Page Comparison

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 - mandatory

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

date from and date to are mapped to a period of time between them

mapped - mandatory

diagnosis

tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4

reference to Condition resource

There is an error with the POST for both versions. When the error is found complete the mapping.

mapped - mandatory

from fhir to imis not mapped (diagnosis)

provider

tblClaim.Adjuster

to be validated

not mapped

total

tblClaim.Claimed

mapped as Money data type

mapped - mandatory

created

tblClaim.DateClaimed

mapped - mandatory

supportingInfo

tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation

information category is distinguishing the type of information
renamed from information (STU3) to supportingInfo (R4)

mapped

facility

tblClaim.HFID

reference to Location resource

mapped - mandatory

enterer

tblClaim.ClaimAdminId

reference to Practitioner resource

mapped

type

tblClaim.VisitType

mapped - mandatory

item.productOrService

tblClaimItems.tblItem.ItemCode / tblClaimServices.tblServices.ServiceCode

actual Code value

mapped - mandatory

item.extension.productOrServiceReference

tblClaimItems.ItemUUID / tblClaimServices.ServiceUUID

reference to Medication resource if medical item
reference to ActivityDefinition resource if medical service

mapped

item.quantity

tblClaimItems.QtyProvided / tblClaimServices.QtyProvided

mapped

item.unitPrice

tblClaimItems.PriceAsked / tblClaimServices.PriceAsked

price could differ from the price defined in medical item/service definition

mapped

item.category.text

“service” or “item”

distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped - mandatory

default_audit_user_id

default value which will be used for 'audit_user_id' field

"default_audit_user_id": 1,

R4_fhir_identifier_type_config

configuration of system and codes used to represent the specific types of identifiers

"R4_fhir_identifier_type_config":{
"system":"https://hl7.org/fhir/valueset-identifier-type.html",
"fhir_code_for_imis_db_uuid_type":"UUID",
"fhir_code_for_imis_db_id_type":"ACSN",
"fhir_code_for_imis_chfid_type":"SB",
"fhir_code_for_imis_passport_type":"PPN",
"fhir_code_for_imis_facility_id_type":"FI",
"fhir_code_for_imis_claim_admin_code_type":"FILL",
"fhir_code_for_imis_claim_code_type":"MR",
"fhir_code_for_imis_location_code_type":"LC",
"fhir_code_for_imis_diagnosis_code_type":"DC",
"fhir_code_for_imis_item_code_type":"IC",
"fhir_code_for_imis_service_code_type":"SC",
},

R4_fhir_issue_type_config

configuration of system and codes used to represent the specific types of operation outcome

"R4_fhir_issue_type_config":{
"fhir_code_for_exception":"exception",
"fhir_code_for_not_found":"not-found",
"fhir_code_for_informational":"informational"
},

R4_fhir_claim_config

configuration of system and codes used to represent the specific types of claim codes

"R4_fhir_claim_config":{
"fhir_claim_information_guarantee_id_code":"guarantee_id",
"fhir_claim_information_explanation_code":"explanation",
"fhir_claim_item_explanation_code":"item_explanation",
"fhir_claim_item_code":"item",
"fhir_claim_service_code":"service",
"fhir_claim_status_rejected_code":"rejected",
"fhir_claim_status_entered_code":"entered",
"fhir_claim_status_checked_code":"checked",
"fhir_claim_status_processed_code":"processed",
"fhir_claim_status_valuated_code":"valuatedevaluated",
"fhir_claim_item_status_code":"claim_item_status",
"fhir_claim_item_status_passed_code":"passed",
"fhir_claim_item_status_rejected_code":"rejected",
"fhir_claim_item_general_adjudication_code":"general",
"fhir_claim_item_rejected_reason_adjudication_code":"rejected_reason",
},