臺灣健保癌症用藥事前審查實作指引
1.0.8 - STU1.0.8

臺灣健保癌症用藥事前審查實作指引 - Downloaded Version 1.0.8 See the Directory of published versions

## : 事前審查回覆 - JSON Representation

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    {
      "resourceType" : "Bundle",
      "id" : "bun-response",
      "meta" : {
        "profile" : [
          🔗 "https://nhicore.nhi.gov.tw/pas/StructureDefinition/Bundle-response-twpas"
        ]
      },
      "type" : "searchset",
      "total" : 1,
      "link" : [
        {
          "relation" : "self",
          "url" : "https://twcore.mohw.gov.tw/fhir/ClaimResponse?request.patient.identifier=A123456789"
        }
      ],
      "entry" : [
        {
          "fullUrl" : "https://nhicore.nhi.gov.tw/pas/ClaimResponse/claim-response-example",
          "resource" : {
            "resourceType" : "ClaimResponse",
            "id" : "claim-response-example",
            "meta" : {
              "profile" : [
                🔗 "https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><a name=\"ClaimResponse_claim-response-example\"> </a><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ClaimResponse-twpas.html\">事前審查結果-ClaimResponse TWPAS</a></p></div><p><b>狀態</b>：Active</p><p><b>類型</b>：<span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>用途</b>：Preauthorization</p><p><b>病人</b>：<a href=\"Patient-pat-min.html\">Patient/pat-min</a></p><p><b>核定日期</b>：2024-07-30</p><p><b>關聯的事前審查</b>：<a href=\"Claim-cla-1.html\">Claim/cla-1</a></p><p><b>保險商</b>：<a href=\"Organization-org-nhi.html\">Organization 衛生福利部中央健康保險署</a></p><p><b>處置狀態</b>：Processing Complete</p><p><b>案件受理狀態</b>：審畢結果</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>：1</p><h3>受理審查案件核定註記</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>類型</b></td><td><b>受理審查案件核定註記</b></td><td><b>核定數量</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td><td>同意備查 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"CodeSystem-nhi-approve-comment.html\">NHI-健保事前審查-核定註記</a>#1) </span>)</td><td>2</td></tr></table><h3>個別醫令核定註記</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>類型</b></td><td><b>Claim.item.sequence</b></td><td><b>個別醫令核定註記</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td><td>1</td><td>同意備查 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"CodeSystem-nhi-approve-comment.html\">NHI-健保事前審查-核定註記</a>#1) </span>)</td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td><td>2</td><td>同意備查 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"CodeSystem-nhi-approve-comment.html\">NHI-健保事前審查-核定註記</a>#1) </span>)</td></tr></table></blockquote></div>"
            },
            "status" : "active",
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
                  "code" : "institutional"
                }
              ]
            },
            "use" : "preauthorization",
            "patient" : {
              🔗 "reference" : "Patient/pat-min"
            },
            "created" : "2024-07-30",
            "insurer" : {
              🔗 "reference" : "Organization/org-nhi"
            },
            "request" : {
              🔗 "reference" : "Claim/cla-1"
            },
            "outcome" : "complete",
            "disposition" : "審畢結果",
            "item" : [
              {
                "itemSequence" : 1,
                "adjudication" : [
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                          "code" : "submitted"
                        }
                      ]
                    },
                    "reason" : {
                      "coding" : [
                        {
                          "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment",
                          "code" : "1"
                        }
                      ]
                    },
                    "value" : 2
                  }
                ],
                "detail" : [
                  {
                    "detailSequence" : 1,
                    "adjudication" : [
                      {
                        "category" : {
                          "coding" : [
                            {
                              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                              "code" : "submitted"
                            }
                          ]
                        },
                        "reason" : {
                          "coding" : [
                            {
                              "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment",
                              "code" : "1"
                            }
                          ]
                        }
                      }
                    ]
                  },
                  {
                    "detailSequence" : 2,
                    "adjudication" : [
                      {
                        "category" : {
                          "coding" : [
                            {
                              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                              "code" : "submitted"
                            }
                          ]
                        },
                        "reason" : {
                          "coding" : [
                            {
                              "system" : "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment",
                              "code" : "1"
                            }
                          ]
                        }
                      }
                    ]
                  }
                ]
              }
            ]
          },
          "search" : {
            "mode" : "match"
          }
        }
      ]
    }