4
class: profile
kind: resource
url: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antwort-kostenuebernahme
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 2026.0.1