identifier

tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode

Claim can have multiple identifiers. The most important one is mapped from ClaimUUID.

mapped ?

patient

tblClaim.InsureeUUID

reference to Patient resource

mapped ?

outcome

tblClaim.ClaimStatus

changed from CodeableConcept to code

mapped

payment.adjustmentReason

tblClaim.Adjustment

mapped

total.category.code

string “benefit”

returning the benefit amount

to be mapped

total.amount

tblClaim.Approved

mapped as Money data type

to be mapped

payment.date

tblClaimed.DateProcessed

openIMIS doesn’t specify any payment date. Payment is done from external systems.

to be removed

communicationRequest

tblClaim.feedbackId

reference to CommunicationRequest resource
decision if Feedback to be shared with Health Facilities

to be mapped

error.code.coding.code

tblClaim.rejectionReason

mapped

error.code.text

tblClaim.rejectionReason as primary language text

to be mapped

item.adjudication.reason

tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason

adjudication.reason contains the rejection code
(with adjudication.category = "rejected_reason")

mapped

item.adjudication.value

tblClaimItems.QtyApproved

mapped

item.adjudication.amount

tblClaimItems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimItems.LimitationValue / tblClaimItems.RemuneratedAmount / tblClaimItems.DeductableAmount / tblClaimItems.ExceedCeilingAmount / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated / tblClaimServices.LimitationValue / tblClaimServices.RemunratedAmount / tblClaimServices.DeductableAmount / tblClaimServices.ExceededCeilingAmount

Monetary amount / value is taken from limitation value by default

The openIMIS field considered here depends on the status of the claims.

only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped

processNote.text

tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.Limitation / tblClaimServices.PriceOrigin

claimResponse.item.noteNumber can be used to join information about the mapped field and claim item

mapped - to be checked

disposition

not mapped

created

TimeUtils.date

current date is taken on the moment of processing claim

Should be mapped to ValidityTo for the date of last change?

mapped