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 |