: Billing Rule Effect - JSON Representation
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{
"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."
}
]
}
