Generated Narrative: StructureDefinition vn-core-payment-reconciliation Name Flags Card. Type Description & Constraints PaymentReconciliation 0..* PaymentReconciliation PaymentReconciliation resource #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:formNumber S 0..1 string Số hiệu biên bản 06/BH (TT 12/2026/TT-BTC) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-reconciliation-form #xD; extension:auditStatus S 0..1 CodeableConcept Trạng thái giám định BHYT (received | under-review | approved | rejected | disputed) URL: http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-audit-status Binding: Trạng thái giám định BHYT — VN Claim Audit Status ValueSet (extensible) #xD; status S 1..1 code Trạng thái resource (active | cancelled | draft | entered-in-error) #xD; period S 1..1 Period Chu kỳ quyết toán BHYT (tháng/quý) #xD; created S 1..1 dateTime Ngày lập biên bản 06/BH #xD; paymentIssuer S 0..1 Reference(Cơ sở y tế VN Core — VN Core Organization Profile) Cơ quan BHXH chi trả (BHXH cấp tỉnh/Trung ương) #xD; request S 0..1 Reference(Task) Hồ sơ/đề nghị thanh toán liên quan (optional) #xD; outcome S 0..1 code Kết quả tổng quát chuẩn FHIR (queued | complete | error | partial) #xD; paymentAmount S 1..1 Money Tổng tiền BHXH thanh toán theo biên bản 06/BH #xD; detail S 1..* BackboneElement Chi tiết quyết toán theo từng Claim (mỗi dòng 06/BH) #xD; type S 1..1 CodeableConcept Loại giao dịch (payment | adjustment | advance...) #xD; request S 0..1 Reference(Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile) Tham chiếu Claim được quyết toán #xD; amount S 0..1 Money Số tiền quyết toán cho Claim (VND) #xD; Documentation for this format
Quyết toán BHYT VN Core — VN Core Payment Reconciliation Profile
Omi HealthTech / VN Core FHIR Community Initiative
Profile PaymentReconciliation cho biên bản quyết toán/thanh toán chi phí KCB BHYT giữa cơ sở KCB và cơ quan BHXH (biểu mẫu 06/BH). Mỗi PaymentReconciliation tổng hợp kết quả giám định cho một chu kỳ quyết toán (thông thường theo tháng/quý) và liệt kê các Claim được duyệt/từ chối/tranh chấp. Căn cứ: - TT 12/2026/TT-BTC — Bộ Tài chính, hướng dẫn giám định, thanh toán, quyết toán chi phí KCB BHYT điện tử; Điều 6 và Phụ lục biểu mẫu 06/BH. - NĐ 188/2025/NĐ-CP (ban hành 01/07/2025, hiệu lực 15/08/2025) — Hướng dẫn thi hành Luật BHYT. - NĐ 164/2025/NĐ-CP (29/06/2025) — Giao dịch điện tử trong lĩnh vực BHXH. - Luật 51/2024/QH15 — Luật BHYT sửa đổi.
Canadian Dental Association eclaims standard
This resource provides the details including amount of a payment and allocates the payment items being paid.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Số hiệu biên bản 06/BH (TT 12/2026/TT-BTC)
Số hiệu biên bản quyết toán/thanh toán chi phí KCB BHYT (biểu mẫu 06/BH) giữa cơ sở KCB và cơ quan BHXH. Căn cứ: - TT 12/2026/TT-BTC — Bộ Tài chính, Điều 6 và Phụ lục biểu mẫu 06/BH (Biên bản quyết toán chi phí KCB BHYT).
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Trạng thái giám định BHYT (received | under-review | approved | rejected | disputed)
Mở rộng vòng đời giám định BHYT Việt Nam theo TT 12/2026/TT-BTC. Bổ sung cho `PaymentReconciliation.outcome` chuẩn FHIR vốn chỉ có queued/complete/error/partial.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business Identifier for a payment reconciliation
A unique identifier assigned to this payment reconciliation.
Allows payment reconciliations to be distinguished and referenced.
Trạng thái resource (active | cancelled | draft | entered-in-error)
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A code specifying the state of the resource instance.
Khoảng thời gian áp dụng cho biên bản quyết toán 06/BH — thông thường là một tháng hoặc một quý theo TT 12/2026/TT-BTC.
Needed to allow receivers to monitor and reconcile payment issuer schedules.
Need to record a timestamp for use by both the recipient and the issuer.
Cơ quan BHXH chi trả (BHXH cấp tỉnh/Trung ương)
This party is also responsible for the reconciliation.
Need to identify the party resonsible for the payment and this resource.
Hồ sơ/đề nghị thanh toán liên quan (optional)
Tham chiếu Task đại diện cho hồ sơ đề nghị thanh toán mà PaymentReconciliation này quyết toán. Optional — có thể null nếu workflow không track Task.
Needed to allow the response to be linked to the request.
The practitioner who is responsible for the services rendered to the patient.
Need to identify the party responsible for the request.
Kết quả tổng quát chuẩn FHIR (queued | complete | error | partial)
Giữ binding required chuẩn FHIR. Để biểu diễn vòng đời giám định BHYT Việt Nam theo TT 12/2026/TT-BTC, dùng PaymentReconciliation.extension[auditStatus] với VNClaimAuditStatusVS.
The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
To advise the requestor of an overall processing outcome.
A human readable description of the status of the request for the reconciliation.
The date of payment as indicated on the financial instrument.
To advise the payee when payment can be expected.
Tổng tiền BHXH thanh toán theo biên bản 06/BH
Total payment amount as indicated on the financial instrument.
Needed to provide the actual payment amount.
Issuer's unique identifier for the payment instrument.
For example: EFT number or check number.
Enable the receiver to reconcile when payment is received.
Chi tiết quyết toán theo từng Claim (mỗi dòng 06/BH)
Distribution of the payment amount for a previously acknowledged payable.
Needed to show how the payment amount is distributed across the payables.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Business identifier of the payment detail
Unique identifier for the current payment item for the referenced payable.
Business identifier of the prior payment detail
Unique identifier for the prior payment item for the referenced payable.
Loại giao dịch (payment | adjustment | advance...)
Code to indicate the nature of the payment.
For example: payment, adjustment, funds advance, etc.
Needed to provide context for the amount.
The reason for the amount: payment, adjustment, advance.
A resource, such as a Claim, the evaluation of which could lead to payment.
Needed to provide a linkage to the original request.
The party which submitted the claim or financial transaction.
A resource, such as a ClaimResponse, which contains a commitment to payment.
Needed to provide a linkage to the payment commitment.
The date from the response resource containing a commitment to pay.
A reference to the individual who is responsible for inquiries regarding the response and its payment.
The party which is receiving the payment.
The monetary amount allocated from the total payment to the payable.
Needed to explain the distribution of the payment to the payables.
A code for the form to be used for printing the content.
May be needed to identify specific jurisdictional forms.
Needed to specify the specific form used for producing output for this response.
A note that describes or explains the processing in a human readable form.
Provides the specific textual explanations associated with the processing.
To convey the expectation for when the text is used.
The explanation or description associated with the processing.
Required to provide human readable explanation.