Page Comparison

openIMIS Field

Card.

Type

ClaimResponse.identifier

0..*

Identifier

tblClaim.ClaimID

1..1

int

Claim database Primary Key

mapped

tblClaim.ClaimUUID

1..1

uniqueidentifier

Claim UUID

mapped

tblClaim.ClaimCode

1..1

nvarchar(8)

Claim Code - unique per HF

mapped

ClaimResponse.status

1..1

code

tblClaim.ReviewStatus

0..1

tinyint

status in [1: “Idle“, 2: “Not Selected”, 4: “Selected for Review”, 8: “Reviewed”, 16: “ByPassed”]

Required

mapped

ClaimResponse.type

1..1

CodeableConcept

tblClaim.VisitType

0..1

char(1)

Required

mapped

ClaimResponse.use

1..1

code

N/A

Always value “claim”

Required

mapped

ClaimResponse.patient

1..1

Reference(Patient)

tblClaim.InsureeID → tblInsuree.InsureeUUID

1..1

uniqueidentifier

Reference to Patient resource

Required

mapped

ClaimResponse.created

1..1

dateTime

tblClaim.ValidityFrom

1..1

datetime

Last update datetime. Currently set to current datetime.

Required

not mapped

ClaimResponse.insurer

1..1

Reference(Organization)

N/A

Always value “Organisation/openIMIS“

“openIMIS” can be changed in module configuration

Required

mapped

ClaimResponse.requestor

0..1

Reference(Practitioner | PractitionerRole | Organization)

tblHF.HealthFacility

reference to HealthcareService resource

mapped

outcome

tblClaim.ClaimStatus

changed from CodeableConcept to code

mapped

payment.adjustmentReason

tblClaim.Adjustment

mapped

total

[tblClaim.Approved, tblClaim.Valuated, tblClaim.Reinsured, tblClaim.Claimed]

List of total cost per claim status. Details in category in amount.

mapped

total.category.code

2: Claimed | 4: Checked | 8: Processed/Reviewed | 16: Valuated

based on the tblClaim.ClaimStatus

mapped

total.amount

tblClaim.Approved / tblClaim.Valuated / tblClaim.Reinsured / tblClaim.Claimed

returning the benefit amount
mapped as Money data type

mapped

communicationRequest

tblClaim.feedbackId → tblFeedback.FeedbackUUID

reference to CommunicationRequest resource
Provided only if the User has Claims.Feedback authority (111009)

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.Justification / tblClaimItems.RejectionReason / tblClaimServices.ClaimServiceStatus / tblClaimServices.Justification / tblClaimServices.RejectionReason

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

mapped

item.adjudication.value

tblClaimItems.QtyProvided / tblClaimitems.QtyApproved / tblClaimServices.QtyProvided / tblClaimServices.QtyApproved

mapped

item.adjudication.amount

tblClaimItems.PriceAsked / tblClaimitems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimServices.PriceAsked / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated

Monetary amount / value is taken from limitation value by default

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

mapped

processNote.text

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

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

mapped

disposition

not mapped

request

reference to Claim

mapped

extension.valuePeriod.billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

DateFrom and DateTo are mapped to a period of time between them

mapped - mandatory

extension.valueReference.diagnosis

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

reference to Condition resource

mapped - mandatory