臺灣健保事前審查實作指引
1.1.0 - STU1.1.0

臺灣健保事前審查實作指引 - Downloaded Version null See the Directory of published versions

## : 事前審查回覆 - JSON Representation

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    {
      "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%\"><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"
                      }
                    ]
                  }
                }
              ]
            }
          ]
        }
      ]
    }