ExampleDentalClaimMixed
type: Claim
node role: treeRoot
resource.id:
  value: ExampleDentalClaimMixed
resource.meta:
  meta.profile:
    value: https://fhir.cognovis.de/dental/StructureDefinition/dental-claim-de
    index: 0
    link: https://fhir.cognovis.de/dental/StructureDefinition/dental-claim-de
domain resource.text:
  narrative.status:
    value: extensions
  narrative.div: Generated Narrative: Claim ExampleDentalClaimMixed Profile: Zahnärztlicher Abrechnungsanspruch (DE) status: Active type: Professional use: Claim patient: Aylin Özdemir (official) (no stated gender), DoB: 1988-03-14 ( Krankenversichertennummer) billablePeriod: 2026-05-01 --> 2026-05-31 created: 2026-05-31 insurer: Barmer provider: PractitionerRole Doctor priority: normal supportingInfo sequence: 1 category: Information value: ChargeItem BEMA-91d supportingInfo sequence: 2 category: Information value: ChargeItem GOZ-5040 Diagnoses - Sequence Diagnosis[x] * 1 Condition Karies des Dentins insurance sequence: 1 focal: true coverage: Coverage: status = active; type = Gesetzliche Krankenversicherung; period = 2024-01-01 --> (ongoing) insurance sequence: 2 focal: false coverage: Coverage: status = active; type = private Krankenversicherung; period = 2024-01-01 --> (ongoing) item ZE Versorgungsart: gleichartig Versionierter Festzuschuss-Betrag finding: Festzuschuss-Befund nach §55 SGB V: 1.1 (Festzuschuss-Befund 1.1) benefitPercentage: 75 amount: €125,00 (EUR) effectivePeriod: 2026-01-01 --> 2026-12-31 source: https://example.org/festzuschuss/synthetic/2026 sequence: 1 informationSequence: 1 productOrService: BEMA-91d UnitPrices - Value Currency * 210 Euro Nets - Value Currency * 210 Euro item ZE Versorgungsart: gleichartig sequence: 2 informationSequence: 2 productOrService: GOZ-5040 UnitPrices - Value Currency * 480 Euro factor: 1 Nets - Value Currency * 480 Euro Totals - Value Currency * 690 Euro
claim.status:
  value: active
claim.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/claim-type
    coding.code:
      value: professional
claim.use:
  value: claim
claim.patient:
  link: https://fhir.cognovis.de/dental/Patient/pat-gkv-dental-01
  reference.reference:
    value: Patient/pat-gkv-dental-01
claim.billable period:
  period.start:
    value: 2026-05-01
  period.end:
    value: 2026-05-31
claim.created:
  value: 2026-05-31
claim.insurer:
  reference.display:
    value: Barmer
claim.provider:
  link: https://fhir.cognovis.de/dental/PractitionerRole/role-schoell-gibitzenhof
  reference.reference:
    value: PractitionerRole/role-schoell-gibitzenhof
claim.priority:
  codeable concept.coding:
    index: 0
    coding.code:
      value: normal
claim.supporting info:
  index: 0
  claim.supporting info.sequence:
    value: 1
  claim.supporting info.category:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/claiminformationcategory
      coding.code:
        value: info
  claim.supporting info.value reference:
    link: https://fhir.cognovis.de/dental/ChargeItem/ExampleMixedBemaChargeItem
    reference.reference:
      value: ChargeItem/ExampleMixedBemaChargeItem
claim.supporting info:
  index: 1
  claim.supporting info.sequence:
    value: 2
  claim.supporting info.category:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/claiminformationcategory
      coding.code:
        value: info
  claim.supporting info.value reference:
    link: https://fhir.cognovis.de/dental/ChargeItem/ExampleMixedGozChargeItem
    reference.reference:
      value: ChargeItem/ExampleMixedGozChargeItem
claim.diagnosis:
  index: 0
  claim.diagnosis.sequence:
    value: 1
  claim.diagnosis.diagnosis reference:
    link: https://fhir.cognovis.de/dental/Condition/ExampleMixedDentalCondition
    reference.reference:
      value: Condition/ExampleMixedDentalCondition
claim.insurance:
  index: 0
  claim.insurance.sequence:
    value: 1
  claim.insurance.focal:
    value: true
  claim.insurance.coverage:
    link: https://fhir.cognovis.de/dental/Coverage/cov-gkv-dental-01-gkv
    reference.reference:
      value: Coverage/cov-gkv-dental-01-gkv
claim.insurance:
  index: 1
  claim.insurance.sequence:
    value: 2
  claim.insurance.focal:
    value: false
  claim.insurance.coverage:
    link: https://fhir.cognovis.de/dental/Coverage/cov-zzv-dental-01
    reference.reference:
      value: Coverage/cov-zzv-dental-01
claim.item:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart
    extension.value code:
      value: gleichartig
  element.extension:
    index: 1
    element.extension:
      index: 0
      extension.url:
        value: finding
    element.extension:
      index: 1
      extension.url:
        value: benefitPercentage
      extension.value positive int:
        value: 75
    element.extension:
      index: 2
      extension.url:
        value: amount
    element.extension:
      index: 3
      extension.url:
        value: effectivePeriod
    element.extension:
      index: 4
      extension.url:
        value: source
      extension.value uri:
        value: https://example.org/festzuschuss/synthetic/2026
    extension.url:
      value: https://fhir.cognovis.de/dental/StructureDefinition/festzuschuss-betrag
  claim.item.sequence:
    value: 1
  claim.item.information sequence:
    value: 1
    index: 0
  claim.item.product or service:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://fhir.de/CodeSystem/kzbv/bema
      coding.code:
        value: 91d
      coding.display:
        value: BEMA-91d
  claim.item.unit price:
    money.value:
      value: 210
    money.currency:
      value: EUR
  claim.item.net:
    money.value:
      value: 210
    money.currency:
      value: EUR
claim.item:
  index: 1
  element.extension:
    index: 0
    extension.url:
      value: https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart
    extension.value code:
      value: gleichartig
  claim.item.sequence:
    value: 2
  claim.item.information sequence:
    value: 2
    index: 0
  claim.item.product or service:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://fhir.de/CodeSystem/bzaek/goz
      coding.code:
        value: 5040
      coding.display:
        value: GOZ-5040
  claim.item.unit price:
    money.value:
      value: 480
    money.currency:
      value: EUR
  claim.item.factor:
    value: 1
  claim.item.net:
    money.value:
      value: 480
    money.currency:
      value: EUR
claim.total:
  money.value:
    value: 690

value: 1.1

value: Festzuschuss-Befund 1.1

value: 125

value: EUR

value: 2026-01-01

value: 2026-12-31

value: EUR