Split record of claim profile into MBS claim profile and PBS profile

single EOB (ExplanationOfBenefit) profile is best split into an two given the targeted rules for two benefits schemes: 1. Record of completed MBS Claim for reporting purposes 2. Record of PBS | RPBS Claim for reporting purposes #143
AuDigitalHealth · Mar 26, 2022 · 84740fe · 84740fe
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diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-01.xml b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-01.xml
@@ -1,7 +1,7 @@
 <ExplanationOfBenefit xmlns="http://hl7.org/fhir">
 	<id value="mbs-01"/>
 	<meta>
-		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/>
+		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/>
 	</meta>
 	<!--identifier from Bundle uploaded from MBS Medicare repository-->
 	<identifier>

diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-02.xml b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-02.xml
@@ -1,7 +1,7 @@
 <ExplanationOfBenefit xmlns="http://hl7.org/fhir">
 	<id value="mbs-02"/>
 	<meta>
-		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/>
+		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/>
 	</meta>
 	<!--identifier from Bundle uploaded from MBS Medicare repository-->
 	<identifier>

diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-mbs-03.xml b/examples/ExplanationOfBenefit/explanationofbenefit-mbs-03.xml
@@ -0,0 +1,93 @@
+<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
+	<id value="mbs-03"/>
+	<meta>
+		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/>
+	</meta>
+	<!--identifier from Bundle uploaded from MBS Medicare repository-->
+	<identifier>
+		<system value="urn:ietf:rfc:3986"/>
+		<value value="urn:uuid:fbaf3ef9-6e74-44d2-8057-3ceabb1f2bde" />
+	</identifier>
+	<status value="active"/>
+	<type>
+		<coding>
+			<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
+			<code value="professional"/>
+		</coding>
+	</type>
+	<subType>
+		<coding>
+			<system value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
+			<code value="mbs"/>
+		</coding>
+	</subType>
+	<use value="claim"/>
+	<patient>
+		<reference value="Patient/mhr-field-sally"/>
+		<identifier>
+			<type>
+				<coding>
+					<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
+					<code value="NI"/>
+					<display value="National unique individual identifier"/>
+				</coding>
+				<text value="IHI"/>
+			</type>
+			<system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
+			<value value="8003608833357361"/>
+		</identifier>
+	</patient>
+	<created value="2018-12-16"/>
+	<insurer>
+		<reference value="Organization/healthau"/>
+		<display value="Australian Government Department of Health"/>
+	</insurer>
+	<provider>
+		<identifier>
+			<type>
+				<coding>
+					<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
+					<code value="NPI"/>
+					<display value="National provider identifier"/>
+				</coding>
+				<text value="HPI-I"/>
+			</type>
+			<system value="http://ns.electronichealth.net.au/id/hi/hpii/1.0"/>
+			<value value="8003614900041243"/>
+		</identifier>
+		<display value="Dr. Jeong-Hoon Kim"/>
+	</provider>
+	<outcome value="complete"/>
+	<insurance>
+		<focal value="true"/>
+		<coverage>
+			<identifier>
+				<type>
+					<coding>
+						<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
+						<code value="MC"/>
+					</coding>
+					<text value="Medicare Number"/>
+				</type>
+				<system value="http://ns.electronichealth.net.au/id/medicare-number"/>
+				<value value="3951032981"/>
+			</identifier>
+		</coverage>
+	</insurance>
+	<item>
+		<sequence value="1"/>
+		<category>
+			<coding>
+				<system value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
+				<code value="mbs"/>
+			</coding>
+		</category>
+		<productOrService>
+			<coding>
+				<system value="urn:oid:1.2.36.1.2001.1005.21"/>
+				<code value="30191"/>
+			</coding>
+		</productOrService>
+		<servicedDate value="2018-12-16"/>
+	</item>
+</ExplanationOfBenefit>
diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-pbs-01.xml b/examples/ExplanationOfBenefit/explanationofbenefit-pbs-01.xml
@@ -1,7 +1,7 @@
 <ExplanationOfBenefit xmlns="http://hl7.org/fhir">
 	<id value="pbs-01"/>
 	<meta>
-		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/>
+		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/>
 	</meta>
 	<!--identifier from Bundle uploaded from MBS Medicare repository-->
 	<identifier>

diff --git a/examples/ExplanationOfBenefit/explanationofbenefit-pbs-02.xml b/examples/ExplanationOfBenefit/explanationofbenefit-pbs-02.xml
@@ -1,7 +1,7 @@
 <ExplanationOfBenefit xmlns="http://hl7.org/fhir">
 	<id value="pbs-02"/>
 	<meta>
-		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-1"/>
+		<profile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/>
 	</meta>
 	<!--identifier from Bundle uploaded from MBS Medicare repository-->
 	<identifier>

diff --git a/ig.json b/ig.json
@@ -221,9 +221,13 @@
             "base": "StructureDefinition-dh-encounter-core-1.html",
             "defns": "StructureDefinition-dh-encounter-core-1-definitions.html"
         },
-        "StructureDefinition/dh-explanationofbenefit-medicare-1": {
-            "base": "StructureDefinition-dh-explanationofbenefit-medicare-1.html",
-            "defns": "StructureDefinition-dh-explanationofbenefit-medicare-1-definitions.html"
+        "StructureDefinition/dh-explanationofbenefit-medicare-mbs-1": {
+            "base": "StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html",
+            "defns": "StructureDefinition-dh-explanationofbenefit-medicare-mbs-1-definitions.html"
+        },
+        "StructureDefinition/dh-explanationofbenefit-medicare-pbs-1": {
+            "base": "StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html",
+            "defns": "StructureDefinition-dh-explanationofbenefit-medicare-pbs-1-definitions.html"
         },
         "StructureDefinition/dh-flag-air-1": {
             "base": "StructureDefinition-dh-flag-air-1.html",

diff --git a/pages/_includes/dh-explanationofbenefit-medicare-1-examples.md b/pages/_includes/dh-explanationofbenefit-medicare-1-examples.md
diff --git a/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-examples.md b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-examples.md
@@ -0,0 +1,28 @@
+<table class="list" width="100%">            
+   <tr>
+     <th>Example name</th>
+     <th>id</th>
+     <th colspan="3">Format</th>
+   </tr>
+   <tr>
+      <td><a href="ExplanationOfBenefit-mbs-01.html">Record of Claim against MBS for 15275 radiation oncology treatment for Mr. Zhang Wei</a></td>
+      <td>mbs-01</td>
+      <td><a href="ExplanationOfBenefit-mbs-01.xml.html">XML</a></td>
+      <td><a href="ExplanationOfBenefit-mbs-01.json.html">JSON</a></td>
+      <td><a href="ExplanationOfBenefit-mbs-01.ttl.html">Turtle</a></td>
+   </tr>
+   <tr>
+      <td><a href="ExplanationOfBenefit-mbs-02.html">Record of Claim against MBS for 30185 removal of palmar or plantar warts for for Ms. Sally Field</a></td>
+      <td>mbs-02</td>
+      <td><a href="ExplanationOfBenefit-mbs-02.xml.html">XML</a></td>
+      <td><a href="ExplanationOfBenefit-mbs-02.json.html">JSON</a></td>
+      <td><a href="ExplanationOfBenefit-mbs-02.ttl.html">Turtle</a></td>
+   </tr>
+   <tr>
+      <td><a href="ExplanationOfBenefit-mbs-03.html">Record of Claim against MBS for 30191 removal of palmar or plantar warts for for Ms. Sally Field</a></td>
+      <td>mbs-03</td>
+      <td><a href="ExplanationOfBenefit-mbs-03.xml.html">XML</a></td>
+      <td><a href="ExplanationOfBenefit-mbs-03.json.html">JSON</a></td>
+      <td><a href="ExplanationOfBenefit-mbs-03.ttl.html">Turtle</a></td>
+   </tr>
+</table>
diff --git a/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-intro.md b/pages/_includes/dh-explanationofbenefit-medicare-mbs-1-intro.md
@@ -0,0 +1,22 @@
+#### Australian Digital Health Agency Record of Claim against MBS
+This profile defines a record of the claim of an item claimed against the Medicare Benefits Schedule (MBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.
+
+This profile identifies the additional constraints, extensions, and value sets that build on and extend [ExplanationOfBenefit](http://hl7.org/fhir/R4/explanationofbenefit.html) that are supported. 
+
+This profile is designed to set a core ExplanationOfBenefit standard for:
+* Query for a record of an MBS item claim associated with a patient
+* Record or update an MBS item claim associated with a patient
+
+This profile is used by the following APIs:
+* [insert API endpoint](StructureDefinition-TBD-1.html)
+
+
+#### Guidance
+The following guidance applies:
+* TBD
+
+
+#### Boundaries and relationships
+This profile is referenced by 
+[TBD](StructureDefinition-TBD-1.html).
+
diff --git a/...explanationofbenefit-medicare-1-issues.md → ...anationofbenefit-medicare-mbs-1-issues.md b/...explanationofbenefit-medicare-1-issues.md → ...anationofbenefit-medicare-mbs-1-issues.md
diff --git a/...xplanationofbenefit-medicare-1-summary.md → ...nationofbenefit-medicare-mbs-1-summary.md b/...xplanationofbenefit-medicare-1-summary.md → ...nationofbenefit-medicare-mbs-1-summary.md
diff --git a/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-examples.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-examples.md
@@ -0,0 +1,21 @@
+<table class="list" width="100%">            
+   <tr>
+     <th>Example name</th>
+     <th>id</th>
+     <th colspan="3">Format</th>
+   </tr>
+   <tr>
+      <td><a href="ExplanationOfBenefit-pbs-01.html">Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 JAN 2020</a></td>
+      <td>pbs-01</td>
+      <td><a href="ExplanationOfBenefit-pbs-01.xml.html">XML</a></td>
+      <td><a href="ExplanationOfBenefit-pbs-01.json.html">JSON</a></td>
+      <td><a href="ExplanationOfBenefit-pbs-01.ttl.html">Turtle</a></td>
+   </tr>
+   <tr>
+      <td><a href="ExplanationOfBenefit-pbs-02.html">Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for for Ms. Sally Field 16 FEB 2020</a></td>
+      <td>pbs-02</td>
+      <td><a href="ExplanationOfBenefit-pbs-02.xml.html">XML</a></td>
+      <td><a href="ExplanationOfBenefit-pbs-02.json.html">JSON</a></td>
+      <td><a href="ExplanationOfBenefit-pbs-02.ttl.html">Turtle</a></td>
+   </tr>
+</table>
diff --git a/...-explanationofbenefit-medicare-1-intro.md → ...lanationofbenefit-medicare-pbs-1-intro.md b/...-explanationofbenefit-medicare-1-intro.md → ...lanationofbenefit-medicare-pbs-1-intro.md
@@ -1,15 +1,13 @@
-#### Australian Digital Health Agency Record of Claim against PBS, RPBS, or MBS
-This profile defines a record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS), Repatriation Pharmaceutical Benefits Scheme (RPBS), or Medicare Benefits Schedule (MBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.
+#### Australian Digital Health Agency Record of Claim against PBS or RPBS
+This profile defines a record of the claim of an item claimed against the Pharmaceutical Benefits Schedule (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) for the electronic exchange of digital health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.
 
 This profile identifies the additional constraints, extensions, and value sets that build on and extend [ExplanationOfBenefit](http://hl7.org/fhir/R4/explanationofbenefit.html) that are supported. 
 
 This profile is designed to set a core ExplanationOfBenefit standard for:
 * Query for a record of a PBS item claim associated with a patient
 * Query for a record of an RPBS item claim associated with a patient
-* Query for a record of an MBS item claim associated with a patient
 * Record or update a PBS item claim associated with a patient
 * Record or update an RPBS item claim associated with a patient
-* Record or update an MBS item claim associated with a patient
 
 This profile is used by the following APIs:
 * [insert API endpoint](StructureDefinition-TBD-1.html)

diff --git a/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-issues.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-issues.md
@@ -0,0 +1,19 @@
+<table class="list" width="100%">
+<tbody>
+  <tr>
+    <th>Reference</th>
+    <th>Description</th>
+    <th>Issue No.</th>
+  </tr>
+  <tr>
+        <td>Constraint presentation</td>
+        <td>The full set of constraints (i.e. invariants) defined in this profile are only presented in the Detailed Descriptions tab or the raw representation (e.g. XML) of the profile. The Differential Table only presents constraints introduced in this profile in addition to the constraints present in the base profile and base resource. The Snapshot Table only presents the constraints visible in the Differential Table and additionally presents those constraints set in slices in the base profile.</td>
+        <td>See Zulip <a href="https://chat.fhir.org/#narrow/stream/179252-IG-creation/topic/Derived.20profile.20snapshot.20missing.20upstream.20invariants">Derived profile snapshot missing upstream invariants</a> stream</td>
+  </tr>
+  <tr>
+        <td>ExplanationOfBenefit.priority</td>
+        <td>This element is not of use in this profile, however the canonical FHIR resource definition binds to an exmple CodeSystem not ValueSet - this is throwing errors. Current workaround is to profile that element to point to the ValueSet instead.</td>
+        <td>N/A</td>
+  </tr>
+ </tbody>
+</table>
diff --git a/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-summary.md b/pages/_includes/dh-explanationofbenefit-medicare-pbs-1-summary.md
@@ -0,0 +1 @@
+This file is intentionally empty. It is required to be included by the IG Publisher.
diff --git a/pages/_includes/dh-medicationrequest-pbs-claim-1-intro.md b/pages/_includes/dh-medicationrequest-pbs-claim-1-intro.md
@@ -19,4 +19,4 @@ The following guidance applies:
 
 #### Boundaries and relationships
 This profile is referenced by 
-[ADHA Record of Claim against PBS, RPBS, or MBS](StructureDefinition-dh-explanationofbenefit-medicare-1.html).
+[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html).
diff --git a/pages/_includes/dh-organization-core-1-intro.md b/pages/_includes/dh-organization-core-1-intro.md
@@ -33,10 +33,14 @@ This profile is referenced by
 [ADHA System Device](StructureDefinition-dh-device-system-1.html), 
 [ADHA Core DiagnosticReport](StructureDefinition-dh-diagnosticreport-core-1.html), 
 [ADHA Advance Care Planning Document DocumentReference](StructureDefinition-dh-documentreference-core-1.html), 
+[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), 
+[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), 
 [ADHA Core Flag](StructureDefinition-dh-flag-core-1.html), 
+[ADHA Australian Immunisation Register Notice](StructureDefinition-dh-flag-air-1.html),  
 [ADHA Core Location](StructureDefinition-dh-location-core-1.html), 
-[ADHA Core HealthcareService](StructureDefinition-dh-healthcareservice-core-1.html), 
+[ADHA Core HealthcareService](StructureDefinition-dh-healthcareservice-core-1.html),  
 [ADHA Core Immunization](StructureDefinition-dh-immunization-core-1.html), 
+[ADHA Record of Immunisation from Australian Immunisation Register](StructureDefinition-dh-immunization-air-1.html),  
 [ADHA Core MedicationDispense](StructureDefinition-dh-medicationdispense-1.html), 
 [ADHA Core MedicationRequest](StructureDefinition-dh-medicationrequest-1.html), 
 [ADHA Core Patient](StructureDefinition-dh-patient-core-1.html), 

diff --git a/pages/_includes/dh-patient-core-1-intro.md b/pages/_includes/dh-patient-core-1-intro.md
@@ -101,7 +101,12 @@ This profile is referenced by
 [ADHA Core DiagnosticReport](StructureDefinition-dh-diagnosticreport-core-1.html), 
 [ADHA Implantable Medical Device](StructureDefinition-dh-device-implantable-1.html), 
 [ADHA Advance Care Planning Document DocumentReference](StructureDefinition-dh-documentreference-core-1.html), 
+[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), 
+[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), 
+[ADHA Core Flag](StructureDefinition-dh-flag-core-1.html), 
+[ADHA Australian Immunisation Register Notice](StructureDefinition-dh-flag-air-1.html), 
 [ADHA Core Immunization](StructureDefinition-dh-immunization-core-1.html), 
+[ADHA Record of Immunisation from Australian Immunisation Register](StructureDefinition-dh-immunization-air-1.html), 
 [ADHA Core List](StructureDefinition-dh-list-core-1.html), 
 [ADHA Immunisation History List](StructureDefinition-dh-list-immunization-1.html), 
 [ADHA Prescription and or Dispense History List](StructureDefinition-dh-list-medication-pdl-1.html), 

diff --git a/pages/_includes/dh-practitioner-core-1-intro.md b/pages/_includes/dh-practitioner-core-1-intro.md
@@ -20,5 +20,7 @@ The following guidance applies:
 
 #### Boundaries and relationships
 This profile is referenced by 
-[ADHA Advance Care Directive Custodian Record Document Composition](StructureDefinition-dh-composition-acdcr-1.html).
+[ADHA Advance Care Directive Custodian Record Document Composition](StructureDefinition-dh-composition-acdcr-1.html), 
+[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html), 
+[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), and 
 [ADHA Core PractitionerRole](StructureDefinition-dh-practitionerrole-core-1.html).
diff --git a/pages/_includes/dh-practitionerrole-core-1-intro.md b/pages/_includes/dh-practitionerrole-core-1-intro.md
@@ -15,6 +15,7 @@ The following guidance applies:
 
 
 This profile is referenced by 
-[Australian Digital Health Agency Core Patient](StructureDefinition-dh-patient-core-1.html), 
-[Australian Digital Health Agency My Health Record Patient](StructureDefinition-dh-patient-mhr-1.html), and 
+[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html),  
+[ADHA Record of Claim against PBS or RPBS](StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html), [Australian Digital Health Agency Core Patient](StructureDefinition-dh-patient-core-1.html), 
+[Australian Digital Health Agency My Health Record Patient](StructureDefinition-dh-patient-mhr-1.html), and  
 [ADHA Core ServiceRequest](StructureDefinition-dh-servicerequest-core-1.html).
diff --git a/pages/_includes/dh-servicerequest-mbs-claim-1-intro.md b/pages/_includes/dh-servicerequest-mbs-claim-1-intro.md
@@ -18,4 +18,4 @@ The following guidance applies:
 
 #### Boundaries and relationships
 This profile is referenced by 
-[ADHA Record of Claim against PBS, RPBS, or MBS](StructureDefinition-dh-explanationofbenefit-medicare-1.html).
+[ADHA Record of Claim against MBS](StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html).
diff --git a/pages/_includes/profiles.md b/pages/_includes/profiles.md
@@ -1,4 +1,4 @@
-# {{ page.title }}
+# c{{ page.title }}
 {:.no_toc}
 <!-- TOC  the css styling for this is \pages\assets\css\project.css under 'markdown-toc'-->
 * Do not remove this line (it will not be displayed)
@@ -377,7 +377,10 @@ Core FHIR profiles defined in this implementation guide.
                         <td class="frm-null"/>
                         <td class="frm-set">
                             <ul class="frm-set">
-                                <li><a href="StructureDefinition-dh-explanationofbenefit-medicare-1.html">ADHA Record of Claim against PBS, RPBS, or MBS</a></li>
+                                <li><a href="StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html">ADHA Record of Claim against MBS</a></li>
+                            </ul>
+                            <ul class="frm-set">
+                                <li><a href="StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html">ADHA Record of Claim against PBS or RPBS</a></li>
                             </ul>
                         </td>     
                         <td class="frm-null"/>
Original file line number	Diff line number	Diff line change
		@@ -0,0 +1 @@
		This file is intentionally empty. It is required to be included by the IG Publisher.