VGR-SE Reimbursement Implementation Guide
0.8.0 - qa
VGR-SE Reimbursement Implementation Guide
0.8.0 - qa
This page is part of the VGR Reimbursement Implementation Guide (v0.8.0: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.
| VGRReimbursement CapabilityStatement for Electronic Health Record (EHR) System |
This CapabilityStatement describes the requirements for an Electronic Health Record (EHR) system acting as a server to expose the necessary FHIR resources for reimbursement processing. |
| VGRReimbursement CapabilityStatement for Reimbursement Application |
This CapabilityStatement describes the requirements for a Reimbursement Application acting as a client to consume the necessary FHIR resources for reimbursement processing. |
These define constraints on FHIR resources for systems conforming to this implementation guide.
| VGRBaseEncounter |
This base profile is to be used when profiling the Encounter resouce in VGR. |
| VGRBasePatient |
This base profile is to be used when profiling the Patient resouce in VGR. This profile is based on the Swedish Base Profile for Patient. |
| VGRReimbursementAccount |
The Account-resource profiled for Healthcare Reimbursement in VGR. The element |
| VGRReimbursementCoverage |
The Coverage-resource profiled for Healthcare Reimbursement in VGR. Coverage represents a Payment Commitment (betalningsf??rbindelse), issued by a Payment Commitment Issuer (utf??rdare av betalningsf??rbindelse). NB: Payor is constrained to 1..1 and must point to the contained instance of VGRPayorOrganizationPlaceholder. This is to handle the fact that the actual Payor organization is not neccessarily known in all Reimbursement use cases. |
| VGRReimbursementEncounter |
The Encounter-resource profiled for Healthcare Reimbursement in VGR. |
These define constraints on FHIR data types for systems conforming to this implementation guide.
| Extension f??r Sarskild Betalarstatus |
Extension to add an element for Sarskild Betalarstatus to the Encounter resource. |
These define sets of codes used by systems conforming to this implementation guide.
| SarskildBetalarstatusVS |
Specifies type of regulation to identify payer. |
| TypeOfCoverageVS |
Specifies what type of coverage this is. |
| UtfardareAvBetalningsforbindelseVS |
Specifies which organization will pay for the healthcare encounter when it is not VGR |
| VGRKVMedicinsktVerksamhetsOmradeVS |
Specifies medical area of activity. |
These define new code systems used by systems conforming to this implementation guide.
| SarskildBetalarstatusCS |
Specifies the type of regulation to be used for identifying the payer for individuals who cannot be identified as registered residents in Sweden at the start of the healthcare encounter. |
| TypeOfCoverageCS |
specifies what type of coverage this is |
| VGRKVLanOchKommunerCS |
This code system is part of VGR:s (originally SCB:s) code system for counties and municipalities, but contains only codes for counties. |
| VGRKVMedicinsktVerksamhetsOmradeCS |
The code system consists of codes and code texts from the Swedish National Board of Health and Welfare's code system for medical areas of activity (MVO), with regional additions to meet the needs for configuring Millennium. Specifies medical area of activity. https://vgrinformatik.se/kodtjanst/kodverk/metadata-och-kodtext/179 |
| VGRKVUtfardareAvBetalningsforbindelseCS |
Codes for organizations other than regions which can pay for a healthcare encounter. |
These define identifier and/or code system identities used by systems conforming to this implementation guide.
| NationelltReservnummerNS |
Swedish national reserve identifier (nationellt reservnummer, NRID) is a unique identification number issued by Inera for individuals who need to be identified in healthcare or administrative systems but do not have a Swedish personal identity number (personnummer) or coordination number (samordningsnummer). |
| PersonnummerNS |
Swedish National identification number system 'personnummer', idenfication number issued to individuals who are registered as residents. |
| SamordningsnummerNS |
Swedish National identification number system 'samordningsnummer', idenfication number issued to individuals who are not registered as residents but still need official ID for a limited time, a k a 'samordningsnummer'. |
| VGRGRIDNS |
Deprecated regional identification system for patients maintained and unique within V??stra G??talandsregionen, a k a 'Gammalt reservnummer'. |
| VGRLRIDNS |
Regional identification system for patients maintained and unique within V??stra G??talandsregionen, a k a 'lokalt reservnummer' (Lokalt reservnummer). |
These define transformations to convert between codes by systems conforming with this implementation guide.
| V??rd- och omsorgsform to ActEncounterCode |
A map from HSA V??rd- och omsorgsform to HL7 v3 Value Set ActEncounterCode |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
| Account for inline usage in Encounter with associated Coverage |
Exemplifies the #inline Account required to connect an Encounter to a Coverage. |
| Coverage agreement with insurance company |
Exemplifies VGRReimbursementCoverage representing financial agreement (betalningsf??rbindelse) with (unidentified) insurance company |
| Encounter with associated Coverage (betalningsf??rbindelse) |
Exemplifies VGRReimbursementEncounter using an #inline Account to connect to a Coverage describing the financial agreement with external payor |
| Encounter with extension for s??rskild betalarstatus |
Examplifies VGRReimbursementEncounter with s??rskild betalarstatus 8802 EU/EES, i.e. patient insured in other EU/EES country or convention. |
| Patient with identifier VGR GRID 19001111A912 |
Exemplifies a VGRBasePatient with identifier of type GRID, i.e. on 'VGR Gammalt reservid' format. |
| Patient with identifier VGR LRID 19810829M071 |
Exemplifies a VGRBasePatient with identifier of type LRID, i.e. on 'VGR Lokalt reservid' format. |
These are resources that are used within this implementation guide that do not fit into one of the other categories.
| Parameters for Terminology selection of SNOMED CT-SE |
This parameter resource is used to specify the system version of SNOMED CT-SE to be used in the terminology service. |