German Practice Management FHIR Profiles (R4)
0.90.0 - STU1 Germany

German Practice Management FHIR Profiles (R4) - Local Development build (v0.90.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Function training rejection - JSON Representation

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{
  "resourceType" : "ClaimResponse",
  "id" : "ExampleFunctionTrainingRejection",
  "meta" : {
    "profile" : [
      🔗 "https://fhir.cognovis.de/praxis/StructureDefinition/rehabilitation-participation-pas-claim-response-de"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ExampleFunctionTrainingRejection</b></p><a name=\"ExampleFunctionTrainingRejection\"> </a><a name=\"hcExampleFunctionTrainingRejection\"> </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-rehabilitation-participation-pas-claim-response-de.html\">Rehabilitation Participation PAS ClaimResponse DE</a></p></div><p><b>identifier</b>: <code>https://fhir.cognovis.de/praxis/NamingSystem/authorization-response-id</code>/E56-DECISION-2026-0002</p><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>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-ExampleRehabPatient.html\">Alex Becker (official) Unknown, DoB: 1978-04-17</a></p><p><b>created</b>: 2026-07-19 09:30:00+0200</p><p><b>insurer</b>: <a href=\"Organization-ExampleRehabPayer.html\">Organization Example statutory payer</a></p><p><b>request</b>: <a href=\"Claim-ExampleFunctionTrainingClaim.html\">Claim: identifier = https://fhir.cognovis.de/praxis/NamingSystem/authorization-request-id#E56-PAS-2026-0002; status = active; type = Professional; use = preauthorization; created = 2026-07-16 11:00:00+0200; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: The requested service requires additional clinical evidence.</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Category</b></td><td><b>Reason</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></td><td><span title=\"Codes:{https://fhir.cognovis.de/praxis/CodeSystem/rehabilitation-authorization-decision-reason insufficient-clinical-evidence}\">Insufficient Clinical Evidence</span></td><td>0</td></tr></table></blockquote></div>"
  },
  "identifier" : [
    {
      "system" : "https://fhir.cognovis.de/praxis/NamingSystem/authorization-response-id",
      "value" : "E56-DECISION-2026-0002"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional"
      }
    ]
  },
  "use" : "preauthorization",
  "patient" : {
    🔗 "reference" : "Patient/ExampleRehabPatient"
  },
  "created" : "2026-07-19T09:30:00+02:00",
  "insurer" : {
    🔗 "reference" : "Organization/ExampleRehabPayer"
  },
  "request" : {
    🔗 "reference" : "Claim/ExampleFunctionTrainingClaim"
  },
  "outcome" : "complete",
  "disposition" : "The requested service requires additional clinical evidence.",
  "item" : [
    {
      "itemSequence" : 1,
      "adjudication" : [
        {
          "category" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                "code" : "eligible"
              }
            ]
          },
          "reason" : {
            "coding" : [
              {
                "system" : "https://fhir.cognovis.de/praxis/CodeSystem/rehabilitation-authorization-decision-reason",
                "code" : "insufficient-clinical-evidence"
              }
            ]
          },
          "value" : 0
        }
      ]
    }
  ]
}