{
  "resourceType": "StructureDefinition",
  "id": "KBV-PR-PTV-Claim",
  "url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_PTV_Claim",
  "version": "1.0.0",
  "name": "KBV_PR_PTV_Claim",
  "status": "draft",
  "date": "2026-05-01",
  "publisher": "Kassenärztliche Bundesvereinigung (KBV)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.kbv.de"
        }
      ]
    }
  ],
  "description": "Das Profil bildet übergreifend die Antragsdaten für eine psychotherapeutische Behandlung ab.",
  "copyright": "Copyright © [2025], Kassenärztliche Bundesvereinigung (KBV). All rights reserved. Im folgenden Profil können Codes aus den Codesystemen Snomed, Loinc oder Ucum enthalten sein, die dem folgenden Urheberrecht unterliegen: This material includes SNOMED Clinical Terms® SNOMED CT® which is used by permission of SNOMED International. All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists. SNOMED and SNOMED CT are registered trademarks of SNOMED International. Implementers of these artefacts must have the appropriate SNOMED CT Affiliate license. This material contains content from Loinc http://loinc.org. Loinc is copyright ©; 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes Loinc Committee and is available at no cost under the license at http://loinc.org/license. Loinc® is a registered United States trademark of Regenstrief Institute, Inc. This product includes all or a portion of the UCUM table, UCUM codes, and UCUM definitions or is derived from it, subject to a license from Regenstrief Institute, Inc. and The UCUM Organization. Your use of the UCUM table, UCUM codes, UCUM definitions also is subject to this license, a copy of which is available at http://unitsofmeasure.org. The current complete UCUM table, UCUM Specification are available for download at http://unitsofmeasure.org. The UCUM table and UCUM codes are copyright ©; 1995-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures UCUM Organization. All rights reserved. THE UCUM TABLE IN ALL FORMATS, UCUM DEFINITIONS, AND SPECIFICATION ARE PROVIDED "AS IS." ANY EXPRESS OR IMPLIED WARRANTIES ARE DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Claim",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Claim",
        "path": "Claim",
        "short": "Eine Zusammenfassung des Antrages auf Psychotherapie",
        "definition": "Die Zusammenfassung des Antrages aus betriebswirtschaflicher Sicht, imt einem Verweis auf den Behandlungsplan (CarePlan)",
        "mustSupport": true
      },
      {
        "id": "Claim.id",
        "path": "Claim.id",
        "mustSupport": true
      },
      {
        "id": "Claim.meta",
        "path": "Claim.meta",
        "mustSupport": true
      },
      {
        "id": "Claim.meta.id",
        "path": "Claim.meta.id",
        "max": "0"
      },
      {
        "id": "Claim.meta.extension",
        "path": "Claim.meta.extension",
        "max": "0"
      },
      {
        "id": "Claim.meta.versionId",
        "path": "Claim.meta.versionId",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.meta.lastUpdated",
        "path": "Claim.meta.lastUpdated",
        "max": "0"
      },
      {
        "id": "Claim.meta.source",
        "path": "Claim.meta.source",
        "max": "0"
      },
      {
        "id": "Claim.meta.profile",
        "path": "Claim.meta.profile",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.meta.profile:PTVProfile",
        "path": "Claim.meta.profile",
        "sliceName": "PTVProfile",
        "min": 1,
        "max": "1",
        "fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_PTV_Claim|1.0",
        "mustSupport": true
      },
      {
        "id": "Claim.meta.security",
        "path": "Claim.meta.security",
        "max": "0"
      },
      {
        "id": "Claim.meta.tag",
        "path": "Claim.meta.tag",
        "max": "0"
      },
      {
        "id": "Claim.implicitRules",
        "path": "Claim.implicitRules",
        "max": "0"
      },
      {
        "id": "Claim.language",
        "path": "Claim.language",
        "max": "0"
      },
      {
        "id": "Claim.contained",
        "path": "Claim.contained",
        "max": "0"
      },
      {
        "id": "Claim.extension:Unfallinformationen",
        "path": "Claim.extension",
        "sliceName": "Unfallinformationen",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Accident|1.3"
            ]
          }
        ],
        "mustSupport": true,
        "isModifier": false
      },
      {
        "id": "Claim.extension:Unfallinformationen.extension",
        "path": "Claim.extension.extension",
        "max": "0"
      },
      {
        "id": "Claim.extension:Unfallinformationen.url",
        "path": "Claim.extension.url",
        "fixedUri": "https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Accident"
      },
      {
        "id": "Claim.modifierExtension",
        "path": "Claim.modifierExtension",
        "max": "0"
      },
      {
        "id": "Claim.identifier",
        "path": "Claim.identifier",
        "max": "0"
      },
      {
        "id": "Claim.status",
        "path": "Claim.status",
        "mustSupport": true
      },
      {
        "id": "Claim.type",
        "path": "Claim.type",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "professional"
            }
          ]
        },
        "mustSupport": true,
        "binding": {
          "strength": "required"
        }
      },
      {
        "id": "Claim.type.id",
        "path": "Claim.type.id",
        "mustSupport": true
      },
      {
        "id": "Claim.type.extension",
        "path": "Claim.type.extension",
        "max": "0"
      },
      {
        "id": "Claim.type.coding",
        "path": "Claim.type.coding",
        "fixedCoding": {
          "userSelected": false
        },
        "mustSupport": true
      },
      {
        "id": "Claim.subType",
        "path": "Claim.subType",
        "max": "0"
      },
      {
        "id": "Claim.use",
        "path": "Claim.use",
        "definition": "Eine Information darüber, ob es sich bei dem Antrag um Folgendes handelt: die Abrechnung bereits erbrachter Produkte und Dienstleistungen; die Beantragung einer Genehmigung und Abrechnung für künftige Leistungen; oder die Beantragung einer unverbindlichen Abrechnung der aufgeführten Produkte und Dienstleistungen, die künftig erbracht werden könnten.",
        "fixedCode": "preauthorization",
        "mustSupport": true
      },
      {
        "id": "Claim.patient",
        "path": "Claim.patient",
        "short": "Der Patient",
        "definition": "Der Patient, der die psychotherapeuthische Behnaldung in Ansprich nehmen soll",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Patient|1.3"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.billablePeriod",
        "path": "Claim.billablePeriod",
        "max": "0"
      },
      {
        "id": "Claim.created",
        "path": "Claim.created",
        "short": "Ausstellungsdatum",
        "definition": "Feld enthält das Datum, an dem das Dokument erstellt worden ist.",
        "mustSupport": true
      },
      {
        "id": "Claim.enterer",
        "path": "Claim.enterer",
        "short": "Verantwortlicher Psychotherapeut",
        "definition": "Der ausgebildete Psychotherapeut, der für die Antragsstellung verantwortlich ist und die Behandlung federführend begleitet.",
        "max": "0"
      },
      {
        "id": "Claim.insurer",
        "path": "Claim.insurer",
        "short": "Versicherung",
        "definition": "Dieser Block enthält allgemeine Informationen zum Kostenträger.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Organization"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.provider",
        "path": "Claim.provider",
        "short": "Praxisinhaber",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Practitioner|1.3",
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_PTV_Psychotherapy_Institution"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.priority",
        "path": "Claim.priority",
        "fixedCodeableConcept": {
          "text": "normal"
        },
        "mustSupport": true
      },
      {
        "id": "Claim.fundsReserve",
        "path": "Claim.fundsReserve",
        "max": "0"
      },
      {
        "id": "Claim.related",
        "path": "Claim.related",
        "max": "0"
      },
      {
        "id": "Claim.prescription",
        "path": "Claim.prescription",
        "max": "0"
      },
      {
        "id": "Claim.originalPrescription",
        "path": "Claim.originalPrescription",
        "max": "0"
      },
      {
        "id": "Claim.payee",
        "path": "Claim.payee",
        "max": "0"
      },
      {
        "id": "Claim.referral",
        "path": "Claim.referral",
        "short": "Verlinkung zum CarePlan",
        "definition": "Im CarePLan wird beschrieben, welche Arten von Psychotherapieleistungen und mit welcher Begründung erbracht werden.",
        "max": "0"
      },
      {
        "id": "Claim.facility",
        "path": "Claim.facility",
        "max": "0"
      },
      {
        "id": "Claim.careTeam",
        "path": "Claim.careTeam",
        "max": "0"
      },
      {
        "id": "Claim.supportingInfo",
        "path": "Claim.supportingInfo",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "Claim.supportingInfo.extension",
        "path": "Claim.supportingInfo.extension",
        "max": "0"
      },
      {
        "id": "Claim.supportingInfo.modifierExtension",
        "path": "Claim.supportingInfo.modifierExtension",
        "max": "0"
      },
      {
        "id": "Claim.supportingInfo.category",
        "path": "Claim.supportingInfo.category",
        "fixedCodeableConcept": {
          "text": "info"
        },
        "mustSupport": false
      },
      {
        "id": "Claim.supportingInfo.code",
        "path": "Claim.supportingInfo.code",
        "max": "0"
      },
      {
        "id": "Claim.supportingInfo.timing[x]",
        "path": "Claim.supportingInfo.timing[x]",
        "max": "0"
      },
      {
        "id": "Claim.supportingInfo.value[x]",
        "path": "Claim.supportingInfo.value[x]",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_PTV_CarePlan"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.supportingInfo.reason",
        "path": "Claim.supportingInfo.reason",
        "max": "0"
      },
      {
        "id": "Claim.diagnosis",
        "path": "Claim.diagnosis",
        "max": "1"
      },
      {
        "id": "Claim.diagnosis.diagnosis[x]",
        "path": "Claim.diagnosis.diagnosis[x]",
        "short": "ICD-10-Diagnosen",
        "definition": "Antragsgebründende Diagnosen, die eine psychotherapeutische Behandlung rechtfertigen würden",
        "type": [
          {
            "code": "CodeableConcept"
          },
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_PTV_Condition_ICD"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.diagnosis.type",
        "path": "Claim.diagnosis.type",
        "max": "0"
      },
      {
        "id": "Claim.diagnosis.onAdmission",
        "path": "Claim.diagnosis.onAdmission",
        "max": "0"
      },
      {
        "id": "Claim.diagnosis.packageCode",
        "path": "Claim.diagnosis.packageCode",
        "max": "0"
      },
      {
        "id": "Claim.procedure",
        "path": "Claim.procedure",
        "max": "0"
      },
      {
        "id": "Claim.insurance",
        "path": "Claim.insurance",
        "mustSupport": true
      },
      {
        "id": "Claim.insurance.extension",
        "path": "Claim.insurance.extension",
        "max": "0"
      },
      {
        "id": "Claim.insurance.modifierExtension",
        "path": "Claim.insurance.modifierExtension",
        "max": "0"
      },
      {
        "id": "Claim.insurance.identifier.extension",
        "path": "Claim.insurance.identifier.extension",
        "max": "0"
      },
      {
        "id": "Claim.insurance.identifier.type",
        "path": "Claim.insurance.identifier.type",
        "max": "0"
      },
      {
        "id": "Claim.insurance.coverage",
        "path": "Claim.insurance.coverage",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage|1.3"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.insurance.coverage.extension",
        "path": "Claim.insurance.coverage.extension",
        "max": "0"
      },
      {
        "id": "Claim.insurance.coverage.type",
        "path": "Claim.insurance.coverage.type",
        "max": "0"
      },
      {
        "id": "Claim.insurance.businessArrangement",
        "path": "Claim.insurance.businessArrangement",
        "max": "0"
      },
      {
        "id": "Claim.insurance.preAuthRef",
        "path": "Claim.insurance.preAuthRef",
        "max": "0"
      },
      {
        "id": "Claim.insurance.claimResponse",
        "path": "Claim.insurance.claimResponse",
        "max": "0"
      },
      {
        "id": "Claim.accident",
        "path": "Claim.accident",
        "max": "0"
      },
      {
        "id": "Claim.item",
        "path": "Claim.item",
        "mustSupport": true
      },
      {
        "id": "Claim.item.sequence",
        "path": "Claim.item.sequence",
        "mustSupport": true
      },
      {
        "id": "Claim.item.careTeamSequence",
        "path": "Claim.item.careTeamSequence",
        "max": "0"
      },
      {
        "id": "Claim.item.diagnosisSequence",
        "path": "Claim.item.diagnosisSequence",
        "max": "0"
      },
      {
        "id": "Claim.item.procedureSequence",
        "path": "Claim.item.procedureSequence",
        "max": "0"
      },
      {
        "id": "Claim.item.informationSequence",
        "path": "Claim.item.informationSequence",
        "max": "0"
      },
      {
        "id": "Claim.item.revenue",
        "path": "Claim.item.revenue",
        "max": "0"
      },
      {
        "id": "Claim.item.category",
        "path": "Claim.item.category",
        "max": "0"
      },
      {
        "id": "Claim.item.productOrService",
        "path": "Claim.item.productOrService",
        "short": "Therapieeinheiten für Patienten oder Bezugsperson",
        "definition": "Gibt an für wen die Therapieeinheiten beantragt werden. Für den Patienten oder die Bezugsperson.",
        "comment": ".",
        "requirements": ".",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "description": "Therapieeinheiten für Patienten oder Bezugsperson"
        }
      },
      {
        "id": "Claim.item.productOrService.coding.system",
        "path": "Claim.item.productOrService.coding.system",
        "fixedUri": "https://fhir.kbv.de/CodeSystem/KBV_CS_PTV_Therapy_Units"
      },
      {
        "id": "Claim.item.productOrService.coding.version",
        "path": "Claim.item.productOrService.coding.version",
        "max": "0"
      },
      {
        "id": "Claim.item.productOrService.coding.userSelected",
        "path": "Claim.item.productOrService.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Claim.item.modifier",
        "path": "Claim.item.modifier",
        "max": "0"
      },
      {
        "id": "Claim.item.programCode",
        "path": "Claim.item.programCode",
        "max": "0"
      },
      {
        "id": "Claim.item.serviced[x]",
        "path": "Claim.item.serviced[x]",
        "max": "0"
      },
      {
        "id": "Claim.item.location[x]",
        "path": "Claim.item.location[x]",
        "max": "0"
      },
      {
        "id": "Claim.item.quantity",
        "path": "Claim.item.quantity",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.item.quantity.extension",
        "path": "Claim.item.quantity.extension",
        "max": "0"
      },
      {
        "id": "Claim.item.quantity.system",
        "path": "Claim.item.quantity.system",
        "max": "0"
      },
      {
        "id": "Claim.item.quantity.code",
        "path": "Claim.item.quantity.code",
        "max": "0"
      },
      {
        "id": "Claim.item.unitPrice",
        "path": "Claim.item.unitPrice",
        "max": "0"
      },
      {
        "id": "Claim.item.factor",
        "path": "Claim.item.factor",
        "max": "0"
      },
      {
        "id": "Claim.item.net",
        "path": "Claim.item.net",
        "max": "0"
      },
      {
        "id": "Claim.item.udi",
        "path": "Claim.item.udi",
        "max": "0"
      },
      {
        "id": "Claim.item.bodySite",
        "path": "Claim.item.bodySite",
        "max": "0"
      },
      {
        "id": "Claim.item.subSite",
        "path": "Claim.item.subSite",
        "max": "0"
      },
      {
        "id": "Claim.item.encounter",
        "path": "Claim.item.encounter",
        "max": "0"
      },
      {
        "id": "Claim.item.detail",
        "path": "Claim.item.detail",
        "max": "0"
      },
      {
        "id": "Claim.total",
        "path": "Claim.total",
        "max": "0"
      }
    ]
  }
}