German Practice Management FHIR Profiles (R4)
Version 0.99.1 - release

Billing-Rule Exchange Contract

Billing-Rule Exchange Contract

The reusable billing-rule carrier, typed rule payload, source-manifest, evaluation outcome, and catalog contracts are owned by the German Billing and Billing Core Implementation Guides. New implementations use those canonicals directly.

The equivalent Praxis canonicals remain resolvable only as migration predecessors while named consumers complete their cutover. They do not receive new generic financial semantics. The exact canonical replacements and release gate are published in the Praxis-to-Billing Migration.

Praxis retains clinical transforms and workflows that may emit or reference a Billing contract. For example, the upper-arm StructureMap is a medical workflow that emits billing candidates; it does not define the reusable billing-rule or ChargeItem contract.

Consumer rule

Consumers must distinguish these responsibilities:

Concern Owner
Generic catalog, rule, payer, case, service-line, submission, tax, budget, and settlement semantics German Billing or Billing Core IG
Medical diagnosis, imaging evidence, referral, care plan, and practice-workflow constraints Praxis IG
Product policy, executable evaluation, customer catalogs, and runtime configuration Implementing system

Ignoring an unsupported rule or unavailable required fact and reporting success is never a valid fallback. Evaluation behavior follows the Billing Core outcome contract.

Transitional compatibility details

The predecessor PraxisBillingRuleSetLibrary and PraxisBillingRuleChargeItemDefinition names remain documented so existing consumers can migrate them without guessing: no runtime rule instances are published. PlanDefinition remains the carrier for forward-directed clinical plans, never executable billing-rule evaluation. Typed modifier rules form a must-understand boundary: RULES_UNAVAILABLE and other unsupported or incomplete states fail closed, although a product may render them as needs-review.

The predecessor BillingCountingScopeQualifier represents variable parameters through windowMultiple, anchorCode, anchorDirection, anchorSection, and sameSelector. Quantity never mints concept identity. Declared required facts are a floor; the fact set derived from a concrete rule is never smaller and may be larger. These semantics now evolve under Billing Core, while the Praxis copy remains frozen for cutover compatibility.