German Dental FHIR Profiles (R4) - Local Development build (v0.41.6) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: Beispiel DentalClaimDE Mischrechnung BEMA und GOZ - JSON Representation

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{
  "resourceType" : "Claim",
  "id" : "ExampleDentalClaimMixed",
  "meta" : {
    "profile" : [
      🔗 "https://fhir.cognovis.de/dental/StructureDefinition/dental-claim-de"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim ExampleDentalClaimMixed</b></p><a name=\"ExampleDentalClaimMixed\"> </a><a name=\"hcExampleDentalClaimMixed\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-dental-claim-de.html\">Zahnärztlicher Abrechnungsanspruch (DE)</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-pat-gkv-dental-01.html\">Aylin Özdemir (official) (no stated gender), DoB: 1988-03-14 ( Krankenversichertennummer)</a></p><p><b>billablePeriod</b>: 2026-05-01 --&gt; 2026-05-31</p><p><b>created</b>: 2026-05-31</p><p><b>insurer</b>: Barmer</p><p><b>provider</b>: <a href=\"PractitionerRole-role-schoell-gibitzenhof.html\">PractitionerRole Doctor</a></p><p><b>priority</b>: <span title=\"Codes:\">normal</span></p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></p><p><b>value</b>: <a href=\"ChargeItem-ExampleMixedBemaChargeItem.html\">ChargeItem BEMA-91d</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></p><p><b>value</b>: <a href=\"ChargeItem-ExampleMixedGozChargeItem.html\">ChargeItem GOZ-5040</a></p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Condition-ExampleMixedDentalCondition.html\">Condition Karies des Dentins</a></td></tr></table><blockquote><p><b>insurance</b></p><p><b>sequence</b>: 1</p><p><b>focal</b>: true</p><p><b>coverage</b>: <a href=\"Coverage-cov-gkv-dental-01-gkv.html\">Coverage: status = active; type = Gesetzliche Krankenversicherung; period = 2024-01-01 --&gt; (ongoing)</a></p></blockquote><blockquote><p><b>insurance</b></p><p><b>sequence</b>: 2</p><p><b>focal</b>: false</p><p><b>coverage</b>: <a href=\"Coverage-cov-zzv-dental-01.html\">Coverage: status = active; type = private Krankenversicherung; period = 2024-01-01 --&gt; (ongoing)</a></p></blockquote><blockquote><p><b>item</b></p><p><b>ZE Versorgungsart</b>: gleichartig</p><blockquote><p><b>Versionierter Festzuschuss-Betrag</b></p><ul><li>finding: <a href=\"CodeSystem-festzuschuss-befund.html#festzuschuss-befund-1.461\">Festzuschuss-Befund nach §55 SGB V: 1.1</a> (Festzuschuss-Befund 1.1)</li><li>benefitPercentage: 75</li><li>amount: <span title=\"Euro\">€125,00</span> (EUR)</li><li>effectivePeriod: 2026-01-01 --&gt; 2026-12-31</li><li>source: <a href=\"https://simplifier.net/resolve?scope=de.basisprofil.r4@1.5.4&amp;canonical=https://example.org/festzuschuss/synthetic/2026\">https://example.org/festzuschuss/synthetic/2026</a></li></ul></blockquote><p><b>sequence</b>: 1</p><p><b>informationSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://fhir.de/CodeSystem/kzbv/bema 91d}\">BEMA-91d</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>210</td><td>Euro</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>210</td><td>Euro</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>ZE Versorgungsart</b>: gleichartig</p><p><b>sequence</b>: 2</p><p><b>informationSequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{http://fhir.de/CodeSystem/bzaek/goz 5040}\">GOZ-5040</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>480</td><td>Euro</td></tr></table><p><b>factor</b>: 1</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>480</td><td>Euro</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>690</td><td>Euro</td></tr></table></div>"
  },
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    🔗 "reference" : "Patient/pat-gkv-dental-01"
  },
  "billablePeriod" : {
    "start" : "2026-05-01",
    "end" : "2026-05-31"
  },
  "created" : "2026-05-31",
  "insurer" : {
    "display" : "Barmer"
  },
  "provider" : {
    🔗 "reference" : "PractitionerRole/role-schoell-gibitzenhof"
  },
  "priority" : {
    "coding" : [
      {
        "code" : "normal"
      }
    ]
  },
  "supportingInfo" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code" : "info"
          }
        ]
      },
      "valueReference" : {
        🔗 "reference" : "ChargeItem/ExampleMixedBemaChargeItem"
      }
    },
    {
      "sequence" : 2,
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code" : "info"
          }
        ]
      },
      "valueReference" : {
        🔗 "reference" : "ChargeItem/ExampleMixedGozChargeItem"
      }
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisReference" : {
        🔗 "reference" : "Condition/ExampleMixedDentalCondition"
      }
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        🔗 "reference" : "Coverage/cov-gkv-dental-01-gkv"
      }
    },
    {
      "sequence" : 2,
      "focal" : false,
      "coverage" : {
        🔗 "reference" : "Coverage/cov-zzv-dental-01"
      }
    }
  ],
  "item" : [
    {
      "extension" : [
        {
          "url" : "https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart",
          "valueCode" : "gleichartig"
        },
        {
          "extension" : [
            {
              "url" : "finding",
              "valueCoding" : {
                "system" : "https://fhir.cognovis.de/dental/CodeSystem/festzuschuss-befund",
                "code" : "1.1",
                "display" : "Festzuschuss-Befund 1.1"
              }
            },
            {
              "url" : "benefitPercentage",
              "valuePositiveInt" : 75
            },
            {
              "url" : "amount",
              "valueMoney" : {
                "value" : 125,
                "currency" : "EUR"
              }
            },
            {
              "url" : "effectivePeriod",
              "valuePeriod" : {
                "start" : "2026-01-01",
                "end" : "2026-12-31"
              }
            },
            {
              "url" : "source",
              "valueUri" : "https://example.org/festzuschuss/synthetic/2026"
            }
          ],
          "url" : "https://fhir.cognovis.de/dental/StructureDefinition/festzuschuss-betrag"
        }
      ],
      "sequence" : 1,
      "informationSequence" : [
        1
      ],
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://fhir.de/CodeSystem/kzbv/bema",
            "code" : "91d",
            "display" : "BEMA-91d"
          }
        ]
      },
      "unitPrice" : {
        "value" : 210,
        "currency" : "EUR"
      },
      "net" : {
        "value" : 210,
        "currency" : "EUR"
      }
    },
    {
      "extension" : [
        {
          "url" : "https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart",
          "valueCode" : "gleichartig"
        }
      ],
      "sequence" : 2,
      "informationSequence" : [
        2
      ],
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://fhir.de/CodeSystem/bzaek/goz",
            "code" : "5040",
            "display" : "GOZ-5040"
          }
        ]
      },
      "unitPrice" : {
        "value" : 480,
        "currency" : "EUR"
      },
      "factor" : 1,
      "net" : {
        "value" : 480,
        "currency" : "EUR"
      }
    }
  ],
  "total" : {
    "value" : 690,
    "currency" : "EUR"
  }
}