diff --git a/resources/explanationofbenefit-medicare.xml b/resources/explanationofbenefit-medicare.xml index 5f8fc72..63d47d8 100644 --- a/resources/explanationofbenefit-medicare.xml +++ b/resources/explanationofbenefit-medicare.xml @@ -2,7 +2,7 @@ - + <status value="active"/> @@ -31,16 +31,14 @@ <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()" + value="prescription.exists() implies (subType.coding.code='pbs' or subType.coding.code='rpbs' or item.category.coding.code='pbs' or item.category.coding.code='rpbs')" /> </constraint> <constraint> <key value="inv-dh-eob-02"/> <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()" - /> + <expression value="prescription.empty() implies (subType.coding.code='mbs' or subType.coding.code='dva' or item.category.coding.code='mbs' or item.category.coding.code='dva')"/> </constraint> <constraint> <key value="inv-dh-eob-03"/> @@ -51,8 +49,8 @@ <constraint> <key value="inv-dh-eob-04"/> <severity value="error"/> - <human value="A PBS claim (subType='pbs') SHALL be of type 'Pharmacy' (type='pharmacy')."/> - <expression value="subType.coding.code='pbs' implies type.coding.code='pharmacy'"/> + <human value="A PBS claim SHALL be of type 'Pharmacy' (type='pharmacy')."/> + <expression value="prescription.exists() implies type.coding.code='pharmacy'"/> </constraint> <constraint> <key value="inv-dh-eob-05"/>