diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-01.xml b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-01.xml index c92a4a90a..5d53f1b60 100644 --- a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-01.xml +++ b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-01.xml @@ -1,7 +1,7 @@ - + diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-02.xml b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-02.xml index 8cdc5db64..bcce427e8 100644 --- a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-02.xml +++ b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-02.xml @@ -1,7 +1,7 @@ - + diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-03.xml b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-03.xml new file mode 100644 index 000000000..712249de8 --- /dev/null +++ b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-03.xml @@ -0,0 +1,93 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-pbs-01.xml b/examples/ExplanationOfBenefit/explanationofbenefit-pbs-01.xml index ab963d65b..3cfe1d100 100644 --- a/examples/ExplanationOfBenefit/explanationofbenefit-pbs-01.xml +++ b/examples/ExplanationOfBenefit/explanationofbenefit-pbs-01.xml @@ -1,7 +1,7 @@ - + diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-pbs-02.xml b/examples/ExplanationOfBenefit/explanationofbenefit-pbs-02.xml index bb5615a3e..ed602ad02 100644 --- a/examples/ExplanationOfBenefit/explanationofbenefit-pbs-02.xml +++ b/examples/ExplanationOfBenefit/explanationofbenefit-pbs-02.xml @@ -1,7 +1,7 @@ - + diff --git a/ig.json b/ig.json index 931d78c83..1ad818a0c 100644 --- a/ig.json +++ b/ig.json @@ -221,9 +221,13 @@ "base": "StructureDefinition-dh-encounter-core-1.html", "defns": "StructureDefinition-dh-encounter-core-1-definitions.html" }, - "StructureDefinition/dh-explanationofbenefit-medicare-1": { - "base": "StructureDefinition-dh-explanationofbenefit-medicare-1.html", - "defns": "StructureDefinition-dh-explanationofbenefit-medicare-1-definitions.html" + "StructureDefinition/dh-explanationofbenefit-medicare-mbs-1": { + "base": "StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html", + "defns": "StructureDefinition-dh-explanationofbenefit-medicare-mbs-1-definitions.html" + }, + "StructureDefinition/dh-explanationofbenefit-medicare-pbs-1": { + "base": "StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html", + "defns": "StructureDefinition-dh-explanationofbenefit-medicare-pbs-1-definitions.html" }, "StructureDefinition/dh-flag-air-1": { "base": "StructureDefinition-dh-flag-air-1.html", diff --git a/pages/_includes/dh-explanationofbenefit-medicare-1-examples.md b/pages/_includes/dh-explanationofbenefit-medicare-1-examples.md deleted file mode 100644 index ca95339e3..000000000 --- a/pages/_includes/dh-explanationofbenefit-medicare-1-examples.md +++ /dev/null @@ -1,35 +0,0 @@ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Example nameidFormat
Record of Claim against MBS for radiation oncology treatment for Mr. Zhang Weimbs-01XMLJSONTurtle
Record of Claim against MBS for removal of palmar or plantar warts for for Ms. Sally Fieldmbs-02XMLJSONTurtle
Record of Claim against PBS for cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 JAN 2020pbs-01XMLJSONTurtle
Record of Claim against PBS for cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 FEB 2020pbs-02XMLJSONTurtle
\ No newline at end of file diff --git a/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-examples.md b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-examples.md new file mode 100644 index 000000000..adc7ec65f --- /dev/null +++ b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-examples.md @@ -0,0 +1,28 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Example nameidFormat
Record of Claim against MBS for 15275 radiation oncology treatment for Mr. Zhang Weimbs-01XMLJSONTurtle
Record of Claim against MBS for 30185 removal of palmar or plantar warts for for Ms. Sally Fieldmbs-02XMLJSONTurtle
Record of Claim against MBS for 30191 removal of palmar or plantar warts for for Ms. Sally Fieldmbs-03XMLJSONTurtle
\ No newline at end of file diff --git a/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-intro.md b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-intro.md new file mode 100644 index 000000000..bd7394e24 --- /dev/null +++ b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-intro.md @@ -0,0 +1,22 @@ +#### Australian Digital Health Agency Record of Claim against MBS +This profile defines a record of the claim of an item claimed against the Medicare Benefits Schedule (MBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia. + +This profile identifies the additional constraints, extensions, and value sets that build on and extend [ExplanationOfBenefit](http://hl7.org/fhir/R4/explanationofbenefit.html) that are supported. + +This profile is designed to set a core ExplanationOfBenefit standard for: +* Query for a record of an MBS item claim associated with a patient +* Record or update an MBS item claim associated with a patient + +This profile is used by the following APIs: +* [insert API endpoint](StructureDefinition-TBD-1.html) + + +#### Guidance +The following guidance applies: +* TBD + + +#### Boundaries and relationships +This profile is referenced by +[TBD](StructureDefinition-TBD-1.html). + diff --git a/pages/_includes/dh-explanationofbenefit-medicare-1-issues.md b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-issues.md similarity index 100% rename from pages/_includes/dh-explanationofbenefit-medicare-1-issues.md rename to pages/_includes/dh-explanationofbenefit-medicare-mbs-1-issues.md diff --git a/pages/_includes/dh-explanationofbenefit-medicare-1-summary.md b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-summary.md similarity index 100% rename from pages/_includes/dh-explanationofbenefit-medicare-1-summary.md rename to pages/_includes/dh-explanationofbenefit-medicare-mbs-1-summary.md diff --git a/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-examples.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-examples.md new file mode 100644 index 000000000..e7a0de425 --- /dev/null +++ b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-examples.md @@ -0,0 +1,21 @@ + + + + + + + + + + + + + + + + + + + + +
Example nameidFormat
Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 JAN 2020pbs-01XMLJSONTurtle
Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 FEB 2020pbs-02XMLJSONTurtle
\ No newline at end of file diff --git a/pages/_includes/dh-explanationofbenefit-medicare-1-intro.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-intro.md similarity index 67% rename from pages/_includes/dh-explanationofbenefit-medicare-1-intro.md rename to pages/_includes/dh-explanationofbenefit-medicare-pbs-1-intro.md index c33687bc0..fa195d2b6 100644 --- a/pages/_includes/dh-explanationofbenefit-medicare-1-intro.md +++ b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-intro.md @@ -1,15 +1,13 @@ -#### Australian Digital Health Agency Record of Claim against PBS, RPBS, or MBS -This profile defines a record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS), Repatriation Pharmaceutical Benefits Scheme (RPBS), or Medicare Benefits Schedule (MBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia. +#### Australian Digital Health Agency Record of Claim against PBS or RPBS +This profile defines a record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia. This profile identifies the additional constraints, extensions, and value sets that build on and extend [ExplanationOfBenefit](http://hl7.org/fhir/R4/explanationofbenefit.html) that are supported. This profile is designed to set a core ExplanationOfBenefit standard for: * Query for a record of a PBS item claim associated with a patient * Query for a record of an RPBS item claim associated with a patient -* Query for a record of an MBS item claim associated with a patient * Record or update a PBS item claim associated with a patient * Record or update an RPBS item claim associated with a patient -* Record or update an MBS item claim associated with a patient This profile is used by the following APIs: * [insert API endpoint](StructureDefinition-TBD-1.html) diff --git a/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-issues.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-issues.md new file mode 100644 index 000000000..5be31289d --- /dev/null +++ b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-issues.md @@ -0,0 +1,19 @@ + + + + + + + + + + + + + + + + + + +
ReferenceDescriptionIssue No.
Constraint presentationThe full set of constraints (i.e. invariants) defined in this profile are only presented in the Detailed Descriptions tab or the raw representation (e.g. XML) of the profile. The Differential Table only presents constraints introduced in this profile in addition to the constraints present in the base profile and base resource. The Snapshot Table only presents the constraints visible in the Differential Table and additionally presents those constraints set in slices in the base profile.See Zulip Derived profile snapshot missing upstream invariants stream
ExplanationOfBenefit.priorityThis element is not of use in this profile, however the canonical FHIR resource definition binds to an exmple CodeSystem not ValueSet - this is throwing errors. Current workaround is to profile that element to point to the ValueSet instead.N/A
diff --git a/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-summary.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-summary.md new file mode 100644 index 000000000..ce4f4e5fb --- /dev/null +++ b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-summary.md @@ -0,0 +1 @@ +This file is intentionally empty. It is required to be included by the IG Publisher. \ No newline at end of file diff --git a/pages/_includes/dh-medicationrequest-pbs-claim-1-intro.md b/pages/_includes/dh-medicationrequest-pbs-claim-1-intro.md index cdb183973..1eb1075c3 100644 --- a/pages/_includes/dh-medicationrequest-pbs-claim-1-intro.md +++ b/pages/_includes/dh-medicationrequest-pbs-claim-1-intro.md @@ -19,4 +19,4 @@ The following guidance applies: #### Boundaries and relationships This profile is referenced by -[ADHA Record of Claim against PBS, RPBS, or MBS](StructureDefinition-dh-explanationofbenefit-medicare-1.html). \ No newline at end of file +[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html). \ No newline at end of file diff --git a/pages/_includes/dh-organization-core-1-intro.md b/pages/_includes/dh-organization-core-1-intro.md index 921cf9963..6f2bcba29 100644 --- a/pages/_includes/dh-organization-core-1-intro.md +++ b/pages/_includes/dh-organization-core-1-intro.md @@ -33,10 +33,14 @@ This profile is referenced by [ADHA System Device](StructureDefinition-dh-device-system-1.html), [ADHA Core DiagnosticReport](StructureDefinition-dh-diagnosticreport-core-1.html), [ADHA Advance Care Planning Document DocumentReference](StructureDefinition-dh-documentreference-core-1.html), +[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), +[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), [ADHA Core Flag](StructureDefinition-dh-flag-core-1.html), +[ADHA Australian Immunisation Register Notice](StructureDefinition-dh-flag-air-1.html), [ADHA Core Location](StructureDefinition-dh-location-core-1.html), -[ADHA Core HealthcareService](StructureDefinition-dh-healthcareservice-core-1.html), +[ADHA Core HealthcareService](StructureDefinition-dh-healthcareservice-core-1.html), [ADHA Core Immunization](StructureDefinition-dh-immunization-core-1.html), +[ADHA Record of Immunisation from Australian Immunisation Register](StructureDefinition-dh-immunization-air-1.html), [ADHA Core MedicationDispense](StructureDefinition-dh-medicationdispense-1.html), [ADHA Core MedicationRequest](StructureDefinition-dh-medicationrequest-1.html), [ADHA Core Patient](StructureDefinition-dh-patient-core-1.html), diff --git a/pages/_includes/dh-patient-core-1-intro.md b/pages/_includes/dh-patient-core-1-intro.md index d9c0846dd..f07f19119 100644 --- a/pages/_includes/dh-patient-core-1-intro.md +++ b/pages/_includes/dh-patient-core-1-intro.md @@ -101,7 +101,12 @@ This profile is referenced by [ADHA Core DiagnosticReport](StructureDefinition-dh-diagnosticreport-core-1.html), [ADHA Implantable Medical Device](StructureDefinition-dh-device-implantable-1.html), [ADHA Advance Care Planning Document DocumentReference](StructureDefinition-dh-documentreference-core-1.html), +[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), +[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), +[ADHA Core Flag](StructureDefinition-dh-flag-core-1.html), +[ADHA Australian Immunisation Register Notice](StructureDefinition-dh-flag-air-1.html), [ADHA Core Immunization](StructureDefinition-dh-immunization-core-1.html), +[ADHA Record of Immunisation from Australian Immunisation Register](StructureDefinition-dh-immunization-air-1.html), [ADHA Core List](StructureDefinition-dh-list-core-1.html), [ADHA Immunisation History List](StructureDefinition-dh-list-immunization-1.html), [ADHA Prescription and or Dispense History List](StructureDefinition-dh-list-medication-pdl-1.html), diff --git a/pages/_includes/dh-practitioner-core-1-intro.md b/pages/_includes/dh-practitioner-core-1-intro.md index 692b6e744..57d02dd0a 100644 --- a/pages/_includes/dh-practitioner-core-1-intro.md +++ b/pages/_includes/dh-practitioner-core-1-intro.md @@ -20,5 +20,7 @@ The following guidance applies: #### Boundaries and relationships This profile is referenced by -[ADHA Advance Care Directive Custodian Record Document Composition](StructureDefinition-dh-composition-acdcr-1.html). +[ADHA Advance Care Directive Custodian Record Document Composition](StructureDefinition-dh-composition-acdcr-1.html), +[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), +[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), and [ADHA Core PractitionerRole](StructureDefinition-dh-practitionerrole-core-1.html). \ No newline at end of file diff --git a/pages/_includes/dh-practitionerrole-core-1-intro.md b/pages/_includes/dh-practitionerrole-core-1-intro.md index 0996ee826..38c927e05 100644 --- a/pages/_includes/dh-practitionerrole-core-1-intro.md +++ b/pages/_includes/dh-practitionerrole-core-1-intro.md @@ -15,6 +15,7 @@ The following guidance applies: This profile is referenced by -[Australian Digital Health Agency Core Patient](StructureDefinition-dh-patient-core-1.html), -[Australian Digital Health Agency My Health Record Patient](StructureDefinition-dh-patient-mhr-1.html), and +[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), +[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), [Australian Digital Health Agency Core Patient](StructureDefinition-dh-patient-core-1.html), +[Australian Digital Health Agency My Health Record Patient](StructureDefinition-dh-patient-mhr-1.html), and [ADHA Core ServiceRequest](StructureDefinition-dh-servicerequest-core-1.html). \ No newline at end of file diff --git a/pages/_includes/dh-servicerequest-mbs-claim-1-intro.md b/pages/_includes/dh-servicerequest-mbs-claim-1-intro.md index 2fca47b5a..4aab43027 100644 --- a/pages/_includes/dh-servicerequest-mbs-claim-1-intro.md +++ b/pages/_includes/dh-servicerequest-mbs-claim-1-intro.md @@ -18,4 +18,4 @@ The following guidance applies: #### Boundaries and relationships This profile is referenced by -[ADHA Record of Claim against PBS, RPBS, or MBS](StructureDefinition-dh-explanationofbenefit-medicare-1.html). +[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html). diff --git a/pages/_includes/profiles.md b/pages/_includes/profiles.md index 373403d3b..5d12cc588 100644 --- a/pages/_includes/profiles.md +++ b/pages/_includes/profiles.md @@ -1,4 +1,4 @@ -# {{ page.title }} +# c{{ page.title }} {:.no_toc} * Do not remove this line (it will not be displayed) @@ -377,7 +377,10 @@ Core FHIR profiles defined in this implementation guide. + diff --git a/resources/dh-explanationofbenefit-medicare-1.xml b/resources/dh-explanationofbenefit-medicare-mbs-1.xml similarity index 66% rename from resources/dh-explanationofbenefit-medicare-1.xml rename to resources/dh-explanationofbenefit-medicare-mbs-1.xml index 2dbee8077..a7cf4c09e 100644 --- a/resources/dh-explanationofbenefit-medicare-1.xml +++ b/resources/dh-explanationofbenefit-medicare-mbs-1.xml @@ -1,11 +1,11 @@  - - + + - - - <status value="active"/> + <name value="DHExplanationofBenefitMBS"/> + <title value="ADHA Record of Claim against MBS"/> + <status value="draft"/> <experimental value="false"/> <publisher value="Australian Digital Health Agency"/> <contact> @@ -14,7 +14,7 @@ <value value="help@digitalhealth.gov.au"/> </telecom> </contact> - <description value="This profile defines a record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS), Repatriation Pharmaceutical Benefits Scheme (RPBS), or Medicare Benefits Schedule (MBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia."/> + <description value="This profile defines a record of the claim of an item claimed against the Medicare Benefits Schedule (MBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia."/> <copyright value="Copyright © 2022 Australian Digital Health Agency - All rights reserved. This content is licensed under a Creative Commons Attribution 4.0 International License. See https://creativecommons.org/licenses/by/4.0/." /> <fhirVersion value="4.0.1" /> <kind value="resource"/> @@ -25,48 +25,19 @@ <differential> <element id="ExplanationOfBenefit"> <path value="ExplanationOfBenefit"/> - <short value="Record of Claim against PBS, RPBS, or MBS"/> - <definition value="A record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS), Repatriation Pharmaceutical Benefits Scheme (RPBS), or Medicare Benefits Schedule (MBS). PBS claim items include information about pharmaceutical items prescribed and dispensed to an individual that were partially or fully funded under the PBS or Repatriation Pharmaceutical Benefits Scheme (RPBS). MBS claim items include information about healthcare services provided to an individual that were partially or fully funded by the Australian Government run benefits scheme."/> + <short value="Record of Claim against MBS"/> + <definition value="A record of the claim of an item claimed against the Medicare Benefits Schedule (MBS). MBS claim items include information about healthcare services provided to an individual that were partially or fully funded by the Australian Government run benefits scheme."/> <constraint> - <key value="inv-dh-eob-medicare-01"/> + <key value="inv-dh-eob-mbs-01"/> <severity value="error"/> <human value="The patient shall at least have a reference or an identifier with at least a system and a value"/> <expression value="patient.reference.exists() or patient.identifier.where(system.count() + value.count() >1).exists()"/> - <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> - </constraint> - <constraint> - <key value="inv-dh-eob-medicare-02"/> - <severity value="error"/> - <human value="A PBS or RPBS claim SHALL include a prescription"/> - <expression value="(item.category.coding.code='pbs' or item.category.coding.code='rpbs') implies prescription.exists()"/> - <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> - </constraint> - <constraint> - <key value="inv-dh-eob-medicare-03"/> - <severity value="error"/> - <human value="A MBS or DVABS claim SHALL NOT include a prescription"/> - <expression value="(item.category.coding.code='mbs' or item.category.coding.code='dva') implies prescription.exists().not()"/> - <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> - </constraint> - <constraint> - <key value="inv-dh-eob-medicare-04"/> - <severity value="error"/> - <human value="One of subType or item.category SHALL be present"/> - <expression value="subType.exists() or item.category.exists()"/> - <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> - </constraint> - <constraint> - <key value="inv-dh-eob-medicare-05"/> - <severity value="error"/> - <human value="A PBS claim (subType='pbs') SHALL be of type 'pharmacy'"/> - <expression value="subType.coding.code='pbs' implies type.coding.code='pharmacy'"/> - <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> + <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/> </constraint> </element> <element id="ExplanationOfBenefit.identifier"> <path value="ExplanationOfBenefit.identifier"/> <min value="1"/> - <max value="1"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.status"> @@ -76,9 +47,14 @@ <element id="ExplanationOfBenefit.type"> <path value="ExplanationOfBenefit.type"/> <mustSupport value="true"/> + <binding> + <strength value="required"/> + <valueSet value="http://hl7.org/fhir/ValueSet/claim-type"/> + </binding> </element> <element id="ExplanationOfBenefit.subType"> <path value="ExplanationOfBenefit.subType"/> + <min value="1"/> <mustSupport value="true"/> <binding> <strength value="required"/> @@ -125,14 +101,6 @@ <valueSet value="http://hl7.org/fhir/ValueSet/process-priority"/> </binding> </element> - <element id="ExplanationOfBenefit.prescription"> - <path value="ExplanationOfBenefit.prescription"/> - <type> - <code value="Reference"/> - <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-medicationrequest-pbs-claim-1"/> - </type> - <mustSupport value="true"/> - </element> <element id="ExplanationOfBenefit.referral"> <path value="ExplanationOfBenefit.referral"/> <type> @@ -171,11 +139,15 @@ </element> <element id="ExplanationOfBenefit.item.productOrService"> <path value="ExplanationOfBenefit.item.productOrService"/> + <short value="MBS Billing code"/> + <definition value="The billing code the service was claimed with against the Australian Department of Health Modifications of MBS Item and DVA Fee Schedule Item (urn:oid:1.2.36.1.2001.1005.21)."/> + <comment value="The code as instantiated may be padded with leading zeros when compared with the original (as published by the Department of Health)."/> + <patternCodeableConcept> + <coding> + <system value="urn:oid:1.2.36.1.2001.1005.21"/> + </coding> + </patternCodeableConcept> <mustSupport value="true"/> - <binding> - <strength value="required"/> - <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-dhs-modifications-pbs-mbs-dva-item-1"/> - </binding> </element> <element id="ExplanationOfBenefit.item.serviced[x]"> <path value="ExplanationOfBenefit.item.serviced[x]"/> diff --git a/resources/dh-explanationofbenefit-medicare-pbs-1.xml b/resources/dh-explanationofbenefit-medicare-pbs-1.xml new file mode 100644 index 000000000..d3fd693ab --- /dev/null +++ b/resources/dh-explanationofbenefit-medicare-pbs-1.xml @@ -0,0 +1,165 @@ +<?xml version="1.0" encoding="utf-8"?> +<StructureDefinition xmlns="http://hl7.org/fhir"> + <id value="dh-explanationofbenefit-medicare-pbs-1"/> + <url value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/> + <version value="0.0.1"/> + <name value="DHExplanationofBenefitPBS"/> + <title value="ADHA Record of Claim against PBS or RPBS"/> + <status value="draft"/> + <experimental value="false"/> + <publisher value="Australian Digital Health Agency"/> + <contact> + <telecom> + <system value="email"/> + <value value="help@digitalhealth.gov.au"/> + </telecom> + </contact> + <description value="This profile defines a record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia."/> + <copyright value="Copyright © 2022 Australian Digital Health Agency - All rights reserved. This content is licensed under a Creative Commons Attribution 4.0 International License. See https://creativecommons.org/licenses/by/4.0/." /> + <fhirVersion value="4.0.1" /> + <kind value="resource"/> + <abstract value="false"/> + <type value="ExplanationOfBenefit"/> + <baseDefinition value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit"/> + <derivation value="constraint"/> + <differential> + <element id="ExplanationOfBenefit"> + <path value="ExplanationOfBenefit"/> + <short value="Record of Claim against PBS or RPBS"/> + <definition value="A record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS). PBS claim items include information about pharmaceutical items prescribed and dispensed to an individual that were partially or fully funded under the PBS or Repatriation Pharmaceutical Benefits Scheme (RPBS)."/> + <constraint> + <key value="inv-dh-eob-pbs-01"/> + <severity value="error"/> + <human value="The patient shall at least have a reference or an identifier with at least a system and a value"/> + <expression value="patient.reference.exists() or patient.identifier.where(system.count() + value.count() >1).exists()"/> + <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/> + </constraint> + </element> + <element id="ExplanationOfBenefit.identifier"> + <path value="ExplanationOfBenefit.identifier"/> + <min value="1"/> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.status"> + <path value="ExplanationOfBenefit.status"/> + <fixedCode value="active"/> + </element> + <element id="ExplanationOfBenefit.type"> + <path value="ExplanationOfBenefit.type"/> + <patternCodeableConcept> + <coding> + <system value="http://terminology.hl7.org/CodeSystem/claim-type" /> + <code value="pharmacy" /> + </coding> + </patternCodeableConcept> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.subType"> + <path value="ExplanationOfBenefit.subType"/> + <min value="1"/> + <mustSupport value="true"/> + <binding> + <strength value="required"/> + <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-medicare-benefit-claim-category-1"/> + </binding> + </element> + <element id="ExplanationOfBenefit.use"> + <path value="ExplanationOfBenefit.use"/> + <fixedCode value="claim"/> + </element> + <element id="ExplanationOfBenefit.patient"> + <path value="ExplanationOfBenefit.patient"/> + <type> + <code value="Reference"/> + <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-patient-core-1"/> + </type> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.created"> + <path value="ExplanationOfBenefit.created"/> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.insurer"> + <path value="ExplanationOfBenefit.insurer"/> + <short value="Australian Government department that subsidises the benefits scheme"/> + <type> + <code value="Reference"/> + <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-organization-core-1"/> + </type> + </element> + <element id="ExplanationOfBenefit.provider"> + <path value="ExplanationOfBenefit.provider"/> + <type> + <code value="Reference"/> + <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-practitioner-core-1"/> + <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-practitionerrole-core-1"/> + </type> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.priority"> + <path value="ExplanationOfBenefit.priority"/> + <binding> + <strength value="example"/> + <valueSet value="http://hl7.org/fhir/ValueSet/process-priority"/> + </binding> + </element> + <element id="ExplanationOfBenefit.prescription"> + <path value="ExplanationOfBenefit.prescription"/> + <min value="1"/> + <type> + <code value="Reference"/> + <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-medicationrequest-pbs-claim-1"/> + </type> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.outcome"> + <path value="ExplanationOfBenefit.outcome"/> + <fixedCode value="complete"/> + </element> + <element id="ExplanationOfBenefit.insurance.focal"> + <path value="ExplanationOfBenefit.insurance.focal"/> + <fixedBoolean value="true"/> + </element> + <element id="ExplanationOfBenefit.item"> + <path value="ExplanationOfBenefit.item"/> + <min value="1"/> + <max value="1"/> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.item.sequence"> + <path value="ExplanationOfBenefit.item.sequence"/> + <fixedPositiveInt value="1"/> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.item.category"> + <path value="ExplanationOfBenefit.item.category"/> + <min value="1"/> + <mustSupport value="true"/> + <binding> + <strength value="extensible"/> + <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-medicare-benefit-claim-category-1"/> + </binding> + </element> + <element id="ExplanationOfBenefit.item.productOrService"> + <path value="ExplanationOfBenefit.item.productOrService"/> + <short value="PBS Billing code"/> + <definition value="The billing code the service was claimed with against the Australian Department of Health Modified PBS Schedule Item (urn:oid:1.2.36.1.2001.1005.22)."/> + <comment value="The code as instantiated may be padded with leading zeros when compared with the original (as published by the Department of Health)."/> + <patternCodeableConcept> + <coding> + <system value="urn:oid:1.2.36.1.2001.1005.22"/> + </coding> + </patternCodeableConcept> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.item.serviced[x]"> + <path value="ExplanationOfBenefit.item.serviced[x]"/> + <min value="1"/> + <mustSupport value="true"/> + </element> + <element id="ExplanationOfBenefit.item.quantity"> + <path value="ExplanationOfBenefit.item.quantity"/> + <mustSupport value="true"/> + </element> + </differential> +</StructureDefinition> diff --git a/resources/dh-medicationrequest-pbs-claim-1.xml b/resources/dh-medicationrequest-pbs-claim-1.xml index c14eda678..2bfc3703a 100644 --- a/resources/dh-medicationrequest-pbs-claim-1.xml +++ b/resources/dh-medicationrequest-pbs-claim-1.xml @@ -25,6 +25,8 @@ <differential> <element id="MedicationRequest"> <path value="MedicationRequest"/> + <short value="PBS or RPBS claim item"/> + <definition value="A PBS claim item includes information about pharmaceutical items prescribed and dispensed to an individual that were partially or fully funded under the PBS or Repatriation Pharmaceutical Benefits Scheme (RPBS)."/> <constraint> <key value="inv-dh-medreq-01"/> <severity value="error"/> diff --git a/resources/dh-servicerequest-mbs-claim-1.xml b/resources/dh-servicerequest-mbs-claim-1.xml index a7a90cfb3..18d1d5b6f 100644 --- a/resources/dh-servicerequest-mbs-claim-1.xml +++ b/resources/dh-servicerequest-mbs-claim-1.xml @@ -25,6 +25,8 @@ <differential> <element id="ServiceRequest"> <path value="ServiceRequest"/> + <short value="MBS claim item"/> + <definition value="An MBS claim item includes information about healthcare services provided to an individual that were partially or fully funded by the Australian Government run benefits scheme."/> </element> <element id="ServiceRequest.status"> <path value="ServiceRequest.status"/> diff --git a/resources/implementationguide-core-1.xml b/resources/implementationguide-core-1.xml index 44e7ba410..f7a2d5936 100644 --- a/resources/implementationguide-core-1.xml +++ b/resources/implementationguide-core-1.xml @@ -272,9 +272,16 @@ </resource> <resource> <reference> - <reference value="StructureDefinition/dh-explanationofbenefit-medicare-1"/> + <reference value="StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/> </reference> - <name value="Australian Digital Health Agency Record of Claim against PBS, RPBS, or MBS"/> + <name value="Australian Digital Health Agency Record of Claim against MBS"/> + <exampleBoolean value="false"/> + </resource> + <resource> + <reference> + <reference value="StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/> + </reference> + <name value="Australian Digital Health Agency Record of Claim against PBS or RPBS"/> <exampleBoolean value="false"/> </resource> <resource> @@ -885,29 +892,36 @@ <reference> <reference value="ExplanationOfBenefit/mbs-01"/> </reference> - <name value="Record of Claim against MBS for radiation oncology treatment for Mr. Zhang Wei"/> - <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> + <name value="Record of Claim against MBS for 15275 radiation oncology treatment for Mr. Zhang Wei"/> + <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/> </resource> <resource> <reference> <reference value="ExplanationOfBenefit/mbs-02"/> </reference> - <name value="Record of Claim against MBS for removal of palmar or plantar warts for for Ms. Sally Field"/> - <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> + <name value="Record of Claim against MBS for 30185 removal of palmar or plantar warts for Ms. Sally Field"/> + <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/> + </resource> + <resource> + <reference> + <reference value="ExplanationOfBenefit/mbs-03"/> + </reference> + <name value="Record of Claim against MBS for 30191 removal of palmar or plantar warts for Ms. Sally Field"/> + <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/> </resource> <resource> <reference> <reference value="ExplanationOfBenefit/pbs-01"/> </reference> - <name value="Record of Claim against PBS for cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 JAN 2020"/> - <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> + <name value="Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 JAN 2020"/> + <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/> </resource> <resource> <reference> <reference value="ExplanationOfBenefit/pbs-02"/> </reference> - <name value="Record of Claim against PBS for cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 FEB 2020"/> - <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/> + <name value="Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 FEB 2020"/> + <exampleCanonical value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/> </resource> <!--FLAG EXAMPLES--> <resource>