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 - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="ExampleDentalClaimMixed"/>
  <meta>
    <profile
             value="https://fhir.cognovis.de/dental/StructureDefinition/dental-claim-de"/>
  </meta>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>🔗 
    <reference value="Patient/pat-gkv-dental-01"/>
  </patient>
  <billablePeriod>
    <start value="2026-05-01"/>
    <end value="2026-05-31"/>
  </billablePeriod>
  <created value="2026-05-31"/>
  <insurer>
    <display value="Barmer"/>
  </insurer>
  <provider>🔗 
    <reference value="PractitionerRole/role-schoell-gibitzenhof"/>
  </provider>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
        <code value="info"/>
      </coding>
    </category>
    <valueReference>🔗 
      <reference value="ChargeItem/ExampleMixedBemaChargeItem"/>
    </valueReference>
  </supportingInfo>
  <supportingInfo>
    <sequence value="2"/>
    <category>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
        <code value="info"/>
      </coding>
    </category>
    <valueReference>🔗 
      <reference value="ChargeItem/ExampleMixedGozChargeItem"/>
    </valueReference>
  </supportingInfo>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisReference>🔗 
      <reference value="Condition/ExampleMixedDentalCondition"/>
    </diagnosisReference>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/cov-gkv-dental-01-gkv"/>
    </coverage>
  </insurance>
  <insurance>
    <sequence value="2"/>
    <focal value="false"/>
    <coverage>🔗 
      <reference value="Coverage/cov-zzv-dental-01"/>
    </coverage>
  </insurance>
  <item>
    <extension
               url="https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart">
      <valueCode value="gleichartig"/>
    </extension>
    <extension
               url="https://fhir.cognovis.de/dental/StructureDefinition/festzuschuss-betrag">
      <extension url="finding">
        <valueCoding>
          <system
                  value="https://fhir.cognovis.de/dental/CodeSystem/festzuschuss-befund"/>
          <code value="1.1"/>
          <display value="Festzuschuss-Befund 1.1"/>
        </valueCoding>
      </extension>
      <extension url="benefitPercentage">
        <valuePositiveInt value="75"/>
      </extension>
      <extension url="amount">
        <valueMoney>
          <value value="125"/>
          <currency value="EUR"/>
        </valueMoney>
      </extension>
      <extension url="effectivePeriod">
        <valuePeriod>
          <start value="2026-01-01"/>
          <end value="2026-12-31"/>
        </valuePeriod>
      </extension>
      <extension url="source">
        <valueUri value="https://example.org/festzuschuss/synthetic/2026"/>
      </extension>
    </extension>
    <sequence value="1"/>
    <informationSequence value="1"/>
    <productOrService>
      <coding>
        <system value="http://fhir.de/CodeSystem/kzbv/bema"/>
        <code value="91d"/>
        <display value="BEMA-91d"/>
      </coding>
    </productOrService>
    <unitPrice>
      <value value="210"/>
      <currency value="EUR"/>
    </unitPrice>
    <net>
      <value value="210"/>
      <currency value="EUR"/>
    </net>
  </item>
  <item>
    <extension
               url="https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart">
      <valueCode value="gleichartig"/>
    </extension>
    <sequence value="2"/>
    <informationSequence value="2"/>
    <productOrService>
      <coding>
        <system value="http://fhir.de/CodeSystem/bzaek/goz"/>
        <code value="5040"/>
        <display value="GOZ-5040"/>
      </coding>
    </productOrService>
    <unitPrice>
      <value value="480"/>
      <currency value="EUR"/>
    </unitPrice>
    <factor value="1"/>
    <net>
      <value value="480"/>
      <currency value="EUR"/>
    </net>
  </item>
  <total>
    <value value="690"/>
    <currency value="EUR"/>
  </total>
</Claim>