: Billing Required Fact - JSON Representation
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{
"resourceType" : "CodeSystem",
"id" : "billing-required-fact",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem billing-required-fact</b></p><a name=\"billing-required-fact\"> </a><a name=\"hcbilling-required-fact\"> </a><p>This case-sensitive code system <code>https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">service-occurrence<a name=\"billing-required-fact-service-occurrence\"> </a></td><td>Service occurrence</td><td>An occurrence of a billed or previously rendered service.</td></tr><tr><td style=\"white-space:nowrap\">service-value<a name=\"billing-required-fact-service-value\"> </a></td><td>Service value</td><td>A monetary, point, duration, quantity, or factor value attached to a service.</td></tr><tr><td style=\"white-space:nowrap\">diagnosis<a name=\"billing-required-fact-diagnosis\"> </a></td><td>Diagnosis</td><td>A diagnosis and its relevant status, certainty, site, and time context.</td></tr><tr><td style=\"white-space:nowrap\">procedure<a name=\"billing-required-fact-procedure\"> </a></td><td>Procedure</td><td>A documented procedure and its time and site context.</td></tr><tr><td style=\"white-space:nowrap\">finding<a name=\"billing-required-fact-finding\"> </a></td><td>Finding</td><td>A documented clinical or administrative finding or measurement.</td></tr><tr><td style=\"white-space:nowrap\">patient-attribute<a name=\"billing-required-fact-patient-attribute\"> </a></td><td>Patient attribute</td><td>A demographic or status attribute of the patient.</td></tr><tr><td style=\"white-space:nowrap\">provider-eligibility<a name=\"billing-required-fact-provider-eligibility\"> </a></td><td>Provider eligibility</td><td>A specialty, authorization, role, or relationship fact that establishes whether a provider may render or bill the service.</td></tr><tr><td style=\"white-space:nowrap\">care-setting<a name=\"billing-required-fact-care-setting\"> </a></td><td>Care setting</td><td>A place, case type, care setting, time, or treatment-kind fact.</td></tr><tr><td style=\"white-space:nowrap\">contract-participation<a name=\"billing-required-fact-contract-participation\"> </a></td><td>Contract participation</td><td>A patient, provider, or practice enrollment in a contract or module.</td></tr><tr><td style=\"white-space:nowrap\">accompanying-information<a name=\"billing-required-fact-accompanying-information\"> </a></td><td>Accompanying information</td><td>A structured field, justification, report, or itemized cost record.</td></tr><tr><td style=\"white-space:nowrap\">prior-authorization<a name=\"billing-required-fact-prior-authorization\"> </a></td><td>Prior authorization</td><td>An applicable approved plan or authorization.</td></tr><tr><td style=\"white-space:nowrap\">patient-agreement<a name=\"billing-required-fact-patient-agreement\"> </a></td><td>Patient agreement</td><td>An applicable agreement signed or accepted by the patient.</td></tr><tr><td style=\"white-space:nowrap\">billing-factor<a name=\"billing-required-fact-billing-factor\"> </a></td><td>Billing factor</td><td>The factor or multiplier applied to a billed item.</td></tr><tr><td style=\"white-space:nowrap\">analogue-reference<a name=\"billing-required-fact-analogue-reference\"> </a></td><td>Analogue reference</td><td>The declared listed service used as an analogue for an unlisted service.</td></tr><tr><td style=\"white-space:nowrap\">cost-evidence<a name=\"billing-required-fact-cost-evidence\"> </a></td><td>Cost evidence</td><td>Evidence supporting material, laboratory, or other reimbursable costs.</td></tr><tr><td style=\"white-space:nowrap\">approved-plan<a name=\"billing-required-fact-approved-plan\"> </a></td><td>Approved plan</td><td>An approved treatment or cost plan and its entitlement-relevant findings.</td></tr><tr><td style=\"white-space:nowrap\">volume<a name=\"billing-required-fact-volume\"> </a></td><td>Volume</td><td>An accumulated count, value, or quota for the declared counting subject and window.</td></tr><tr><td style=\"white-space:nowrap\">treatment-episode<a name=\"billing-required-fact-treatment-episode\"> </a></td><td>Treatment episode</td><td>The start, end, and continuity of the treatment episode a service belongs to, used to place the service inside an episode-relative counting window.</td></tr><tr><td style=\"white-space:nowrap\">provider-specialty-group<a name=\"billing-required-fact-provider-specialty-group\"> </a></td><td>Provider specialty group</td><td>The grouping identity of the rendering provider: the specialty group or the care sector the provider belongs to. It is used to group providers for counting and to condition rules on that grouping, including rules that apply differently in an organisation spanning more than one care sector. The applicable values arrive as parameters and are never enumerated by this concept. It is grouping identity and does not assert that the provider is eligible to render or bill the service.</td></tr></table></div>"
},
"url" : "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact",
"identifier" : [
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.3.7985.16.19"
}
],
"version" : "1",
"name" : "BillingRequiredFactCS",
"title" : "Billing Required Fact",
"status" : "active",
"experimental" : false,
"date" : "2026-08-22T18:18:46+02:00",
"publisher" : "cognovis GmbH",
"contact" : [
{
"name" : "cognovis GmbH",
"telecom" : [
{
"system" : "url",
"value" : "https://www.cognovis.de"
},
{
"system" : "email",
"value" : "info@cognovis.de"
}
]
}
],
"description" : "Fact categories that a billing-rule evaluator may require from its caller.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "DE"
}
]
}
],
"copyright" : "Copyright 2026+ cognovis GmbH. Cognovis-authored material is licensed under Apache-2.0; third-party material retains its own terms as documented in THIRD_PARTY_NOTICES.md.",
"caseSensitive" : true,
"content" : "complete",
"count" : 19,
"concept" : [
{
"code" : "service-occurrence",
"display" : "Service occurrence",
"definition" : "An occurrence of a billed or previously rendered service."
},
{
"code" : "service-value",
"display" : "Service value",
"definition" : "A monetary, point, duration, quantity, or factor value attached to a service."
},
{
"code" : "diagnosis",
"display" : "Diagnosis",
"definition" : "A diagnosis and its relevant status, certainty, site, and time context."
},
{
"code" : "procedure",
"display" : "Procedure",
"definition" : "A documented procedure and its time and site context."
},
{
"code" : "finding",
"display" : "Finding",
"definition" : "A documented clinical or administrative finding or measurement."
},
{
"code" : "patient-attribute",
"display" : "Patient attribute",
"definition" : "A demographic or status attribute of the patient."
},
{
"code" : "provider-eligibility",
"display" : "Provider eligibility",
"definition" : "A specialty, authorization, role, or relationship fact that establishes whether a provider may render or bill the service."
},
{
"code" : "care-setting",
"display" : "Care setting",
"definition" : "A place, case type, care setting, time, or treatment-kind fact."
},
{
"code" : "contract-participation",
"display" : "Contract participation",
"definition" : "A patient, provider, or practice enrollment in a contract or module."
},
{
"code" : "accompanying-information",
"display" : "Accompanying information",
"definition" : "A structured field, justification, report, or itemized cost record."
},
{
"code" : "prior-authorization",
"display" : "Prior authorization",
"definition" : "An applicable approved plan or authorization."
},
{
"code" : "patient-agreement",
"display" : "Patient agreement",
"definition" : "An applicable agreement signed or accepted by the patient."
},
{
"code" : "billing-factor",
"display" : "Billing factor",
"definition" : "The factor or multiplier applied to a billed item."
},
{
"code" : "analogue-reference",
"display" : "Analogue reference",
"definition" : "The declared listed service used as an analogue for an unlisted service."
},
{
"code" : "cost-evidence",
"display" : "Cost evidence",
"definition" : "Evidence supporting material, laboratory, or other reimbursable costs."
},
{
"code" : "approved-plan",
"display" : "Approved plan",
"definition" : "An approved treatment or cost plan and its entitlement-relevant findings."
},
{
"code" : "volume",
"display" : "Volume",
"definition" : "An accumulated count, value, or quota for the declared counting subject and window."
},
{
"code" : "treatment-episode",
"display" : "Treatment episode",
"definition" : "The start, end, and continuity of the treatment episode a service belongs to, used to place the service inside an episode-relative counting window."
},
{
"code" : "provider-specialty-group",
"display" : "Provider specialty group",
"definition" : "The grouping identity of the rendering provider: the specialty group or the care sector the provider belongs to. It is used to group providers for counting and to condition rules on that grouping, including rules that apply differently in an organisation spanning more than one care sector. The applicable values arrive as parameters and are never enumerated by this concept. It is grouping identity and does not assert that the provider is eligible to render or bill the service."
}
]
}
