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 - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="ExampleFunctionTrainingRejection"/>
  <meta>
    <profile
             value="https://fhir.cognovis.de/praxis/StructureDefinition/rehabilitation-participation-pas-claim-response-de"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <system
            value="https://fhir.cognovis.de/praxis/NamingSystem/authorization-response-id"/>
    <value value="E56-DECISION-2026-0002"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>🔗 
    <reference value="Patient/ExampleRehabPatient"/>
  </patient>
  <created value="2026-07-19T09:30:00+02:00"/>
  <insurer>🔗 
    <reference value="Organization/ExampleRehabPayer"/>
  </insurer>
  <request>🔗 
    <reference value="Claim/ExampleFunctionTrainingClaim"/>
  </request>
  <outcome value="complete"/>
  <disposition
               value="The requested service requires additional clinical evidence."/>
  <item>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
          <code value="eligible"/>
        </coding>
      </category>
      <reason>
        <coding>
          <system
                  value="https://fhir.cognovis.de/praxis/CodeSystem/rehabilitation-authorization-decision-reason"/>
          <code value="insufficient-clinical-evidence"/>
        </coding>
      </reason>
      <value value="0"/>
    </adjudication>
  </item>
</ClaimResponse>