: Billing Required Fact - XML Representation
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<CodeSystem xmlns="http://hl7.org/fhir">
<id value="billing-required-fact"/>
<text>
<status value="generated"/>
<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>
</text>
<url
value="https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.3.7985.16.19"/>
</identifier>
<version value="1"/>
<name value="BillingRequiredFactCS"/>
<title value="Billing Required Fact"/>
<status value="active"/>
<experimental value="false"/>
<date value="2026-08-22T18:18:46+02:00"/>
<publisher value="cognovis GmbH"/>
<contact>
<name value="cognovis GmbH"/>
<telecom>
<system value="url"/>
<value value="https://www.cognovis.de"/>
</telecom>
<telecom>
<system value="email"/>
<value value="info@cognovis.de"/>
</telecom>
</contact>
<description
value="Fact categories that a billing-rule evaluator may require from its caller."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="DE"/>
</coding>
</jurisdiction>
<copyright
value="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 value="true"/>
<content value="complete"/>
<count value="19"/>
<concept>
<code value="service-occurrence"/>
<display value="Service occurrence"/>
<definition
value="An occurrence of a billed or previously rendered service."/>
</concept>
<concept>
<code value="service-value"/>
<display value="Service value"/>
<definition
value="A monetary, point, duration, quantity, or factor value attached to a service."/>
</concept>
<concept>
<code value="diagnosis"/>
<display value="Diagnosis"/>
<definition
value="A diagnosis and its relevant status, certainty, site, and time context."/>
</concept>
<concept>
<code value="procedure"/>
<display value="Procedure"/>
<definition
value="A documented procedure and its time and site context."/>
</concept>
<concept>
<code value="finding"/>
<display value="Finding"/>
<definition
value="A documented clinical or administrative finding or measurement."/>
</concept>
<concept>
<code value="patient-attribute"/>
<display value="Patient attribute"/>
<definition value="A demographic or status attribute of the patient."/>
</concept>
<concept>
<code value="provider-eligibility"/>
<display value="Provider eligibility"/>
<definition
value="A specialty, authorization, role, or relationship fact that establishes whether a provider may render or bill the service."/>
</concept>
<concept>
<code value="care-setting"/>
<display value="Care setting"/>
<definition
value="A place, case type, care setting, time, or treatment-kind fact."/>
</concept>
<concept>
<code value="contract-participation"/>
<display value="Contract participation"/>
<definition
value="A patient, provider, or practice enrollment in a contract or module."/>
</concept>
<concept>
<code value="accompanying-information"/>
<display value="Accompanying information"/>
<definition
value="A structured field, justification, report, or itemized cost record."/>
</concept>
<concept>
<code value="prior-authorization"/>
<display value="Prior authorization"/>
<definition value="An applicable approved plan or authorization."/>
</concept>
<concept>
<code value="patient-agreement"/>
<display value="Patient agreement"/>
<definition
value="An applicable agreement signed or accepted by the patient."/>
</concept>
<concept>
<code value="billing-factor"/>
<display value="Billing factor"/>
<definition value="The factor or multiplier applied to a billed item."/>
</concept>
<concept>
<code value="analogue-reference"/>
<display value="Analogue reference"/>
<definition
value="The declared listed service used as an analogue for an unlisted service."/>
</concept>
<concept>
<code value="cost-evidence"/>
<display value="Cost evidence"/>
<definition
value="Evidence supporting material, laboratory, or other reimbursable costs."/>
</concept>
<concept>
<code value="approved-plan"/>
<display value="Approved plan"/>
<definition
value="An approved treatment or cost plan and its entitlement-relevant findings."/>
</concept>
<concept>
<code value="volume"/>
<display value="Volume"/>
<definition
value="An accumulated count, value, or quota for the declared counting subject and window."/>
</concept>
<concept>
<code value="treatment-episode"/>
<display value="Treatment episode"/>
<definition
value="The start, end, and continuity of the treatment episode a service belongs to, used to place the service inside an episode-relative counting window."/>
</concept>
<concept>
<code value="provider-specialty-group"/>
<display value="Provider specialty group"/>
<definition
value="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."/>
</concept>
</CodeSystem>
