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. 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 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>
