{
  "resourceType" : "CodeSystem",
  "id" : "billing-rule-effect",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem billing-rule-effect</b></p><a name=\"billing-rule-effect\"> </a><a name=\"hcbilling-rule-effect\"> </a><p>This case-sensitive code system <code>https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect</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\">reject<a name=\"billing-rule-effect-reject\"> </a></td><td>Reject</td><td>The billed item is non-conformant and must be rejected or corrected.</td></tr><tr><td style=\"white-space:nowrap\">requires-justification<a name=\"billing-rule-effect-requires-justification\"> </a></td><td>Requires justification</td><td>The billed item requires a documented justification.</td></tr><tr><td style=\"white-space:nowrap\">requires-approval<a name=\"billing-rule-effect-requires-approval\"> </a></td><td>Requires approval</td><td>The billed item requires an applicable approval or authorization.</td></tr><tr><td style=\"white-space:nowrap\">requires-agreement<a name=\"billing-rule-effect-requires-agreement\"> </a></td><td>Requires agreement</td><td>The billed item requires an applicable patient or contractual agreement.</td></tr><tr><td style=\"white-space:nowrap\">replace-code<a name=\"billing-rule-effect-replace-code\"> </a></td><td>Replace code</td><td>The billed item must be replaced by a declared alternative code.</td></tr><tr><td style=\"white-space:nowrap\">price-adjust<a name=\"billing-rule-effect-price-adjust\"> </a></td><td>Price adjustment</td><td>The rule changes the applicable price, points, factor, or valuation.</td></tr><tr><td style=\"white-space:nowrap\">advisory<a name=\"billing-rule-effect-advisory\"> </a></td><td>Advisory</td><td>The rule produces a non-blocking advisory finding.</td></tr><tr><td style=\"white-space:nowrap\">reporting-only<a name=\"billing-rule-effect-reporting-only\"> </a></td><td>Reporting only</td><td>The rule produces a reporting obligation without changing billability.</td></tr></table></div>"
  },
  "url" : "https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.3.7985.16.21"
  }],
  "version" : "1",
  "name" : "BillingRuleEffectCS",
  "title" : "Billing Rule Effect",
  "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" : "Observable effects produced when a declarative billing rule matches or is violated.",
  "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" : 8,
  "concept" : [{
    "code" : "reject",
    "display" : "Reject",
    "definition" : "The billed item is non-conformant and must be rejected or corrected."
  },
  {
    "code" : "requires-justification",
    "display" : "Requires justification",
    "definition" : "The billed item requires a documented justification."
  },
  {
    "code" : "requires-approval",
    "display" : "Requires approval",
    "definition" : "The billed item requires an applicable approval or authorization."
  },
  {
    "code" : "requires-agreement",
    "display" : "Requires agreement",
    "definition" : "The billed item requires an applicable patient or contractual agreement."
  },
  {
    "code" : "replace-code",
    "display" : "Replace code",
    "definition" : "The billed item must be replaced by a declared alternative code."
  },
  {
    "code" : "price-adjust",
    "display" : "Price adjustment",
    "definition" : "The rule changes the applicable price, points, factor, or valuation."
  },
  {
    "code" : "advisory",
    "display" : "Advisory",
    "definition" : "The rule produces a non-blocking advisory finding."
  },
  {
    "code" : "reporting-only",
    "display" : "Reporting only",
    "definition" : "The rule produces a reporting obligation without changing billability."
  }]
}