Implementierungsleitfaden ISiK-Basismodul

Abrechnungsfall (Account)

Motivation

Komplementär zum Datenobjekt "Kontakt - Encounter" können Fälle, im Sinne einer Gruppierung von medizinischen Leistungen, innerhalb eines gemeinsamen Kontextes, zu einem Abrechnungsfall zusammengefasst werden. Ein solcher Abrechnungsfall kann mehrere Kontakte umfassen (z.B. vorstationärer Besuch, stationärer Aufenthalt und nachstationärer Besuch).

Gemeinsam mit dem Einrichtungskontakt bildet der Abrechnungsfall einen wichtigen Einstiegspunkt in die Dokumentation der Behandlungsleistungen der Patienten. Als Bindeglied zwischen den Kontakten und dem Versicherungsverhältnis erfolgt eine feingranulare Auflistung, in welchen Zeiträumen ein Behandlungskontext zwischen einer Gesundheitseinrichtung und der Patienten bestand. Zudem werden Diagnosen abschließend / nachträglich dokumentiert, sodass eine Übersicht von relevanten (DRG)-Diagnosen ermöglicht wird, ohne die Gesamtheit aller Kontakte betrachten zu müssen.

Kompatibilität

Für das Profil ISiKAbrechnungsfall wurde bis zum Zeitpunkt der Veröffentlichung kein Abgleich der Kompatibilität zu anderen Profilen (der KBV und der Medizininformatik-Initiative) durchgeführt.

Profil

Name	Canonical
ISiKAbrechnungsfall	https://gematik.de/fhir/isik/v3/Basismodul/StructureDefinition/ISiKAbrechnungsfall

Account	I		Account	There are no (further) constraints on this element Element Id Account Short description Tracks balance, charges, for patient or cost center Alternate names Cost center, Record Definition A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc. Data Type Account Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act rim:Account
id	S Σ	0..1	System.String	There are no (further) constraints on this element Element Id Account.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data Type System.String
extension	S I	0..*	Extension	There are no (further) constraints on this element Element Id Account.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
AbrechnungsDiagnoseProzedur	S I	0..*	Extension(Complex)	Element Id Account.extension:AbrechnungsDiagnoseProzedur Short description Fallbezogene Abrechnungsrelevanz von Diagnosen und Prozeduren Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments In dieser Extension SOLL das 'Use' Element nur einfach verwendet werden, um eine eindeutige Zuweisung (1 zu N) gegenüber dem Element 'Referenz' zu gewährleisten. Data Type Extension(Complex) Extension URL http://fhir.de/StructureDefinition/ExtensionAbrechnungsDiagnoseProzedur Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
identifier	S Σ	1..*	Identifier	Element Id Account.identifier Short description Account number Definition Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number). Data Type Identifier Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier w5:FiveWs.identifier rim:.id
Abrechnungsnummer	S Σ	1..1	Identifier-Profil für die Abbildung einer Abrechnungsnummer ("Fallnummer")Pattern	Element Id Account.identifier:Abrechnungsnummer Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Data Type Identifier-Profil für die Abbildung einer Abrechnungsnummer ("Fallnummer") Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "AN" } ] } } Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier w5:FiveWs.identifier rim:.id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Account.identifier:Abrechnungsnummer.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	S Σ	1..1	CodeableConceptBindingPattern	There are no (further) constraints on this element Element Id Account.identifier:Abrechnungsnummer.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ISiKAccountIdentifierType (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "AN" } ] } Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	S Σ	1..1	uri	There are no (further) constraints on this element Element Id Account.identifier:Abrechnungsnummer.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	S Σ	1..1	string	There are no (further) constraints on this element Element Id Account.identifier:Abrechnungsnummer.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Account.identifier:Abrechnungsnummer.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Account.identifier:Abrechnungsnummer.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
status	S Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Account.status Short description active \| inactive \| entered-in-error \| on-hold \| unknown Definition Indicates whether the account is presently used/usable or not. Comments This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid. Data Type code Binding Indicates whether the account is available to be used. AccountStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.status rim:.statusCode
type	S Σ	1..1	CodeableConceptBinding	Element Id Account.type Short description E.g. patient, expense, depreciation Definition Categorizes the account for reporting and searching purposes. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The usage type of this account, permits categorization of accounts. ISiKAccountType (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class rim:.code
name	Σ	0..1	string	There are no (further) constraints on this element Element Id Account.name Short description Human-readable label Alternate names Title Definition Name used for the account when displaying it to humans in reports, etc. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.what[x] rim:.title
subject	S Σ I	1..1	Reference(Patient)	Element Id Account.subject Short description The entity that caused the expenses Alternate names target Definition Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Account. Comments Accounts can be applied to non-patients for tracking other non-patient related activities, such as group services (patients not tracked, and costs charged to another body), or might not be allocated. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] rim:.subject w5:FiveWs.subject
servicePeriod	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Account.servicePeriod Short description Transaction window Definition The date range of services associated with this account. Comments It is possible for transactions to be posted outside the service period, as long as the service was provided within the defined service period. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] w5:FiveWs.done[x] rim:.coverage.insurancePolicy.effectiveTime
coverage	S Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id Account.coverage Short description The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account Definition The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account. Comments Typically. this may be some form of insurance, internal charges, or self-pay. Local or jurisdictional business rules may determine which coverage covers which types of billable items charged to the account, and in which order. Where the order is important, a local/jurisdictional extension may be defined to specify the order for the type of charge. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.coverage
extension	S I	1..1	Extension	There are no (further) constraints on this element Element Id Account.coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
Abrechnungsart	S I	1..1	Extension(Coding)	Element Id Account.coverage.extension:Abrechnungsart Short description Abrechnungsart Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(Coding) Extension URL http://fhir.de/StructureDefinition/ExtensionAbrechnungsart Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
coverage	S Σ I	1..1	Reference(Coverage)	There are no (further) constraints on this element Element Id Account.coverage.coverage Short description The party(s), such as insurances, that may contribute to the payment of this account Definition The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay). A coverage may only be responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Coverage) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.coverage.insurancePolicy.author
priority	Σ	0..1	positiveInt	There are no (further) constraints on this element Element Id Account.coverage.priority Short description The priority of the coverage in the context of this account Alternate names coordination of benefit priority Definition The priority of the coverage in the context of this account. Comments It is common in some jurisdictions for there to be multiple coverages allocated to an account, and a sequence is required to order the settling of the account (often with insurance claiming). Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.coverage.sequenceNumber
owner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Account.owner Short description Entity managing the Account Definition Indicates the service area, hospital, department, etc. with responsibility for managing the Account. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.holder
description	Σ	0..1	string	There are no (further) constraints on this element Element Id Account.description Short description Explanation of purpose/use Definition Provides additional information about what the account tracks and how it is used. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.subjectOf.observationEvent[code="annotation"].value
guarantor		0..*	BackboneElement	There are no (further) constraints on this element Element Id Account.guarantor Short description The parties ultimately responsible for balancing the Account Definition The parties responsible for balancing the account if other payment options fall short. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.holder.guarantorRole
party	I	1..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element Id Account.guarantor.party Short description Responsible entity Definition The entity who is responsible. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.holder.guarantorRole[guarantorPerson\|guarantorOrganization]
onHold		0..1	boolean	There are no (further) constraints on this element Element Id Account.guarantor.onHold Short description Credit or other hold applied Definition A guarantor may be placed on credit hold or otherwise have their role temporarily suspended. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.holder.guarantorRole.statusCode
period	I	0..1	Period	There are no (further) constraints on this element Element Id Account.guarantor.period Short description Guarantee account during Definition The timeframe during which the guarantor accepts responsibility for the account. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] rim:.holder.guarantorRole.effectiveTime
partOf	I	0..1	Reference(Account)	There are no (further) constraints on this element Element Id Account.partOf Short description Reference to a parent Account Definition Reference to a parent Account. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Account) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

Weitere Hinweise zu den Abgrenzungen der Begrifflichkeiten Fall und Kontakt finden sie unter Deutsche Basisprofile - Abschnitt Ambulanter/stationärer Fall / Kontakt (Encounter).

Terminology Bindings

Path	Name	Strength	URL
Account.type	ISiKAccountType	required	https://gematik.de/fhir/isik/v3/Basismodul/ValueSet/ISiKAccountType

Anmerkungen zu den Must-Support Feldern

`Account.extension:Abrechnungsdiagnose`

Bedeutung: DRG- und hiervon abweichende Krankenhausdiagnosen sollten im Account zusammenfassend und abschließend angegeben werden. Relevante Prozeduren können ebenfalls aufgelistet werden.

`Account.identifier`

Bedeutung: Der Account muss die Abrechnungsnummer des referenzierenden Kontaktes (Encounter) enthalten. Dies entspricht dem Wert des Elements Encounter.account.identifier.

`Account.status`

Bedeutung: Der Status MUSS insbesondere zur Differenzierung von abgeschlossenen und derzeitig noch aktiven Abrechnungsfällen angegeben werden. Alle in einem System möglichen Status-Werte müssen über FHIR korrekt repräsentiert werden können, mindestens jedoch die Status-Werte "active", "inactive". Deren korrekte Abbildung wird im Rahmen des Bestätigungsverfahrens überprüft.

Hinweise: Siehe Beschreibung in der FHIR Kernspezifikation

`Account.type`

Bedeutung: Alle Accounts MÜSSEN eindeutig kategorisiert werden können, sodass eine Filterung pro Typ möglich ist.

Hinweise: Verpflichtende Kodierung per HL7 v3 Value Set ActEncounterCode als Äquivalent zu Encounter.class.

`Account.subject`

Bedeutung: Ein Patientenbezug des Falls MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.

`Account.coverage`

Bedeutung: Pro Abrechnungskontext (z.B. Selbstzahler, DRG, PEPP) sollte ein eigener Account angelegt werden. Für jeden Account sollte ersichtlich sein über welche Coverage der Account beglichen werden soll.

Interaktionen

Für die Ressource Account MUSS die REST-Interaktion "READ" implementiert werden.

Folgende Suchparameter sind für das Bestätigungsverfahren relevant, auch in Kombination:

Der Suchparameter "_id" MUSS unterstützt werden:

Beispiele:

GET [base]/Account?_id=103270

Anwendungshinweise: Weitere Informationen zur Suche nach "_id" finden sich in der FHIR-Basisspezifikation - Abschnitt "Parameters for all resources".
Der Suchparameter "identifier" MUSS unterstützt werden:

Beispiele:

GET [base]/Account?identifier=http://test.krankenhaus.de/fhir/sid/fallnr|123456

Anwendungshinweise: Weitere Informationen zur Suche nach "Account.identifier" finden sich in der FHIR-Basisspezifikation - Abschnitt "Token Search".
Der Suchparameter "status" MUSS unterstützt werden:

Beispiele:

GET [base]/Account?status=active

Anwendungshinweise: Weitere Informationen zur Suche nach "Account.status" finden sich in der FHIR-Basisspezifikation - Abschnitt "Token Search".
Der Suchparameter "type" MUSS unterstützt werden:

Beispiele:

GET [base]/Account?type=http://terminology.hl7.org/CodeSystem/v3-ActCode|AMB

Anwendungshinweise: Weitere Informationen zur Suche nach "Account.type" finden sich in der FHIR-Basisspezifikation - Abschnitt "Token Search".
Der Suchparameter "patient" MUSS unterstützt werden:

Beispiele:

GET [base]/Account?patient=Patient/123

Anwendungshinweise: Weitere Informationen zur Suche nach "Account.subject" finden sich in der FHIR-Basisspezifikation - Abschnitt "Reference Search".

Beispiele

Valides Minimalbeispiel für das Profil ISiKAbrechnungsfall:

{
    "resourceType": "Account",
    "id": "AbrechnungsfallAmbulant",
    "meta": {
        "profile":  [
            "https://gematik.de/fhir/isik/v3/Basismodul/StructureDefinition/ISiKAbrechnungsfall"
        ]
    },
    "identifier":  [
        {
            "type": {
                "coding":  [
                    {
                        "code": "AN",
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203"
                    }
                ]
            },
            "system": "https://test.krankenhaus.de/fhir/sid/abrechnungsnummer",
            "value": "0123456789"
        }
    ],
    "status": "active",
    "type": {
        "coding":  [
            {
                "code": "AMB",
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode"
            }
        ]
    },
    "subject":  [
        {
            "reference": "Patient/PatientinMusterfrau"
        }
    ],
    "coverage":  [
        {
            "extension":  [
                {
                    "url": "http://fhir.de/StructureDefinition/ExtensionAbrechnungsart",
                    "valueCoding": {
                        "code": "DRG",
                        "system": "http://fhir.de/CodeSystem/dkgev/Abrechnungsart",
                        "display": "Diagnosebezogene Fallgruppen"
                    }
                }
            ],
            "coverage": {
                "reference": "Coverage/CoverageGesetzlich"
            }
        }
    ]
}