Generated Narrative: CodeSystem billing-rule-class Properties This code system defines the following properties for its concepts Name Code URI Type Description defaultEffect defaultEffect https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#defaultEffect Coding Default effect when a rule instance does not declare a more specific supported effect requiredFactTypes requiredFactTypes https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#requiredFactTypes Coding Declared floor of fact categories for this class. A conforming evaluator derives the authoritative required-fact set from the rule class together with its instance parameters; that derived set is never smaller than this floor and may be larger. since since https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#since string Semantic major in which this immutable class concept was introduced replacedBy replacedBy https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#replacedBy Coding Successor class concept when this concept is retired Concepts This case-sensitive code system https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class defines the following codes: Code Display Definition defaultEffect requiredFactTypes since quantity-limit Quantity limit Limits the number of matching services within a counting scope. Reject Service occurrence 1 value-limit Value limit Limits the sum of a measure, such as currency, points, or minutes, within a counting scope. Reject Service value 1 mutual-exclusion Mutual exclusion Forbids selected services from occurring together within a counting scope. Reject Service occurrence 1 inclusive-component Inclusive component Declares that a component service is included in a containing service and is not separately billable in the stated direction. Reject Service occurrence 1 companion-required Companion required Requires one or more companion services, optionally with ordering constraints, within a counting scope. Reject Service occurrence 1 repeat-interval Repeat interval Requires a minimum interval before a matching service may be repeated for the same counting subject. Reject Service occurrence 1 diagnosis-requirement Diagnosis requirement Requires or forbids a diagnosis matching a declared selector, certainty, and time window. Reject Diagnosis 1 procedure-finding-requirement Procedure or finding requirement Requires a documented procedure, finding, or measurement matching the declared selector. Reject Procedure, Finding 1 patient-attribute-constraint Patient attribute constraint Constrains applicability using declared patient demographic or status predicates. Reject Patient attribute 1 provider-eligibility Provider eligibility Constrains applicability using declared provider specialty, authorization, or relationship predicates. Reject Provider eligibility 1 setting-constraint Setting constraint Constrains applicability using declared care setting, billing case, place, time, or treatment-kind predicates. Reject Care setting 1 contract-participation Contract participation Requires participation in a declared contract or module by the patient, provider, or practice. Reject Contract participation 1 accompanying-information-required Accompanying information required Requires declared structured information, justification, report, or itemized cost evidence. Requires justification Accompanying information 1 prior-authorization-required Prior authorization required Requires an approved plan or authorization before the service is rendered or billed. Requires approval Prior authorization 1 patient-agreement-required Patient agreement required Requires a declared patient agreement before billing under the stated conditions. Requires agreement Patient agreement 1 factor-bound Factor bound Applies declared multiplier bounds and maps threshold crossings to a declared effect. Requires justification Billing factor 1 analogue-service Analogue service Constrains billing of an unlisted service by reference to a declared equivalent listed service. Requires justification Analogue reference 1 cost-reimbursement-constraint Cost reimbursement constraint Constrains material or laboratory cost reimbursement using declared evidence requirements or limits. Requires justification Cost evidence 1 quota-degression Quota degression Applies a declared reduced valuation after a volume threshold is exceeded. Price adjustment Volume, Service value 1 plan-finding-entitlement Plan and finding entitlement Derives a permitted treatment path or subsidy from declared findings and an approved plan. Price adjustment Approved plan, Finding 1
Regime-neutral classes of declarative billing rules. A rule class names an observable evaluation algorithm; fee schedules and contracts provide instance parameters.
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Default effect when a rule instance does not declare a more specific supported effect
Declared floor of fact categories for this class. A conforming evaluator derives the authoritative required-fact set from the rule class together with its instance parameters; that derived set is never smaller than this floor and may be larger.
Semantic major in which this immutable class concept was introduced
Successor class concept when this concept is retired
Limits the number of matching services within a counting scope.
Limits the sum of a measure, such as currency, points, or minutes, within a counting scope.
Forbids selected services from occurring together within a counting scope.
Declares that a component service is included in a containing service and is not separately billable in the stated direction.
Requires one or more companion services, optionally with ordering constraints, within a counting scope.
Requires a minimum interval before a matching service may be repeated for the same counting subject.
Requires or forbids a diagnosis matching a declared selector, certainty, and time window.
Requires a documented procedure, finding, or measurement matching the declared selector.
Constrains applicability using declared patient demographic or status predicates.
Constrains applicability using declared provider specialty, authorization, or relationship predicates.
Constrains applicability using declared care setting, billing case, place, time, or treatment-kind predicates.
Requires participation in a declared contract or module by the patient, provider, or practice.
Requires declared structured information, justification, report, or itemized cost evidence.
Requires an approved plan or authorization before the service is rendered or billed.
Requires a declared patient agreement before billing under the stated conditions.
Applies declared multiplier bounds and maps threshold crossings to a declared effect.
Constrains billing of an unlisted service by reference to a declared equivalent listed service.
Constrains material or laboratory cost reimbursement using declared evidence requirements or limits.
Applies a declared reduced valuation after a volume threshold is exceeded.
Derives a permitted treatment path or subsidy from declared findings and an approved plan.