Page Comparison

identifier

tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode

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

mapped

status

one of [entered, checked, reviewed, valuated] based on tblClaim.ClaimStatus

entered state by default

patient

tblClaim.InsureeUUID

reference to Patient resource

mapped - mandatory

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

DateFrom and DateTo 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

ClaimAttachment

see Claim Attachment section

facility

tblClaim.HFID

reference to HealthcareService resource
FHIR specification: reference to Location

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

provider

tblClaimAdmin.ClaimAdminUUID

reference to PractitionerRole resource

mapped for db tool reason

priority

code = “normal”

CodeableConcept

mapped for db tool reason

use

“claim”

mapped for db tool reason

status

“active”

mapped for db tool reason

claim.insurance.focal

True

mapped for db tool reason

claim.insurance.sequence

0

mapped for db tool reason

claim.insurance.coverage

tblPolicy.PolicyUUID

reference to Coverage resource

mapped for db tool reason