Hướng dẫn triển khai FHIR cốt lõi Việt Nam — VN Core FHIR Implementation Guide - Draft for Community Review (v0.10.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Hồ sơ tài nguyên: Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile

Profile Claim cho Việt Nam. Dùng cho yêu cầu thanh toán chi phí khám chữa bệnh BHYT. Mapping từ chuẩn dữ liệu đầu ra phục vụ BHXH hiện hành (QĐ 130/QĐ-BYT → QĐ 4750/QĐ-BYT → QĐ 3176/QĐ-BYT). Bảng kê chi phí theo QĐ 697/QĐ-BYT (19/3/2026) — 12 danh mục, 14 mã. Căn cứ:

• QĐ 130/QĐ-BYT (2023) — Chuẩn dữ liệu đầu ra phục vụ BHXH
• QĐ 4750/QĐ-BYT (2023) — Sửa đổi QĐ 130/QĐ-BYT
• QĐ 3176/QĐ-BYT (29/10/2024), đọc cùng QĐ 1931/QĐ-BYT (29/06/2026, áp dụng từ 01/07/2026) — chuẩn dữ liệu đầu ra KCB hiện hành; QĐ 1931/QĐ-BYT sửa MUC_HUONG và SO_DANG_KY
• QĐ 697/QĐ-BYT (19/3/2026) — Mẫu bảng kê chi phí KCB hiện hành; QĐ 6556/QĐ-BYT đã hết hiệu lực sau giai đoạn chuyển tiếp kết thúc 01/07/2026
• NĐ 188/2025/NĐ-CP — ban hành 01/07/2025, hiệu lực 15/08/2025 — Điều 13 về giá trị sử dụng thẻ, Điều 21 về thay đổi mức hưởng trong đợt điều trị và Điều 50 khoản 4 về trường hợp thẻ hết hạn khi đang điều trị nội trú; không phải căn cứ trực tiếp cho cờ FHIR insurance.focal
• NĐ 90/2026/NĐ-CP (ban hành 30/03/2026, hiệu lực 15/05/2026 — đang áp dụng) — Xử phạt vi phạm hành chính trong lĩnh vực y tế khi hồ sơ/chứng từ BHYT sai quy định
• Luật BHYT 2008 sửa đổi 2014
• Luật 25/2008/QH12 ngày 14/11/2008 về BHYT; Luật 51/2024/QH15 ngày 27/11/2024 sửa đổi Luật BHYT Nguồn TVPL: NĐ 188/2025/NĐ-CP https://thuvienphapluat.vn/van-ban/Bao-hiem/Nghi-dinh-188-2025-ND-CP-huong-dan-Luat-Bao-hiem-y-te-641049.aspx; NĐ 90/2026/NĐ-CP https://thuvienphapluat.vn/van-ban/Vi-pham-hanh-chinh/Nghi-dinh-sua-doi-Nghi-dinh-117-2020-ND-CP-xu-phat-vi-pham-hanh-chinh-trong-linh-vuc-y-te-639959.aspx

Usages:

• Use this Profile: Bundle hồ sơ thanh toán BHYT — VN Core BHYT Submission Bundle
• Refer to this Profile: Kết quả giải quyết BHYT VN Core — VN Core ClaimResponse Profile, Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile and Đối soát và phân bổ khoản thanh toán BHYT — VN Core BHYT Payment Reconciliation
• Examples for this Profile: Claim/ExampleClaimBHYT, Claim/ExampleClaimDiagnosisSnomedOnly, Claim/ExampleClaimHealthCheckupBHYT, Claim/ExampleClaimLineAllocationForeignCurrency... Show 9 more, Claim/ExampleClaimLineAllocationNegativeAmount, Claim/ExampleClaimMALKWithoutAssigner, Claim/ExampleClaimMultiService, Claim/ExampleClaimOtherFundForeignCurrency, Claim/ExampleClaimOutpatient, Claim/ExampleClaimPostServiceWithoutItem, Claim/ExampleClaimProcedureWithoutICD9CM, Claim/ExampleClaimReissuedCard and Claim/ExampleClaimSelfPay
• CapabilityStatements using this Profile: VN Core BHYT Gateway Client CapabilityStatement, VN Core BHYT Gateway Server CapabilityStatement and VN Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

Các dạng xem hình thức của nội dung hồ sơ

Mô tả profile, differential, snapshot và các biểu diễn liên quan.

• Bảng phần tử chính
• Bảng Differential
• Bảng Snapshot
• Nghĩa vụ hỗ trợ
• Thống kê/Tham chiếu
• Tất cả

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: vn-claim-ma-lk-issuer-scoped, vn-claim-single-focal-insurance, vn-claim-diagnosis-has-icd10, vn-claim-procedure-has-icd9cm, vn-claim-post-service-has-item
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:costSummary	SO	0..1	(Complex)	Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
extension:paymentPeriod		0..1	(Complex)	Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod	SO	0..1	CodeableConcept	Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SO	1..*	Identifier	Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
identifier:MALK	SO	1..1	Identifier	Mã liên kết hồ sơ (MA_LK) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA_LK
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value	SΣ	1..1	string	Giá trị MA_LK Example General: 123456
status	?!SOΣ	1..1	code	Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type	SOΣ	1..1	CodeableConcept	Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
subType	SO	0..1	CodeableConcept	Mã đối tượng đến KCB (MA_DOITUONG_KCB theo QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	SOΣ	1..1	code	Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Bệnh nhân (XML 3176: MA_BN) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
created	SOΣ	1..1	dateTime	Ngày tạo yêu cầu Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
insurer	SOΣ	0..1	Reference(Organization)	Cơ quan BHXH thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
provider	SOΣ	1..1	Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile)	Cơ sở KCB thực hiện (XML 3176: MA_CSKCB) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
priority	Σ	1..1	CodeableConcept	Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
related		0..*	BackboneElement	Quan hệ Claim tuỳ chọn ngoài cam kết hỗ trợ tối thiểu — Optional Claim relationship outside the minimum support contract
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		1..1	Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile)	Claim đích của quan hệ tuỳ chọn — Target Claim of the optional relationship
relationship		1..1	CodeableConcept	Loại quan hệ FHIR: prior hoặc associated — FHIR relationship type: prior or associated Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
diagnosis	SO	1..*	BackboneElement	Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH_CHINH, MA_BENH_KT) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
Slices for diagnosis[x]		1..1		Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
diagnosis[x]:diagnosisCodeableConcept	S	0..1	CodeableConcept	Mã bệnh ICD-10 VN (edition 2026 — TT 06/2026/TT-BYT + QĐ 1849/QĐ-BYT; QĐ 4469/QĐ-BYT chỉ là provenance dữ liệu cũ) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type	S	0..*	CodeableConcept	Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
procedure		0..*	BackboneElement	Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT_QT)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
Slices for procedure[x]		1..1		Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance	SOΣ	1..*	BackboneElement	Thông tin BHYT (XML 3176: MA_THE) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	SΣ	1..1	boolean	Coverage to be used for adjudication
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT (Coverage)
accident		0..1	BackboneElement	Thông tin tai nạn thương tích
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	Loại tai nạn (MA_TAI_NAN theo QĐ 3176/QĐ-BYT, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item	SO	0..*	BackboneElement	Chi tiết chi phí — bắt buộc khi use=claim; tuỳ chọn cho preauthorization/predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:department	S	0..1	CodeableConcept	Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup		0..1	CodeableConcept	Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope		0..1	CodeableConcept	Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo	SC	0..1	(Complex)	BHYT: phạm vi, tỷ lệ TT, mức hưởng, trần thanh toán (T_TRANTT) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info Constraints: vn-insurance-cost-ratio-and-lexical
extension:linePaymentAllocation	C	0..1	(Complex)	Bốn nguồn thanh toán của dòng — quỹ BHYT, người bệnh cùng trả, nguồn khác, người bệnh tự trả URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation Constraints: vn-line-payment-allocation-vnd, vn-line-payment-allocation-nonnegative
extension:otherFundBreakdown	C	0..1	(Complex)	Chi tiết nguồn khác chi trả theo dòng: NSNN/VTNN/VTTN/CL (T_NGUONKHAC_*) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown Constraints: vn-other-fund-breakdown-money-vnd-value
extension:anesthesiaMethod		0..1	CodeableConcept	Phương pháp vô cảm dòng DVKT (PP_VO_CAM) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method Binding: Phương pháp vô cảm — Vietnam Anesthesia Method ValueSet (required)
extension:paymentSource	S	0..1	CodeableConcept	Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit		0..1	boolean	Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo	S	0..1	string	Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod		0..1	CodeableConcept	Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method Binding: Phương pháp chế biến vị thuốc cổ truyền — VN Traditional Medicine Processing Method ValueSet (extensible)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Item instance identifier
category	S	0..1	CodeableConcept	Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697/QĐ-BYT) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService	S	1..1	CodeableConcept	Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
quantity	S	0..1	SimpleQuantity(4.0.1)	Số lượng
unitPrice	S	0..1	Money	Đơn giá
net	S	0..1	Money	Thành tiền
total	SO	0..1	Money	Tổng chi phí (XML 3176: T_TONGCHI) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.identifier:MALK.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier:MALK.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	extensible	Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet	📦0.10.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	Base	extensible	Mã chẩn đoán — VN Core Condition Code ValueSet	📦0.10.0	This IG
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	extensible	Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet	📦0.10.0	This IG
Claim.accident.type	Base	extensible	Mã tai nạn thương tích — Vietnam Accident Type ValueSet	📦0.10.0	This IG
Claim.item.category	Base	extensible	Danh mục chi phí KCB — Vietnam Cost Category ValueSet	📦0.10.0	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
vn-claim-diagnosis-has-icd10	error	Claim	Mỗi Claim.diagnosis phải có ít nhất một coding thuộc ICD-10 VN — MA_BENH_CHINH và MA_BENH_KT của QĐ 3176/QĐ-BYT là mã ICD-10; mã SNOMED/YHCT chỉ bổ sung, không thay thế.	diagnosis.all(diagnosis.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd10-cs').exists())
vn-claim-ma-lk-issuer-scoped	error	Claim	Mã liên kết MA_LK ghi dưới URI dùng tạm cấp quốc gia (http://fhir.hl7.org.vn/core/sid/ma-lk) phải kèm `assigner` chỉ rõ cơ sở cấp mã; khuyến nghị chính là mỗi cơ sở công bố URI riêng. A MA_LK record-link code recorded under the shared national placeholder URI SHALL name its assigning facility; per-facility namespace URIs are preferred.	identifier.where(system = 'http://fhir.hl7.org.vn/core/sid/ma-lk').all(assigner.exists())
vn-claim-post-service-has-item	error	Claim	Claim hậu dịch vụ (use=claim) phải có ít nhất một dòng chi phí; preauthorization/predetermination không bị QĐ 697/QĐ-BYT ép cardinality này	use != 'claim' or item.exists()
vn-claim-procedure-has-icd9cm	warning	Claim	Khi Claim.procedure có mặt, mỗi mục phải có ít nhất một coding thuộc ICD-9-CM VN (QĐ 387/QĐ-BYT); mã DVKT/SNOMED chỉ bổ sung.	procedure.all(procedure.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd9-cm-cs').exists())
vn-claim-single-focal-insurance	error	Claim	Quy tắc tuân thủ VN Core: mỗi Claim phải có đúng một insurance.focal=true theo semantics coordination-of-benefits của FHIR. Đây không phải cardinality do NĐ 188/2025/NĐ-CP hoặc QĐ 697/QĐ-BYT quy định; phân đoạn thẻ và mức hưởng khi kết xuất phải được xử lý riêng theo văn bản BHYT hiện hành.	insurance.where(focal = true).count() = 1
vn-insurance-cost-ratio-and-lexical	error	Claim.item.extension:insuranceCostInfo	Các tỷ lệ phải nằm trong khoảng 0-100; chuỗi lexical gốc nếu có phải đi kèm paymentRatio; khoảng hiệu lực trần nếu có phải đi kèm paymentCeiling. Percentage values SHALL be within 0-100; a source lexical string SHALL accompany paymentRatio; a ceiling period SHALL accompany paymentCeiling.	extension.where(url = 'paymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'servicePaymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'benefitLevel').value.ofType(decimal).all($this >= 0 and $this <= 100) and (extension.where(url = 'paymentRatioSourceLexical').empty() or extension.where(url = 'paymentRatio').exists()) and (extension.where(url = 'paymentCeilingPeriod').empty() or extension.where(url = 'paymentCeiling').exists())
vn-line-payment-allocation-nonnegative	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải lớn hơn hoặc bằng 0. Every allocated Money value SHALL be greater than or equal to zero.	extension.value.ofType(Money).all(value >= 0)
vn-line-payment-allocation-vnd	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải dùng VND. Every allocated Money value SHALL use VND.	extension.value.ofType(Money).all(currency = 'VND')
vn-other-fund-breakdown-money-vnd-value	error	Claim.item.extension:otherFundBreakdown	Mọi Money con phải có value và dùng VND. Every child Money SHALL have a value and use VND.	extension.value.ofType(Money).all(value.exists() and currency = 'VND')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: vn-claim-ma-lk-issuer-scoped, vn-claim-single-focal-insurance, vn-claim-diagnosis-has-icd10, vn-claim-procedure-has-icd9cm, vn-claim-post-service-has-item
meta		0..1	Meta	Metadata about the resource
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:costSummary	SO	0..1	(Complex)	Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
extension:paymentPeriod		0..1	(Complex)	Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod	SO	0..1	CodeableConcept	Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Slices for identifier	SO	1..*	Identifier	Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
identifier:MALK	SO	1..1	Identifier	Mã liên kết hồ sơ (MA_LK) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type		0..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA_LK
system		1..1	uri	The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value	S	1..1	string	Giá trị MA_LK
status	SO	1..1	code	Trạng thái yêu cầu thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type	SO	1..1	CodeableConcept	Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
subType	SO	0..1	CodeableConcept	Mã đối tượng đến KCB (MA_DOITUONG_KCB theo QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	SO	1..1	code	Mục đích: claim (thanh toán) | preauthorization | predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
patient	SO	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Bệnh nhân (XML 3176: MA_BN) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
created	SO	1..1	dateTime	Ngày tạo yêu cầu Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
insurer	SO	0..1	Reference(Organization)	Cơ quan BHXH thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
provider	SO	1..1	Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile)	Cơ sở KCB thực hiện (XML 3176: MA_CSKCB) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
priority		1..1	CodeableConcept	Mức ưu tiên xử lý
related		0..*	BackboneElement	Quan hệ Claim tuỳ chọn ngoài cam kết hỗ trợ tối thiểu — Optional Claim relationship outside the minimum support contract
claim		1..1	Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile)	Claim đích của quan hệ tuỳ chọn — Target Claim of the optional relationship
relationship		1..1	CodeableConcept	Loại quan hệ FHIR: prior hoặc associated — FHIR relationship type: prior or associated
diagnosis	SO	1..*	BackboneElement	Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH_CHINH, MA_BENH_KT) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
sequence	S	1..1	positiveInt	Diagnosis instance identifier
Slices for diagnosis[x]		1..1	CodeableConcept, Reference(Condition)	Nature of illness or problem Slice: Unordered, Open by type:$this
diagnosis[x]:diagnosisCodeableConcept	S	0..1	CodeableConcept	Mã bệnh ICD-10 VN (edition 2026 — TT 06/2026/TT-BYT + QĐ 1849/QĐ-BYT; QĐ 4469/QĐ-BYT chỉ là provenance dữ liệu cũ) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type	S	0..*	CodeableConcept	Loại chẩn đoán (chính/phụ)
procedure		0..*	BackboneElement	Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT_QT)
Slices for procedure[x]		1..1	CodeableConcept, Reference(Procedure)	Specific clinical procedure Slice: Unordered, Open by type:$this
procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance	SO	1..*	BackboneElement	Thông tin BHYT (XML 3176: MA_THE) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
focal	S	1..1	boolean	Coverage to be used for adjudication
coverage	S	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT (Coverage)
accident		0..1	BackboneElement	Thông tin tai nạn thương tích
type		0..1	CodeableConcept	Loại tai nạn (MA_TAI_NAN theo QĐ 3176/QĐ-BYT, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item	SO	0..*	BackboneElement	Chi tiết chi phí — bắt buộc khi use=claim; tuỳ chọn cho preauthorization/predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:department	S	0..1	CodeableConcept	Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup		0..1	CodeableConcept	Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope		0..1	CodeableConcept	Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo	S	0..1	(Complex)	BHYT: phạm vi, tỷ lệ TT, mức hưởng, trần thanh toán (T_TRANTT) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:linePaymentAllocation		0..1	(Complex)	Bốn nguồn thanh toán của dòng — quỹ BHYT, người bệnh cùng trả, nguồn khác, người bệnh tự trả URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation
extension:otherFundBreakdown		0..1	(Complex)	Chi tiết nguồn khác chi trả theo dòng: NSNN/VTNN/VTTN/CL (T_NGUONKHAC_*) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown
extension:anesthesiaMethod		0..1	CodeableConcept	Phương pháp vô cảm dòng DVKT (PP_VO_CAM) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method Binding: Phương pháp vô cảm — Vietnam Anesthesia Method ValueSet (required)
extension:paymentSource	S	0..1	CodeableConcept	Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit		0..1	boolean	Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo	S	0..1	string	Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod		0..1	CodeableConcept	Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method Binding: Phương pháp chế biến vị thuốc cổ truyền — VN Traditional Medicine Processing Method ValueSet (extensible)
sequence	S	1..1	positiveInt	Item instance identifier
category	S	0..1	CodeableConcept	Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697/QĐ-BYT) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService	S	1..1	CodeableConcept	Mã dịch vụ/thuốc/TBYT
quantity	S	0..1	SimpleQuantity(4.0.1)	Số lượng
unitPrice	S	0..1	Money	Đơn giá
net	S	0..1	Money	Thành tiền
total	SO	0..1	Money	Tổng chi phí (XML 3176: T_TONGCHI) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.subType	Base	extensible	Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet	📦0.10.0	This IG
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	Base	extensible	Mã chẩn đoán — VN Core Condition Code ValueSet	📦0.10.0	This IG
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	extensible	Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet	📦0.10.0	This IG
Claim.accident.type	Base	extensible	Mã tai nạn thương tích — Vietnam Accident Type ValueSet	📦0.10.0	This IG
Claim.item.category	Base	extensible	Danh mục chi phí KCB — Vietnam Cost Category ValueSet	📦0.10.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
vn-claim-diagnosis-has-icd10	error	Claim	Mỗi Claim.diagnosis phải có ít nhất một coding thuộc ICD-10 VN — MA_BENH_CHINH và MA_BENH_KT của QĐ 3176/QĐ-BYT là mã ICD-10; mã SNOMED/YHCT chỉ bổ sung, không thay thế.	diagnosis.all(diagnosis.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd10-cs').exists())
vn-claim-ma-lk-issuer-scoped	error	Claim	Mã liên kết MA_LK ghi dưới URI dùng tạm cấp quốc gia (http://fhir.hl7.org.vn/core/sid/ma-lk) phải kèm `assigner` chỉ rõ cơ sở cấp mã; khuyến nghị chính là mỗi cơ sở công bố URI riêng. A MA_LK record-link code recorded under the shared national placeholder URI SHALL name its assigning facility; per-facility namespace URIs are preferred.	identifier.where(system = 'http://fhir.hl7.org.vn/core/sid/ma-lk').all(assigner.exists())
vn-claim-post-service-has-item	error	Claim	Claim hậu dịch vụ (use=claim) phải có ít nhất một dòng chi phí; preauthorization/predetermination không bị QĐ 697/QĐ-BYT ép cardinality này	use != 'claim' or item.exists()
vn-claim-procedure-has-icd9cm	warning	Claim	Khi Claim.procedure có mặt, mỗi mục phải có ít nhất một coding thuộc ICD-9-CM VN (QĐ 387/QĐ-BYT); mã DVKT/SNOMED chỉ bổ sung.	procedure.all(procedure.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd9-cm-cs').exists())
vn-claim-single-focal-insurance	error	Claim	Quy tắc tuân thủ VN Core: mỗi Claim phải có đúng một insurance.focal=true theo semantics coordination-of-benefits của FHIR. Đây không phải cardinality do NĐ 188/2025/NĐ-CP hoặc QĐ 697/QĐ-BYT quy định; phân đoạn thẻ và mức hưởng khi kết xuất phải được xử lý riêng theo văn bản BHYT hiện hành.	insurance.where(focal = true).count() = 1

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: vn-claim-ma-lk-issuer-scoped, vn-claim-single-focal-insurance, vn-claim-diagnosis-has-icd10, vn-claim-procedure-has-icd9cm, vn-claim-post-service-has-item
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:costSummary	SO	0..1	(Complex)	Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
extension:paymentPeriod		0..1	(Complex)	Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod	SO	0..1	CodeableConcept	Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SO	1..*	Identifier	Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
identifier:MALK	SO	1..1	Identifier	Mã liên kết hồ sơ (MA_LK) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA_LK
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value	SΣ	1..1	string	Giá trị MA_LK Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SOΣ	1..1	code	Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type	SOΣ	1..1	CodeableConcept	Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
subType	SO	0..1	CodeableConcept	Mã đối tượng đến KCB (MA_DOITUONG_KCB theo QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	SOΣ	1..1	code	Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Bệnh nhân (XML 3176: MA_BN) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	SOΣ	1..1	dateTime	Ngày tạo yêu cầu Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	SOΣ	0..1	Reference(Organization)	Cơ quan BHXH thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
provider	SOΣ	1..1	Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile)	Cơ sở KCB thực hiện (XML 3176: MA_CSKCB) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
priority	Σ	1..1	CodeableConcept	Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Quan hệ Claim tuỳ chọn ngoài cam kết hỗ trợ tối thiểu — Optional Claim relationship outside the minimum support contract
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		1..1	Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile)	Claim đích của quan hệ tuỳ chọn — Target Claim of the optional relationship
relationship		1..1	CodeableConcept	Loại quan hệ FHIR: prior hoặc associated — FHIR relationship type: prior or associated Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment referral
facility		0..1	Reference(Location)	Servicing facility
careTeam		0..*	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis	SO	1..*	BackboneElement	Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH_CHINH, MA_BENH_KT) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
Slices for diagnosis[x]		1..1		Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
diagnosis[x]:diagnosisCodeableConcept	S	0..1	CodeableConcept	Mã bệnh ICD-10 VN (edition 2026 — TT 06/2026/TT-BYT + QĐ 1849/QĐ-BYT; QĐ 4469/QĐ-BYT chỉ là provenance dữ liệu cũ) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type	S	0..*	CodeableConcept	Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT_QT)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
Slices for procedure[x]		1..1		Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
udi		0..*	Reference(Device)	Unique device identifier
insurance	SOΣ	1..*	BackboneElement	Thông tin BHYT (XML 3176: MA_THE) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	SΣ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT (Coverage)
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident		0..1	BackboneElement	Thông tin tai nạn thương tích
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	Loại tai nạn (MA_TAI_NAN theo QĐ 3176/QĐ-BYT, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item	SO	0..*	BackboneElement	Chi tiết chi phí — bắt buộc khi use=claim; tuỳ chọn cho preauthorization/predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:department	S	0..1	CodeableConcept	Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup		0..1	CodeableConcept	Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope		0..1	CodeableConcept	Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo	SC	0..1	(Complex)	BHYT: phạm vi, tỷ lệ TT, mức hưởng, trần thanh toán (T_TRANTT) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info Constraints: vn-insurance-cost-ratio-and-lexical
extension:linePaymentAllocation	C	0..1	(Complex)	Bốn nguồn thanh toán của dòng — quỹ BHYT, người bệnh cùng trả, nguồn khác, người bệnh tự trả URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation Constraints: vn-line-payment-allocation-vnd, vn-line-payment-allocation-nonnegative
extension:otherFundBreakdown	C	0..1	(Complex)	Chi tiết nguồn khác chi trả theo dòng: NSNN/VTNN/VTTN/CL (T_NGUONKHAC_*) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown Constraints: vn-other-fund-breakdown-money-vnd-value
extension:anesthesiaMethod		0..1	CodeableConcept	Phương pháp vô cảm dòng DVKT (PP_VO_CAM) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method Binding: Phương pháp vô cảm — Vietnam Anesthesia Method ValueSet (required)
extension:paymentSource	S	0..1	CodeableConcept	Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit		0..1	boolean	Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo	S	0..1	string	Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod		0..1	CodeableConcept	Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method Binding: Phương pháp chế biến vị thuốc cổ truyền — VN Traditional Medicine Processing Method ValueSet (extensible)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category	S	0..1	CodeableConcept	Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697/QĐ-BYT) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService	S	1..1	CodeableConcept	Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	SimpleQuantity(4.0.1)	Số lượng
unitPrice	S	0..1	Money	Đơn giá
factor		0..1	decimal	Price scaling factor
net	S	0..1	Money	Thành tiền
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
subDetail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total	SO	0..1	Money	Tổng chi phí (XML 3176: T_TONGCHI) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier:MALK.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier:MALK.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	extensible	Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet	📦0.10.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	Base	extensible	Mã chẩn đoán — VN Core Condition Code ValueSet	📦0.10.0	This IG
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	extensible	Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet	📦0.10.0	This IG
Claim.accident.type	Base	extensible	Mã tai nạn thương tích — Vietnam Accident Type ValueSet	📦0.10.0	This IG
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	extensible	Danh mục chi phí KCB — Vietnam Cost Category ValueSet	📦0.10.0	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
vn-claim-diagnosis-has-icd10	error	Claim	Mỗi Claim.diagnosis phải có ít nhất một coding thuộc ICD-10 VN — MA_BENH_CHINH và MA_BENH_KT của QĐ 3176/QĐ-BYT là mã ICD-10; mã SNOMED/YHCT chỉ bổ sung, không thay thế.	diagnosis.all(diagnosis.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd10-cs').exists())
vn-claim-ma-lk-issuer-scoped	error	Claim	Mã liên kết MA_LK ghi dưới URI dùng tạm cấp quốc gia (http://fhir.hl7.org.vn/core/sid/ma-lk) phải kèm `assigner` chỉ rõ cơ sở cấp mã; khuyến nghị chính là mỗi cơ sở công bố URI riêng. A MA_LK record-link code recorded under the shared national placeholder URI SHALL name its assigning facility; per-facility namespace URIs are preferred.	identifier.where(system = 'http://fhir.hl7.org.vn/core/sid/ma-lk').all(assigner.exists())
vn-claim-post-service-has-item	error	Claim	Claim hậu dịch vụ (use=claim) phải có ít nhất một dòng chi phí; preauthorization/predetermination không bị QĐ 697/QĐ-BYT ép cardinality này	use != 'claim' or item.exists()
vn-claim-procedure-has-icd9cm	warning	Claim	Khi Claim.procedure có mặt, mỗi mục phải có ít nhất một coding thuộc ICD-9-CM VN (QĐ 387/QĐ-BYT); mã DVKT/SNOMED chỉ bổ sung.	procedure.all(procedure.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd9-cm-cs').exists())
vn-claim-single-focal-insurance	error	Claim	Quy tắc tuân thủ VN Core: mỗi Claim phải có đúng một insurance.focal=true theo semantics coordination-of-benefits của FHIR. Đây không phải cardinality do NĐ 188/2025/NĐ-CP hoặc QĐ 697/QĐ-BYT quy định; phân đoạn thẻ và mức hưởng khi kết xuất phải được xử lý riêng theo văn bản BHYT hiện hành.	insurance.where(focal = true).count() = 1
vn-insurance-cost-ratio-and-lexical	error	Claim.item.extension:insuranceCostInfo	Các tỷ lệ phải nằm trong khoảng 0-100; chuỗi lexical gốc nếu có phải đi kèm paymentRatio; khoảng hiệu lực trần nếu có phải đi kèm paymentCeiling. Percentage values SHALL be within 0-100; a source lexical string SHALL accompany paymentRatio; a ceiling period SHALL accompany paymentCeiling.	extension.where(url = 'paymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'servicePaymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'benefitLevel').value.ofType(decimal).all($this >= 0 and $this <= 100) and (extension.where(url = 'paymentRatioSourceLexical').empty() or extension.where(url = 'paymentRatio').exists()) and (extension.where(url = 'paymentCeilingPeriod').empty() or extension.where(url = 'paymentCeiling').exists())
vn-line-payment-allocation-nonnegative	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải lớn hơn hoặc bằng 0. Every allocated Money value SHALL be greater than or equal to zero.	extension.value.ofType(Money).all(value >= 0)
vn-line-payment-allocation-vnd	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải dùng VND. Every allocated Money value SHALL use VND.	extension.value.ofType(Money).all(currency = 'VND')
vn-other-fund-breakdown-money-vnd-value	error	Claim.item.extension:otherFundBreakdown	Mọi Money con phải có value và dùng VND. Every child Money SHALL have a value and use VND.	extension.value.ofType(Money).all(value.exists() and currency = 'VND')

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Summary

Mandatory: 5 elements(2 nested mandatory elements)
Must-Support: 32 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

• Bệnh nhân VN Core — VN Core Patient Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)
• Cơ sở y tế VN Core — VN Core Organization Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization)
• Nhân viên y tế VN Core — VN Core Practitioner Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner)
• Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role)
• Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim)
• Thẻ BHYT VN Core — VN Core Coverage Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)

Extensions

This structure refers to these extensions:

• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the values of Claim.identifier
• The element 1 is sliced based on the values of Claim.diagnosis.diagnosis[x]
• The element 1 is sliced based on the values of Claim.procedure.procedure[x]

Dạng xem phần tử chính

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: vn-claim-ma-lk-issuer-scoped, vn-claim-single-focal-insurance, vn-claim-diagnosis-has-icd10, vn-claim-procedure-has-icd9cm, vn-claim-post-service-has-item
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:costSummary	SO	0..1	(Complex)	Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
extension:paymentPeriod		0..1	(Complex)	Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod	SO	0..1	CodeableConcept	Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SO	1..*	Identifier	Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
identifier:MALK	SO	1..1	Identifier	Mã liên kết hồ sơ (MA_LK) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA_LK
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value	SΣ	1..1	string	Giá trị MA_LK Example General: 123456
status	?!SOΣ	1..1	code	Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type	SOΣ	1..1	CodeableConcept	Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
subType	SO	0..1	CodeableConcept	Mã đối tượng đến KCB (MA_DOITUONG_KCB theo QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	SOΣ	1..1	code	Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Bệnh nhân (XML 3176: MA_BN) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
created	SOΣ	1..1	dateTime	Ngày tạo yêu cầu Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
insurer	SOΣ	0..1	Reference(Organization)	Cơ quan BHXH thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
provider	SOΣ	1..1	Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile)	Cơ sở KCB thực hiện (XML 3176: MA_CSKCB) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
priority	Σ	1..1	CodeableConcept	Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
related		0..*	BackboneElement	Quan hệ Claim tuỳ chọn ngoài cam kết hỗ trợ tối thiểu — Optional Claim relationship outside the minimum support contract
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		1..1	Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile)	Claim đích của quan hệ tuỳ chọn — Target Claim of the optional relationship
relationship		1..1	CodeableConcept	Loại quan hệ FHIR: prior hoặc associated — FHIR relationship type: prior or associated Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
diagnosis	SO	1..*	BackboneElement	Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH_CHINH, MA_BENH_KT) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
Slices for diagnosis[x]		1..1		Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
diagnosis[x]:diagnosisCodeableConcept	S	0..1	CodeableConcept	Mã bệnh ICD-10 VN (edition 2026 — TT 06/2026/TT-BYT + QĐ 1849/QĐ-BYT; QĐ 4469/QĐ-BYT chỉ là provenance dữ liệu cũ) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type	S	0..*	CodeableConcept	Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
procedure		0..*	BackboneElement	Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT_QT)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
Slices for procedure[x]		1..1		Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance	SOΣ	1..*	BackboneElement	Thông tin BHYT (XML 3176: MA_THE) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	SΣ	1..1	boolean	Coverage to be used for adjudication
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT (Coverage)
accident		0..1	BackboneElement	Thông tin tai nạn thương tích
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	Loại tai nạn (MA_TAI_NAN theo QĐ 3176/QĐ-BYT, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item	SO	0..*	BackboneElement	Chi tiết chi phí — bắt buộc khi use=claim; tuỳ chọn cho preauthorization/predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:department	S	0..1	CodeableConcept	Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup		0..1	CodeableConcept	Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope		0..1	CodeableConcept	Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo	SC	0..1	(Complex)	BHYT: phạm vi, tỷ lệ TT, mức hưởng, trần thanh toán (T_TRANTT) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info Constraints: vn-insurance-cost-ratio-and-lexical
extension:linePaymentAllocation	C	0..1	(Complex)	Bốn nguồn thanh toán của dòng — quỹ BHYT, người bệnh cùng trả, nguồn khác, người bệnh tự trả URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation Constraints: vn-line-payment-allocation-vnd, vn-line-payment-allocation-nonnegative
extension:otherFundBreakdown	C	0..1	(Complex)	Chi tiết nguồn khác chi trả theo dòng: NSNN/VTNN/VTTN/CL (T_NGUONKHAC_*) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown Constraints: vn-other-fund-breakdown-money-vnd-value
extension:anesthesiaMethod		0..1	CodeableConcept	Phương pháp vô cảm dòng DVKT (PP_VO_CAM) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method Binding: Phương pháp vô cảm — Vietnam Anesthesia Method ValueSet (required)
extension:paymentSource	S	0..1	CodeableConcept	Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit		0..1	boolean	Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo	S	0..1	string	Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod		0..1	CodeableConcept	Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method Binding: Phương pháp chế biến vị thuốc cổ truyền — VN Traditional Medicine Processing Method ValueSet (extensible)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Item instance identifier
category	S	0..1	CodeableConcept	Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697/QĐ-BYT) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService	S	1..1	CodeableConcept	Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
quantity	S	0..1	SimpleQuantity(4.0.1)	Số lượng
unitPrice	S	0..1	Money	Đơn giá
net	S	0..1	Money	Thành tiền
total	SO	0..1	Money	Tổng chi phí (XML 3176: T_TONGCHI) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.identifier:MALK.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier:MALK.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	extensible	Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet	📦0.10.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	Base	extensible	Mã chẩn đoán — VN Core Condition Code ValueSet	📦0.10.0	This IG
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	extensible	Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet	📦0.10.0	This IG
Claim.accident.type	Base	extensible	Mã tai nạn thương tích — Vietnam Accident Type ValueSet	📦0.10.0	This IG
Claim.item.category	Base	extensible	Danh mục chi phí KCB — Vietnam Cost Category ValueSet	📦0.10.0	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
vn-claim-diagnosis-has-icd10	error	Claim	Mỗi Claim.diagnosis phải có ít nhất một coding thuộc ICD-10 VN — MA_BENH_CHINH và MA_BENH_KT của QĐ 3176/QĐ-BYT là mã ICD-10; mã SNOMED/YHCT chỉ bổ sung, không thay thế.	diagnosis.all(diagnosis.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd10-cs').exists())
vn-claim-ma-lk-issuer-scoped	error	Claim	Mã liên kết MA_LK ghi dưới URI dùng tạm cấp quốc gia (http://fhir.hl7.org.vn/core/sid/ma-lk) phải kèm `assigner` chỉ rõ cơ sở cấp mã; khuyến nghị chính là mỗi cơ sở công bố URI riêng. A MA_LK record-link code recorded under the shared national placeholder URI SHALL name its assigning facility; per-facility namespace URIs are preferred.	identifier.where(system = 'http://fhir.hl7.org.vn/core/sid/ma-lk').all(assigner.exists())
vn-claim-post-service-has-item	error	Claim	Claim hậu dịch vụ (use=claim) phải có ít nhất một dòng chi phí; preauthorization/predetermination không bị QĐ 697/QĐ-BYT ép cardinality này	use != 'claim' or item.exists()
vn-claim-procedure-has-icd9cm	warning	Claim	Khi Claim.procedure có mặt, mỗi mục phải có ít nhất một coding thuộc ICD-9-CM VN (QĐ 387/QĐ-BYT); mã DVKT/SNOMED chỉ bổ sung.	procedure.all(procedure.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd9-cm-cs').exists())
vn-claim-single-focal-insurance	error	Claim	Quy tắc tuân thủ VN Core: mỗi Claim phải có đúng một insurance.focal=true theo semantics coordination-of-benefits của FHIR. Đây không phải cardinality do NĐ 188/2025/NĐ-CP hoặc QĐ 697/QĐ-BYT quy định; phân đoạn thẻ và mức hưởng khi kết xuất phải được xử lý riêng theo văn bản BHYT hiện hành.	insurance.where(focal = true).count() = 1
vn-insurance-cost-ratio-and-lexical	error	Claim.item.extension:insuranceCostInfo	Các tỷ lệ phải nằm trong khoảng 0-100; chuỗi lexical gốc nếu có phải đi kèm paymentRatio; khoảng hiệu lực trần nếu có phải đi kèm paymentCeiling. Percentage values SHALL be within 0-100; a source lexical string SHALL accompany paymentRatio; a ceiling period SHALL accompany paymentCeiling.	extension.where(url = 'paymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'servicePaymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'benefitLevel').value.ofType(decimal).all($this >= 0 and $this <= 100) and (extension.where(url = 'paymentRatioSourceLexical').empty() or extension.where(url = 'paymentRatio').exists()) and (extension.where(url = 'paymentCeilingPeriod').empty() or extension.where(url = 'paymentCeiling').exists())
vn-line-payment-allocation-nonnegative	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải lớn hơn hoặc bằng 0. Every allocated Money value SHALL be greater than or equal to zero.	extension.value.ofType(Money).all(value >= 0)
vn-line-payment-allocation-vnd	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải dùng VND. Every allocated Money value SHALL use VND.	extension.value.ofType(Money).all(currency = 'VND')
vn-other-fund-breakdown-money-vnd-value	error	Claim.item.extension:otherFundBreakdown	Mọi Money con phải có value và dùng VND. Every child Money SHALL have a value and use VND.	extension.value.ofType(Money).all(value.exists() and currency = 'VND')

Dạng xem Differential

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: vn-claim-ma-lk-issuer-scoped, vn-claim-single-focal-insurance, vn-claim-diagnosis-has-icd10, vn-claim-procedure-has-icd9cm, vn-claim-post-service-has-item
meta		0..1	Meta	Metadata about the resource
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:costSummary	SO	0..1	(Complex)	Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
extension:paymentPeriod		0..1	(Complex)	Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod	SO	0..1	CodeableConcept	Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Slices for identifier	SO	1..*	Identifier	Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
identifier:MALK	SO	1..1	Identifier	Mã liên kết hồ sơ (MA_LK) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type		0..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA_LK
system		1..1	uri	The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value	S	1..1	string	Giá trị MA_LK
status	SO	1..1	code	Trạng thái yêu cầu thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type	SO	1..1	CodeableConcept	Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
subType	SO	0..1	CodeableConcept	Mã đối tượng đến KCB (MA_DOITUONG_KCB theo QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	SO	1..1	code	Mục đích: claim (thanh toán) | preauthorization | predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
patient	SO	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Bệnh nhân (XML 3176: MA_BN) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
created	SO	1..1	dateTime	Ngày tạo yêu cầu Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
insurer	SO	0..1	Reference(Organization)	Cơ quan BHXH thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
provider	SO	1..1	Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile)	Cơ sở KCB thực hiện (XML 3176: MA_CSKCB) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
priority		1..1	CodeableConcept	Mức ưu tiên xử lý
related		0..*	BackboneElement	Quan hệ Claim tuỳ chọn ngoài cam kết hỗ trợ tối thiểu — Optional Claim relationship outside the minimum support contract
claim		1..1	Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile)	Claim đích của quan hệ tuỳ chọn — Target Claim of the optional relationship
relationship		1..1	CodeableConcept	Loại quan hệ FHIR: prior hoặc associated — FHIR relationship type: prior or associated
diagnosis	SO	1..*	BackboneElement	Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH_CHINH, MA_BENH_KT) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
sequence	S	1..1	positiveInt	Diagnosis instance identifier
Slices for diagnosis[x]		1..1	CodeableConcept, Reference(Condition)	Nature of illness or problem Slice: Unordered, Open by type:$this
diagnosis[x]:diagnosisCodeableConcept	S	0..1	CodeableConcept	Mã bệnh ICD-10 VN (edition 2026 — TT 06/2026/TT-BYT + QĐ 1849/QĐ-BYT; QĐ 4469/QĐ-BYT chỉ là provenance dữ liệu cũ) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type	S	0..*	CodeableConcept	Loại chẩn đoán (chính/phụ)
procedure		0..*	BackboneElement	Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT_QT)
Slices for procedure[x]		1..1	CodeableConcept, Reference(Procedure)	Specific clinical procedure Slice: Unordered, Open by type:$this
procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
insurance	SO	1..*	BackboneElement	Thông tin BHYT (XML 3176: MA_THE) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
focal	S	1..1	boolean	Coverage to be used for adjudication
coverage	S	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT (Coverage)
accident		0..1	BackboneElement	Thông tin tai nạn thương tích
type		0..1	CodeableConcept	Loại tai nạn (MA_TAI_NAN theo QĐ 3176/QĐ-BYT, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
item	SO	0..*	BackboneElement	Chi tiết chi phí — bắt buộc khi use=claim; tuỳ chọn cho preauthorization/predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:department	S	0..1	CodeableConcept	Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup		0..1	CodeableConcept	Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope		0..1	CodeableConcept	Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo	S	0..1	(Complex)	BHYT: phạm vi, tỷ lệ TT, mức hưởng, trần thanh toán (T_TRANTT) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
extension:linePaymentAllocation		0..1	(Complex)	Bốn nguồn thanh toán của dòng — quỹ BHYT, người bệnh cùng trả, nguồn khác, người bệnh tự trả URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation
extension:otherFundBreakdown		0..1	(Complex)	Chi tiết nguồn khác chi trả theo dòng: NSNN/VTNN/VTTN/CL (T_NGUONKHAC_*) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown
extension:anesthesiaMethod		0..1	CodeableConcept	Phương pháp vô cảm dòng DVKT (PP_VO_CAM) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method Binding: Phương pháp vô cảm — Vietnam Anesthesia Method ValueSet (required)
extension:paymentSource	S	0..1	CodeableConcept	Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit		0..1	boolean	Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo	S	0..1	string	Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod		0..1	CodeableConcept	Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method Binding: Phương pháp chế biến vị thuốc cổ truyền — VN Traditional Medicine Processing Method ValueSet (extensible)
sequence	S	1..1	positiveInt	Item instance identifier
category	S	0..1	CodeableConcept	Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697/QĐ-BYT) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService	S	1..1	CodeableConcept	Mã dịch vụ/thuốc/TBYT
quantity	S	0..1	SimpleQuantity(4.0.1)	Số lượng
unitPrice	S	0..1	Money	Đơn giá
net	S	0..1	Money	Thành tiền
total	SO	0..1	Money	Tổng chi phí (XML 3176: T_TONGCHI) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.subType	Base	extensible	Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet	📦0.10.0	This IG
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	Base	extensible	Mã chẩn đoán — VN Core Condition Code ValueSet	📦0.10.0	This IG
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	extensible	Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet	📦0.10.0	This IG
Claim.accident.type	Base	extensible	Mã tai nạn thương tích — Vietnam Accident Type ValueSet	📦0.10.0	This IG
Claim.item.category	Base	extensible	Danh mục chi phí KCB — Vietnam Cost Category ValueSet	📦0.10.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
vn-claim-diagnosis-has-icd10	error	Claim	Mỗi Claim.diagnosis phải có ít nhất một coding thuộc ICD-10 VN — MA_BENH_CHINH và MA_BENH_KT của QĐ 3176/QĐ-BYT là mã ICD-10; mã SNOMED/YHCT chỉ bổ sung, không thay thế.	diagnosis.all(diagnosis.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd10-cs').exists())
vn-claim-ma-lk-issuer-scoped	error	Claim	Mã liên kết MA_LK ghi dưới URI dùng tạm cấp quốc gia (http://fhir.hl7.org.vn/core/sid/ma-lk) phải kèm `assigner` chỉ rõ cơ sở cấp mã; khuyến nghị chính là mỗi cơ sở công bố URI riêng. A MA_LK record-link code recorded under the shared national placeholder URI SHALL name its assigning facility; per-facility namespace URIs are preferred.	identifier.where(system = 'http://fhir.hl7.org.vn/core/sid/ma-lk').all(assigner.exists())
vn-claim-post-service-has-item	error	Claim	Claim hậu dịch vụ (use=claim) phải có ít nhất một dòng chi phí; preauthorization/predetermination không bị QĐ 697/QĐ-BYT ép cardinality này	use != 'claim' or item.exists()
vn-claim-procedure-has-icd9cm	warning	Claim	Khi Claim.procedure có mặt, mỗi mục phải có ít nhất một coding thuộc ICD-9-CM VN (QĐ 387/QĐ-BYT); mã DVKT/SNOMED chỉ bổ sung.	procedure.all(procedure.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd9-cm-cs').exists())
vn-claim-single-focal-insurance	error	Claim	Quy tắc tuân thủ VN Core: mỗi Claim phải có đúng một insurance.focal=true theo semantics coordination-of-benefits của FHIR. Đây không phải cardinality do NĐ 188/2025/NĐ-CP hoặc QĐ 697/QĐ-BYT quy định; phân đoạn thẻ và mức hưởng khi kết xuất phải được xử lý riêng theo văn bản BHYT hiện hành.	insurance.where(focal = true).count() = 1

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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: vn-claim-ma-lk-issuer-scoped, vn-claim-single-focal-insurance, vn-claim-diagnosis-has-icd10, vn-claim-procedure-has-icd9cm, vn-claim-post-service-has-item
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:costSummary	SO	0..1	(Complex)	Tổng chi phí theo nhóm: thuốc, VTYT, BHYT, tự trả, cùng chi trả, nguồn khác URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
extension:paymentPeriod		0..1	(Complex)	Kỳ thanh toán BHYT (năm/tháng) — NAM_QT, THANG_QT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
extension:paymentMethod	SO	0..1	CodeableConcept	Phương thức thanh toán (FFS/Capitation/DRG) — MA_PTTT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method Binding: Phương thức thanh toán BHYT — VN Payment Method ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SO	1..*	Identifier	Định danh hồ sơ thanh toán, bao gồm MA_LK Slice: Unordered, Open by value:system Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
identifier:MALK	SO	1..1	Identifier	Mã liên kết hồ sơ (MA_LK) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MA_LK
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://fhir.hl7.org.vn/core/sid/ma-lk
value	SΣ	1..1	string	Giá trị MA_LK Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SOΣ	1..1	code	Trạng thái yêu cầu thanh toán Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
type	SOΣ	1..1	CodeableConcept	Loại yêu cầu: institutional (nội trú), professional (ngoại trú) Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
subType	SO	0..1	CodeableConcept	Mã đối tượng đến KCB (MA_DOITUONG_KCB theo QĐ 3276/QĐ-BYT) Binding: Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet (extensible) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
use	SOΣ	1..1	code	Mục đích: claim (thanh toán) | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
patient	SOΣ	1..1	Reference(Bệnh nhân VN Core — VN Core Patient Profile)	Bệnh nhân (XML 3176: MA_BN) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	SOΣ	1..1	dateTime	Ngày tạo yêu cầu Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	SOΣ	0..1	Reference(Organization)	Cơ quan BHXH thanh toán Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
provider	SOΣ	1..1	Reference(Cơ sở y tế VN Core — VN Core Organization Profile | Nhân viên y tế VN Core — VN Core Practitioner Profile | Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile)	Cơ sở KCB thực hiện (XML 3176: MA_CSKCB) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
priority	Σ	1..1	CodeableConcept	Mức ưu tiên xử lý Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Quan hệ Claim tuỳ chọn ngoài cam kết hỗ trợ tối thiểu — Optional Claim relationship outside the minimum support contract
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		1..1	Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile)	Claim đích của quan hệ tuỳ chọn — Target Claim of the optional relationship
relationship		1..1	CodeableConcept	Loại quan hệ FHIR: prior hoặc associated — FHIR relationship type: prior or associated Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment referral
facility		0..1	Reference(Location)	Servicing facility
careTeam		0..*	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis	SO	1..*	BackboneElement	Chẩn đoán — ICD-10 VN (XML 3176: MA_BENH_CHINH, MA_BENH_KT) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Diagnosis instance identifier
Slices for diagnosis[x]		1..1		Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
diagnosis[x]:diagnosisCodeableConcept	S	0..1	CodeableConcept	Mã bệnh ICD-10 VN (edition 2026 — TT 06/2026/TT-BYT + QĐ 1849/QĐ-BYT; QĐ 4469/QĐ-BYT chỉ là provenance dữ liệu cũ) Binding: Mã chẩn đoán — VN Core Condition Code ValueSet (extensible)
type	S	0..*	CodeableConcept	Loại chẩn đoán (chính/phụ) Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Thủ thuật/phẫu thuật — ICD-9-CM (XML 3176: MA_PTTT_QT)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
Slices for procedure[x]		1..1		Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet (extensible)
udi		0..*	Reference(Device)	Unique device identifier
insurance	SOΣ	1..*	BackboneElement	Thông tin BHYT (XML 3176: MA_THE) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	SΣ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	SΣ	1..1	Reference(Thẻ BHYT VN Core — VN Core Coverage Profile)	Thẻ BHYT (Coverage)
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident		0..1	BackboneElement	Thông tin tai nạn thương tích
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	Loại tai nạn (MA_TAI_NAN theo QĐ 3176/QĐ-BYT, Bảng 8) Binding: Mã tai nạn thương tích — Vietnam Accident Type ValueSet (extensible)
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item	SO	0..*	BackboneElement	Chi tiết chi phí — bắt buộc khi use=claim; tuỳ chọn cho preauthorization/predetermination Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:department	S	0..1	CodeableConcept	Khoa thực hiện (MA_KHOA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department Binding: Danh mục mã khoa — Vietnam Department ValueSet (extensible)
extension:deviceGroup		0..1	CodeableConcept	Nhóm TBYT BHYT N01-N09 cho dòng chi phí thiết bị/vật tư URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group Binding: Nhóm thiết bị y tế theo danh mục BHYT — VN Device Group VS (extensible)
extension:deviceInsuranceScope		0..1	CodeableConcept	Legacy PHAM_VI cho dòng TBYT; dữ liệu mới ưu tiên insuranceCostInfo.scope URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope Binding: Phạm vi hưởng BHYT — Vietnam Insurance Scope ValueSet (extensible)
extension:insuranceCostInfo	SC	0..1	(Complex)	BHYT: phạm vi, tỷ lệ TT, mức hưởng, trần thanh toán (T_TRANTT) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info Constraints: vn-insurance-cost-ratio-and-lexical
extension:linePaymentAllocation	C	0..1	(Complex)	Bốn nguồn thanh toán của dòng — quỹ BHYT, người bệnh cùng trả, nguồn khác, người bệnh tự trả URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation Constraints: vn-line-payment-allocation-vnd, vn-line-payment-allocation-nonnegative
extension:otherFundBreakdown	C	0..1	(Complex)	Chi tiết nguồn khác chi trả theo dòng: NSNN/VTNN/VTTN/CL (T_NGUONKHAC_*) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown Constraints: vn-other-fund-breakdown-money-vnd-value
extension:anesthesiaMethod		0..1	CodeableConcept	Phương pháp vô cảm dòng DVKT (PP_VO_CAM) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method Binding: Phương pháp vô cảm — Vietnam Anesthesia Method ValueSet (required)
extension:paymentSource	S	0..1	CodeableConcept	Nguồn chi trả dòng chi phí (NGUON_CTRA) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source Binding: Nguồn chi trả — Vietnam Payment Source ValueSet (extensible)
extension:recurrentWoundBenefit		0..1	boolean	Flag VET_THUONG_TP cho dòng thuốc/DVKT/VTYT URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
extension:tenderInfo	S	0..1	string	Thông tin thầu dòng chi phí (TT_THAU) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
extension:processingMethod		0..1	CodeableConcept	Phương pháp chế biến YHCT (MA_PP_CHEBIEN) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method Binding: Phương pháp chế biến vị thuốc cổ truyền — VN Traditional Medicine Processing Method ValueSet (extensible)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category	S	0..1	CodeableConcept	Nhóm chi phí: khám, giường, XN, CĐHA, thuốc, TBYT... (QĐ 697/QĐ-BYT) Binding: Danh mục chi phí KCB — Vietnam Cost Category ValueSet (extensible)
productOrService	S	1..1	CodeableConcept	Mã dịch vụ/thuốc/TBYT Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	SimpleQuantity(4.0.1)	Số lượng
unitPrice	S	0..1	Money	Đơn giá
factor		0..1	decimal	Price scaling factor
net	S	0..1	Money	Thành tiền
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
subDetail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total	SO	0..1	Money	Tổng chi phí (XML 3176: T_TONGCHI) Obligations Actor SHALL:populate-if-known Bên gửi hồ sơ BHYT (Submitter) SHALL:no-error & SHALL:persist Bên giám định BHYT (Adjudicator)
Documentation for this format

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier:MALK.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier:MALK.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	extensible	Mã đối tượng đến KCB — Vietnam Patient Visit Type ValueSet	📦0.10.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	Base	extensible	Mã chẩn đoán — VN Core Condition Code ValueSet	📦0.10.0	This IG
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	extensible	Mã thủ thuật/dịch vụ kỹ thuật — VN Core Procedure Code ValueSet	📦0.10.0	This IG
Claim.accident.type	Base	extensible	Mã tai nạn thương tích — Vietnam Accident Type ValueSet	📦0.10.0	This IG
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	extensible	Danh mục chi phí KCB — Vietnam Cost Category ValueSet	📦0.10.0	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
vn-claim-diagnosis-has-icd10	error	Claim	Mỗi Claim.diagnosis phải có ít nhất một coding thuộc ICD-10 VN — MA_BENH_CHINH và MA_BENH_KT của QĐ 3176/QĐ-BYT là mã ICD-10; mã SNOMED/YHCT chỉ bổ sung, không thay thế.	diagnosis.all(diagnosis.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd10-cs').exists())
vn-claim-ma-lk-issuer-scoped	error	Claim	Mã liên kết MA_LK ghi dưới URI dùng tạm cấp quốc gia (http://fhir.hl7.org.vn/core/sid/ma-lk) phải kèm `assigner` chỉ rõ cơ sở cấp mã; khuyến nghị chính là mỗi cơ sở công bố URI riêng. A MA_LK record-link code recorded under the shared national placeholder URI SHALL name its assigning facility; per-facility namespace URIs are preferred.	identifier.where(system = 'http://fhir.hl7.org.vn/core/sid/ma-lk').all(assigner.exists())
vn-claim-post-service-has-item	error	Claim	Claim hậu dịch vụ (use=claim) phải có ít nhất một dòng chi phí; preauthorization/predetermination không bị QĐ 697/QĐ-BYT ép cardinality này	use != 'claim' or item.exists()
vn-claim-procedure-has-icd9cm	warning	Claim	Khi Claim.procedure có mặt, mỗi mục phải có ít nhất một coding thuộc ICD-9-CM VN (QĐ 387/QĐ-BYT); mã DVKT/SNOMED chỉ bổ sung.	procedure.all(procedure.ofType(CodeableConcept).coding.where(system = 'http://fhir.hl7.org.vn/core/CodeSystem/vn-icd9-cm-cs').exists())
vn-claim-single-focal-insurance	error	Claim	Quy tắc tuân thủ VN Core: mỗi Claim phải có đúng một insurance.focal=true theo semantics coordination-of-benefits của FHIR. Đây không phải cardinality do NĐ 188/2025/NĐ-CP hoặc QĐ 697/QĐ-BYT quy định; phân đoạn thẻ và mức hưởng khi kết xuất phải được xử lý riêng theo văn bản BHYT hiện hành.	insurance.where(focal = true).count() = 1
vn-insurance-cost-ratio-and-lexical	error	Claim.item.extension:insuranceCostInfo	Các tỷ lệ phải nằm trong khoảng 0-100; chuỗi lexical gốc nếu có phải đi kèm paymentRatio; khoảng hiệu lực trần nếu có phải đi kèm paymentCeiling. Percentage values SHALL be within 0-100; a source lexical string SHALL accompany paymentRatio; a ceiling period SHALL accompany paymentCeiling.	extension.where(url = 'paymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'servicePaymentRatio').value.ofType(decimal).all($this >= 0 and $this <= 100) and extension.where(url = 'benefitLevel').value.ofType(decimal).all($this >= 0 and $this <= 100) and (extension.where(url = 'paymentRatioSourceLexical').empty() or extension.where(url = 'paymentRatio').exists()) and (extension.where(url = 'paymentCeilingPeriod').empty() or extension.where(url = 'paymentCeiling').exists())
vn-line-payment-allocation-nonnegative	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải lớn hơn hoặc bằng 0. Every allocated Money value SHALL be greater than or equal to zero.	extension.value.ofType(Money).all(value >= 0)
vn-line-payment-allocation-vnd	error	Claim.item.extension:linePaymentAllocation	Mọi khoản tiền phân bổ phải dùng VND. Every allocated Money value SHALL use VND.	extension.value.ofType(Money).all(currency = 'VND')
vn-other-fund-breakdown-money-vnd-value	error	Claim.item.extension:otherFundBreakdown	Mọi Money con phải có value và dùng VND. Every child Money SHALL have a value and use VND.	extension.value.ofType(Money).all(value.exists() and currency = 'VND')

Name	Bên giám định BHYT (Adjudicator)	Bên gửi hồ sơ BHYT (Submitter)
Claim
Slices for extension
extension:costSummary	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
extension:paymentMethod	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for identifier	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
identifier:MALK	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
status	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
type	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
subType	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
use	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
patient	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
created	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
insurer	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
provider	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
diagnosis	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for diagnosis[x]
insurance	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
item	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Slices for extension
total	SHALL:no-error & SHALL:persist	SHALL:populate-if-known
Documentation for this format

Summary

Mandatory: 5 elements(2 nested mandatory elements)
Must-Support: 32 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

• Bệnh nhân VN Core — VN Core Patient Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-patient)
• Cơ sở y tế VN Core — VN Core Organization Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-organization)
• Nhân viên y tế VN Core — VN Core Practitioner Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner)
• Vai trò nhân viên y tế VN Core — VN Core PractitionerRole Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-practitioner-role)
• Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-claim)
• Thẻ BHYT VN Core — VN Core Coverage Profile (http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-coverage)

Extensions

This structure refers to these extensions:

• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-group
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-device-insurance-scope
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-anesthesia-method
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-source
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-recurrent-wound-benefit
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-tender-info
• http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-traditional-processing-method

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the values of Claim.identifier
• The element 1 is sliced based on the values of Claim.diagnosis.diagnosis[x]
• The element 1 is sliced based on the values of Claim.procedure.procedure[x]