A claim represents a chargecode for statutory or private billing (Leistungsziffer EBM oder GOÄ). Claims are assigned to a patient and may be searched using a search request (GET). Search for claims will return a bundle including one or more FHIR items of type KBV_PR_AW_Abrechnung_vertragsaerztlich.


Example for a SEARCH request for all claims of a given patient
{{baseURL}}/{{tenant}}/Claim?page=1&patient=Patient/6009

Example: this search requests fetches all claims defined in RED for patient 6009


  • A search request requires a patient reference, search requests without patient ID will be dismissed.
  • Pagination may be dismissed, but to avoid response timeouts the number of result will be limited.
  • The patient ID is either defined by the 3rd-party-system when creating a patient via POST request (see below) or must be retrieved by a previous search.


Data of a specific claim may be fetched using a read request (GET) including the identifier of the claim. A read request returns one FHIR item of type KBV_PR_AW_Abrechnung_vertragsaerztlich. The claim ID may be fetched by a previous search request.


Example of a READ request for a specific claim
{{baseURL}}/{{tenant}}/Claim/93SvQn806AIlW1nTk3VUKgDyJJIqEyAv

Example: read request for claim with ID 93SvQn806AIlW1nTk3VUKgDyJJIqEyAv


Example of a FHIR item for a claim
<Claim xmlns="http://hl7.org/fhir">
                <id value="93SvQn806AIlW1nTk3VUKgDyJJIqEyAv"/>
                <meta>
                    <versionId value="1"/>
                    <lastUpdated value="2022-07-03T00:00:00+00:00"/>
                    <profile value="https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Abrechnung_vertragsaerztlich|1.2.0"/>
                </meta>
                <text>
                    <status value="extensions"/>
                    <div xmlns="http://www.w3.org/1999/xhtml">Abrechnung vertragsärztlich vom 03.07.2022 (V1) | ID 93SvQn806AIlW1nTk3VUKgDyJJIqEyAv | Patient Dirk Wulf | Behandlerkontext LANR 362364901/BSNR 478818100 Dr. med. Annie More (1) | Priorität normal | Status draft | Abrechnungstyp professional | Zweck normal | Versicherung N.N. | GOP 03003 | Menge 1 | Einheit 1 | zuletzt bearbeitet 2022-07-03T00:00:00+00:00</div>
                </text>
                <extension url="https://fhir.kbv.de/StructureDefinition/KBV_EX_AW_Abrechnung_vertragsaerztlich_Zusatzinformation">
                    <extension url="schein-ID">
                        <valueString value="1"/>
                    </extension>
                    <extension url="kostentraeger-Abrechnungsbereich">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KTS_KTABRECHNUNGSBEREICH"/>
                                <code value="00"/>
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <extension url="abrechnungsgebiet">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_ABRECHNUNGSGEBIET"/>
                                <code value="00"/>
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <extension url="scheinuntergruppe">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_SCHEINART"/>
                                <code value="00"/>
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <extension url="abklaerung_somatischer_Ursachen_vor_Aufnahme_einer_Psychotherapie">
                        <valueBoolean value="false"/>
                    </extension>
                    <extension url="unfall_Unfallfolgen">
                        <valueBoolean value="false"/>
                    </extension>
                    <extension url="anerkannte_Psychotherapie">
                        <valueBoolean value="false"/>
                    </extension>
                </extension>
                <status value="draft"/>
                <type>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
                        <code value="professional"/>
                    </coding>
                </type>
                <subType>
                    <coding>
                        <system value="https://fhir.kbv.de/CodeSystem/KBV_CS_AW_Abrechnung_Art"/>
                        <code value="Vertragsaerztlich"/>
                    </coding>
                </subType>
                <use value="claim"/>
                <patient>
                    <reference value="Patient/W4BYbPJsGvWA2sGEfQd9rLv7FFnDeXbh/_history/1"/>
                </patient>
                <created value="2022-07-01"/>
                <provider>
                    <reference value="PractitionerRole/TcYtTcJHpzXbgAoEAG091FE05w0ZhrXn/_history/1"/>
                </provider>
                <priority>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
                        <code value="normal"/>
                    </coding>
                </priority>
                <related>
                    <claim>
                        <reference value="Claim/VNFAAlhbsa19y3vZR6sYx4QAmBBXn06J/_history/1"/>
                    </claim>
                </related>
                <insurance>
                    <sequence value="1"/>
                    <focal value="true"/>
                    <coverage>
                        <reference value="Coverage/Ncz3qu9i5rCxgsgB9WGP6VTpjD9n6xh2"/>
                    </coverage>
                </insurance>
            </Claim>
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