醫療保險理賠實作指引
1.0.0 - CI Build
醫療保險理賠實作指引
1.0.0 - CI Build
醫療保險理賠實作指引 - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Active as of 2024-07-23 |
Mappings for the ClaimFormModel logical model.
| ClaimFormModel | ||
| ClaimFormModel | BundleiClaim | |
| caseNo | entry:IClaim.identifier | |
| patient | ||
| occupation | entry:patient.occupation | |
| identifier | entry:patient.identifier:idCardNumber | |
| patientNo | entry:patient.identifier:medicalRecord | |
| name | entry:patient.name | |
| gender | entry:patient.gender | |
| birthDate | entry:patient.birthDate | |
| address | entry:patient.address | |
| organization | ||
| identifier | entry:provider.identifier | |
| certificateOfDiagnosis | ||
| patientSource | entry:encounter.class | |
| particularDiagnosis | entry:encounter.type | |
| department | entry:encounter.serviceType.coding.display | |
| departmentCode | entry:encounter.serviceType.coding.code | |
| firstExaminationDate | entry:encounter.period.start | |
| endExaminationDate | entry:encounter.period.end | |
| examinationDay | entry:encounter.length | |
| identifier | entry:condition.identifier | |
| diagnosis | entry:condition.code.coding:icd10-cm-2021.display 或 entry:condition.code.coding:icd10-cm-2014.display 或 entry:condition.code.coding:icd9-cm.display | |
| diagnosisCode | entry:condition.code.coding:icd10-cm-2021.code 或 entry:condition.code.coding:icd10-cm-2014.code 或 entry:condition.code.coding:icd9-cm.code | |
| recordedDate | entry:condition.recordedDate | |
| primaryPhysician | entry:condition.recorder.Reference(PractitionerRole iClaim).where(code = '405279007').practitioner.Reference(Practitioner iClaim).name | |
| primaryPhysicianNo | entry:condition.recorder.Reference(PractitionerRole iClaim).where(code = '405279007').practitioner.Reference(Practitioner iClaim).identifier | |
| medicalSummary | entry:condition.note.text | |
| responsiblePhysician | entry:condition.asserter.Reference(PractitionerRole iClaim).where(code = 'responsiblePhysician').practitioner.Reference(Practitioner iClaim).name | |
| invoice | ||
| chargeItem | entry:IClaim.item.productOrService | |
| medicalIdentity | entry:IClaim.item.modifier | |
| invoiceDate | entry:IClaim.item.servicedDate | |
| selfPayAmount | entry:IClaim.item.where(category = 'base' and modifier = 'pay').net，透過「就醫身分(claim.item.modifier)」和「自付金額/減免(claim.item.category)」來判斷claim.item.net填的金額為「健保點數」／「自費金額」／「減免」，「就醫身分(claim.item.modifier)」為自費，自付金額/減免」為自付金額，則claim.item.net內為「自付金額」。 | |
| discount | entry:IClaim.item.where(category = 'discount' and modifier = 'pay').net，透過「就醫身分(claim.item.modifier)」和「自付金額/減免(claim.item.category)」來判斷claim.item.net填的金額為「健保點數」／「自費金額」／「減免」，「就醫身分(claim.item.modifier)」為自費，自付金額/減免」為減免，則claim.item.net內為「減免」。 | |
| nationalHealthInsuranePoint | entry:IClaim.item.where(modifier = 'PUBLICPOL').net，透過「就醫身分(claim.item.modifier)」和「自付金額/減免(claim.item.category)」來判斷claim.item.net填的金額為「健保點數」／「自費金額」／「減免」，「就醫身分(claim.item.modifier)」為健保，則claim.item.net內為「健保點數」。 | |
| invoiceAmount | entry:IClaim.total | |
| laboratoryReport | ||
| laboratoryReportName | entry:diagnosticReport.code | |
| laboratoryReportNo | entry:observation.identifier | |
| laboratoryItemName | entry:observation.code.coding | |
| samplingDate | entry:observation.effectiveDateTime | |
| reportDate | entry:observation.issued | |
| medicalTechnologist | entry:observation.performer.Reference(PractitionerRole iClaim).where(code = '307988006').practitioner.Reference(Practitioner iClaim).name | |
| reporter | entry:observation.performer.Reference(PractitionerRole iClaim).where(code = 'reporter').practitioner.Reference(Practitioner iClaim).name | |
| laboratoryValue | entry:observation.value | |
| unit | entry:observation.valueQuantity.unit | |
| hL | entry:observation.interpretation | |
| note | entry:observation.note.text | |
| bodySite | entry:observation.bodySite | |
| referenceRange | entry:observation.referenceRange | |
| recordedPhysician | entry:encounter.participant.individual.Reference(PractitionerRole iClaim).where(code = 'recordedPhysician').practitioner.Reference(Practitioner iClaim).name | |
| recordedDepartment | entry:encounter.serviceType.coding | |