| Active as of 2026-08-22 |
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- <http://hl7.org/fhir/CodeSystem/billing-rule-class> a fhir:CodeSystem ; fhir:nodeRole fhir:treeRoot ; fhir:Resource.id [ fhir:value "billing-rule-class"] ; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "generated" ] ; fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem billing-rule-class</b></p><a name=\"billing-rule-class\"> </a><a name=\"hcbilling-rule-class\"> </a><p><b>Properties</b></p><p><b>This code system defines the following properties for its concepts</b></p><table class=\"grid\"><tr><td><b>Name</b></td><td><b>Code</b></td><td><b>URI</b></td><td><b>Type</b></td><td><b>Description</b></td></tr><tr><td>defaultEffect</td><td>defaultEffect</td><td>https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#defaultEffect</td><td>Coding</td><td>Default effect when a rule instance does not declare a more specific supported effect</td></tr><tr><td>requiredFactTypes</td><td>requiredFactTypes</td><td>https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#requiredFactTypes</td><td>Coding</td><td>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.</td></tr><tr><td>since</td><td>since</td><td>https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#since</td><td>string</td><td>Semantic major in which this immutable class concept was introduced</td></tr><tr><td>replacedBy</td><td>replacedBy</td><td>https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#replacedBy</td><td>Coding</td><td>Successor class concept when this concept is retired</td></tr></table><p><b>Concepts</b></p><p>This case-sensitive code system <code>https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class</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><td><b>defaultEffect</b></td><td><b>requiredFactTypes</b></td><td><b>since</b></td></tr><tr><td style=\"white-space:nowrap\">quantity-limit<a name=\"billing-rule-class-quantity-limit\"> </a></td><td>Quantity limit</td><td>Limits the number of matching services within a counting scope.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-occurrence}\">Service occurrence</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">value-limit<a name=\"billing-rule-class-value-limit\"> </a></td><td>Value limit</td><td>Limits the sum of a measure, such as currency, points, or minutes, within a counting scope.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-value}\">Service value</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">mutual-exclusion<a name=\"billing-rule-class-mutual-exclusion\"> </a></td><td>Mutual exclusion</td><td>Forbids selected services from occurring together within a counting scope.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-occurrence}\">Service occurrence</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">inclusive-component<a name=\"billing-rule-class-inclusive-component\"> </a></td><td>Inclusive component</td><td>Declares that a component service is included in a containing service and is not separately billable in the stated direction.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-occurrence}\">Service occurrence</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">companion-required<a name=\"billing-rule-class-companion-required\"> </a></td><td>Companion required</td><td>Requires one or more companion services, optionally with ordering constraints, within a counting scope.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-occurrence}\">Service occurrence</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">repeat-interval<a name=\"billing-rule-class-repeat-interval\"> </a></td><td>Repeat interval</td><td>Requires a minimum interval before a matching service may be repeated for the same counting subject.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-occurrence}\">Service occurrence</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">diagnosis-requirement<a name=\"billing-rule-class-diagnosis-requirement\"> </a></td><td>Diagnosis requirement</td><td>Requires or forbids a diagnosis matching a declared selector, certainty, and time window.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact diagnosis}\">Diagnosis</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">procedure-finding-requirement<a name=\"billing-rule-class-procedure-finding-requirement\"> </a></td><td>Procedure or finding requirement</td><td>Requires a documented procedure, finding, or measurement matching the declared selector.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact procedure}\">Procedure</a>, <a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact finding}\">Finding</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">patient-attribute-constraint<a name=\"billing-rule-class-patient-attribute-constraint\"> </a></td><td>Patient attribute constraint</td><td>Constrains applicability using declared patient demographic or status predicates.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact patient-attribute}\">Patient attribute</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">provider-eligibility<a name=\"billing-rule-class-provider-eligibility\"> </a></td><td>Provider eligibility</td><td>Constrains applicability using declared provider specialty, authorization, or relationship predicates.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact provider-eligibility}\">Provider eligibility</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">setting-constraint<a name=\"billing-rule-class-setting-constraint\"> </a></td><td>Setting constraint</td><td>Constrains applicability using declared care setting, billing case, place, time, or treatment-kind predicates.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact care-setting}\">Care setting</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">contract-participation<a name=\"billing-rule-class-contract-participation\"> </a></td><td>Contract participation</td><td>Requires participation in a declared contract or module by the patient, provider, or practice.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect reject}\">Reject</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact contract-participation}\">Contract participation</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">accompanying-information-required<a name=\"billing-rule-class-accompanying-information-required\"> </a></td><td>Accompanying information required</td><td>Requires declared structured information, justification, report, or itemized cost evidence.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect requires-justification}\">Requires justification</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact accompanying-information}\">Accompanying information</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">prior-authorization-required<a name=\"billing-rule-class-prior-authorization-required\"> </a></td><td>Prior authorization required</td><td>Requires an approved plan or authorization before the service is rendered or billed.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect requires-approval}\">Requires approval</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact prior-authorization}\">Prior authorization</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">patient-agreement-required<a name=\"billing-rule-class-patient-agreement-required\"> </a></td><td>Patient agreement required</td><td>Requires a declared patient agreement before billing under the stated conditions.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect requires-agreement}\">Requires agreement</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact patient-agreement}\">Patient agreement</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">factor-bound<a name=\"billing-rule-class-factor-bound\"> </a></td><td>Factor bound</td><td>Applies declared multiplier bounds and maps threshold crossings to a declared effect.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect requires-justification}\">Requires justification</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact billing-factor}\">Billing factor</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">analogue-service<a name=\"billing-rule-class-analogue-service\"> </a></td><td>Analogue service</td><td>Constrains billing of an unlisted service by reference to a declared equivalent listed service.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect requires-justification}\">Requires justification</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact analogue-reference}\">Analogue reference</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">cost-reimbursement-constraint<a name=\"billing-rule-class-cost-reimbursement-constraint\"> </a></td><td>Cost reimbursement constraint</td><td>Constrains material or laboratory cost reimbursement using declared evidence requirements or limits.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect requires-justification}\">Requires justification</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact cost-evidence}\">Cost evidence</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">quota-degression<a name=\"billing-rule-class-quota-degression\"> </a></td><td>Quota degression</td><td>Applies a declared reduced valuation after a volume threshold is exceeded.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect price-adjust}\">Price adjustment</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact volume}\">Volume</a>, <a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact service-value}\">Service value</a></td><td>1</td></tr><tr><td style=\"white-space:nowrap\">plan-finding-entitlement<a name=\"billing-rule-class-plan-finding-entitlement\"> </a></td><td>Plan and finding entitlement</td><td>Derives a permitted treatment path or subsidy from declared findings and an approved plan.</td><td><a href=\"CodeSystem-billing-rule-effect.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect price-adjust}\">Price adjustment</a></td><td><a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact approved-plan}\">Approved plan</a>, <a href=\"CodeSystem-billing-required-fact.html\" title=\"{https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact finding}\">Finding</a></td><td>1</td></tr></table></div>" ] ; fhir:CodeSystem.url [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class"] ; fhir:CodeSystem.identifier [ fhir:index 0 ; fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ] ; fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.3.7985.16.20" ] ] ; fhir:CodeSystem.version [ fhir:value "1"] ; fhir:CodeSystem.name [ fhir:value "BillingRuleClassCS"] ; fhir:CodeSystem.title [ fhir:value "Billing Rule Class"] ; fhir:CodeSystem.status [ fhir:value "active"] ; fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ; fhir:CodeSystem.date [ fhir:value "2026-08-22T18:18:46+02:00"^^xsd:dateTime] ; fhir:CodeSystem.publisher [ fhir:value "cognovis GmbH"] ; fhir:CodeSystem.contact [ fhir:index 0 ; fhir:ContactDetail.name [ fhir:value "cognovis GmbH" ] ; fhir:ContactDetail.telecom [ fhir:index 0 ; fhir:ContactPoint.system [ fhir:value "url" ] ; fhir:ContactPoint.value [ fhir:value "https://www.cognovis.de" ] ], [ fhir:index 1 ; fhir:ContactPoint.system [ fhir:value "email" ] ; fhir:ContactPoint.value [ fhir:value "info@cognovis.de" ] ] ] ; fhir:CodeSystem.description [ fhir:value "Regime-neutral classes of declarative billing rules. A rule class names an observable evaluation algorithm; fee schedules and contracts provide instance parameters."] ; fhir:CodeSystem.jurisdiction [ fhir:index 0 ; fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ; fhir:Coding.code [ fhir:value "DE" ] ] ] ; fhir:CodeSystem.copyright [ fhir: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."] ; fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ; fhir:CodeSystem.content [ fhir:value "complete"] ; fhir:CodeSystem.count [ fhir:value "20"^^xsd:nonNegativeInteger] ; fhir:CodeSystem.property [ fhir:index 0 ; fhir:CodeSystem.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.property.uri [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#defaultEffect" ] ; fhir:CodeSystem.property.description [ fhir:value "Default effect when a rule instance does not declare a more specific supported effect" ] ; fhir:CodeSystem.property.type [ fhir:value "Coding" ] ], [ fhir:index 1 ; fhir:CodeSystem.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.property.uri [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#requiredFactTypes" ] ; fhir:CodeSystem.property.description [ fhir:value "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." ] ; fhir:CodeSystem.property.type [ fhir:value "Coding" ] ], [ fhir:index 2 ; fhir:CodeSystem.property.code [ fhir:value "since" ] ; fhir:CodeSystem.property.uri [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#since" ] ; fhir:CodeSystem.property.description [ fhir:value "Semantic major in which this immutable class concept was introduced" ] ; fhir:CodeSystem.property.type [ fhir:value "string" ] ], [ fhir:index 3 ; fhir:CodeSystem.property.code [ fhir:value "replacedBy" ] ; fhir:CodeSystem.property.uri [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#replacedBy" ] ; fhir:CodeSystem.property.description [ fhir:value "Successor class concept when this concept is retired" ] ; fhir:CodeSystem.property.type [ fhir:value "Coding" ] ] ; fhir:CodeSystem.concept [ fhir:index 0 ; fhir:CodeSystem.concept.code [ fhir:value "quantity-limit" ] ; fhir:CodeSystem.concept.display [ fhir:value "Quantity limit" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Limits the number of matching services within a counting scope." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-occurrence" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.code [ fhir:value "value-limit" ] ; fhir:CodeSystem.concept.display [ fhir:value "Value limit" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Limits the sum of a measure, such as currency, points, or minutes, within a counting scope." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-value" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.code [ fhir:value "mutual-exclusion" ] ; fhir:CodeSystem.concept.display [ fhir:value "Mutual exclusion" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Forbids selected services from occurring together within a counting scope." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-occurrence" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 3 ; fhir:CodeSystem.concept.code [ fhir:value "inclusive-component" ] ; fhir:CodeSystem.concept.display [ fhir:value "Inclusive component" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Declares that a component service is included in a containing service and is not separately billable in the stated direction." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-occurrence" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 4 ; fhir:CodeSystem.concept.code [ fhir:value "companion-required" ] ; fhir:CodeSystem.concept.display [ fhir:value "Companion required" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires one or more companion services, optionally with ordering constraints, within a counting scope." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-occurrence" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 5 ; fhir:CodeSystem.concept.code [ fhir:value "repeat-interval" ] ; fhir:CodeSystem.concept.display [ fhir:value "Repeat interval" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires a minimum interval before a matching service may be repeated for the same counting subject." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-occurrence" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 6 ; fhir:CodeSystem.concept.code [ fhir:value "diagnosis-requirement" ] ; fhir:CodeSystem.concept.display [ fhir:value "Diagnosis requirement" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires or forbids a diagnosis matching a declared selector, certainty, and time window." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "diagnosis" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 7 ; fhir:CodeSystem.concept.code [ fhir:value "procedure-finding-requirement" ] ; fhir:CodeSystem.concept.display [ fhir:value "Procedure or finding requirement" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires a documented procedure, finding, or measurement matching the declared selector." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "procedure" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "finding" ] ] ], [ fhir:index 3 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 8 ; fhir:CodeSystem.concept.code [ fhir:value "patient-attribute-constraint" ] ; fhir:CodeSystem.concept.display [ fhir:value "Patient attribute constraint" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Constrains applicability using declared patient demographic or status predicates." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "patient-attribute" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 9 ; fhir:CodeSystem.concept.code [ fhir:value "provider-eligibility" ] ; fhir:CodeSystem.concept.display [ fhir:value "Provider eligibility" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Constrains applicability using declared provider specialty, authorization, or relationship predicates." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "provider-eligibility" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 10 ; fhir:CodeSystem.concept.code [ fhir:value "setting-constraint" ] ; fhir:CodeSystem.concept.display [ fhir:value "Setting constraint" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Constrains applicability using declared care setting, billing case, place, time, or treatment-kind predicates." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "care-setting" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 11 ; fhir:CodeSystem.concept.code [ fhir:value "contract-participation" ] ; fhir:CodeSystem.concept.display [ fhir:value "Contract participation" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires participation in a declared contract or module by the patient, provider, or practice." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "reject" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "contract-participation" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 12 ; fhir:CodeSystem.concept.code [ fhir:value "accompanying-information-required" ] ; fhir:CodeSystem.concept.display [ fhir:value "Accompanying information required" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires declared structured information, justification, report, or itemized cost evidence." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "requires-justification" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "accompanying-information" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 13 ; fhir:CodeSystem.concept.code [ fhir:value "prior-authorization-required" ] ; fhir:CodeSystem.concept.display [ fhir:value "Prior authorization required" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires an approved plan or authorization before the service is rendered or billed." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "requires-approval" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "prior-authorization" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 14 ; fhir:CodeSystem.concept.code [ fhir:value "patient-agreement-required" ] ; fhir:CodeSystem.concept.display [ fhir:value "Patient agreement required" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Requires a declared patient agreement before billing under the stated conditions." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "requires-agreement" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "patient-agreement" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 15 ; fhir:CodeSystem.concept.code [ fhir:value "factor-bound" ] ; fhir:CodeSystem.concept.display [ fhir:value "Factor bound" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Applies declared multiplier bounds and maps threshold crossings to a declared effect." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "requires-justification" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "billing-factor" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 16 ; fhir:CodeSystem.concept.code [ fhir:value "analogue-service" ] ; fhir:CodeSystem.concept.display [ fhir:value "Analogue service" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Constrains billing of an unlisted service by reference to a declared equivalent listed service." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "requires-justification" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "analogue-reference" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 17 ; fhir:CodeSystem.concept.code [ fhir:value "cost-reimbursement-constraint" ] ; fhir:CodeSystem.concept.display [ fhir:value "Cost reimbursement constraint" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Constrains material or laboratory cost reimbursement using declared evidence requirements or limits." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "requires-justification" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "cost-evidence" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 18 ; fhir:CodeSystem.concept.code [ fhir:value "quota-degression" ] ; fhir:CodeSystem.concept.display [ fhir:value "Quota degression" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Applies a declared reduced valuation after a volume threshold is exceeded." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "price-adjust" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "volume" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "service-value" ] ] ], [ fhir:index 3 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ], [ fhir:index 19 ; fhir:CodeSystem.concept.code [ fhir:value "plan-finding-entitlement" ] ; fhir:CodeSystem.concept.display [ fhir:value "Plan and finding entitlement" ] ; fhir:CodeSystem.concept.definition [ fhir:value "Derives a permitted treatment path or subsidy from declared findings and an approved plan." ] ; fhir:CodeSystem.concept.property [ fhir:index 0 ; fhir:CodeSystem.concept.property.code [ fhir:value "defaultEffect" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect" ] ; fhir:Coding.code [ fhir:value "price-adjust" ] ] ], [ fhir:index 1 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "approved-plan" ] ] ], [ fhir:index 2 ; fhir:CodeSystem.concept.property.code [ fhir:value "requiredFactTypes" ] ; fhir:CodeSystem.concept.property.valueCoding [ fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact" ] ; fhir:Coding.code [ fhir:value "finding" ] ] ], [ fhir:index 3 ; fhir:CodeSystem.concept.property.code [ fhir:value "since" ] ; fhir:CodeSystem.concept.property.valueString [ fhir:value "1" ] ] ] . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/CodeSystem/billing-rule-class.ttl> a owl:Ontology ; owl:imports fhir:fhir.ttl ; owl:versionIRI <http://build.fhir.org/CodeSystem/billing-rule-class.ttl> .
IG © 2026+ cognovis GmbH. Paket de.cognovis.fhir.praxis#0.99.1 basierend auf FHIR 4.0.1. Generiert 2026-08-22
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