List of content:
...
| OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH | Mapping status |
| ClaimID | PK | Request | claim.Identifier | this isn't required, most important is the ClaimCode (see below) but FHIR claim can have multiple identifiers | I would include ClaimUUID into the Claim instead of ClaimID. | This is the Database ID and should be used only internally | |
| ClaimUUID | uniqueidentifier | Response | claim.Identifier | The unique identifier used as PK for FHIR | Will be added when will be available in the python claim module | mapped | |
| InsureeID | FK(tblInsuree) | Request | claim.patient - Reference(Patient) | The subject of the Products and Services | We can represent the insuree as the FHIR patient resource but the most important is claim.patient.identifier | claim.patient.identifier | mapped |
| ClaimCode | nvarchar | Request | claim.Identifier | Claim number | OK | mapped | |
| DateFrom | smalldatetime | Request | claim.billablePeriod | Period for charge submission | OK | mapped | |
| DateTo | smalldatetime | Request | Period for charge submission | mapped | |||
| ICDID | FK(tblICDCodes) | Request | claim.diagnosis | List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | mapped |
| ClaimStatus | tinyint | Response | claimResponse.outcome | Default value: 2; 1 - rejected 2 - entered 4 - checked 8 - processed 16 - valuated | Used the FHIR codeable concept (code = imis_status, text = displayed status) | Can be also a combination of claimResponse.status and claimResponse.outcome but limited in values. Extension required? | mapped |
| Adjuster | FK(tblUsers) | Request | claim.provider - Reference(Practitioner) | Responsible provider | I'm not sure if this field is used, all records created by me have null values in that field. | Only reference to openIMIS user. | |
| Adjustment | ntext | Response | claimResponse.payment.adjustmentReason | Used FHIR adjustmentReason because of the IMIS Adjustment is text. | claimResponse.payment.adjustment | mapped | |
| Claimed | decimal | Request | claim.total | Total claim cost | OK | mapped | |
| Approved | decimal | Response | claimResponse.totalBenefit | OK | mapped | ||
| Reinsured | decimal | Response | If needed we can create the FHIR extension. | ||||
| Valuated | decimal | Response | If needed we can create the FHIR extension. | ||||
| DateClaimed | date | Request | claim.created | default: getDate() | OK | mapped | |
| DateProcessed | smalldatetime | Response | claimResponse.payment.date | claimResponse.created is used is the request date | If different endpoint to claimResponse, claimResponse.created will be the request date. Maybe claimResponse.payment.date | mapped | |
| Feedback | bit | default value: 0 | No need. To see if replaced by FeedbackID | ||||
| FeedbackID | FK(tblFeedback) | Response | claimResponse.communicationRequest | default value: 0 | claimResponse.communicationRequest | mapped | |
| Explanation | ntext | Request | claim.information.valueString | Additional Data or supporting information | OK | mapped | |
| FeedbackStatus | tinyint | - | default value: 1 1 - idle 2 - not selected 4 - selected for feedback 8 - delicered 16 - by passed else select status | This field probably is used only by the OpenIMIS and isn't requirement by external systems. | Only used internally | ||
| ReviewStatus | tinyint | - | default value: 1 1 - idle 2 - not selected 4 - selected for review 8 - reviewed 16 - by passed else select status | This field probably is used only by the OpenIMIS and isn't requirement by external systems. | Only used internally | ||
| ApprovalStatus | tinyint | - | default value: 1; | Probably not used field | |||
| RejectionReason | tinyint | Response | claimResponse.error | default value: 0 | In Web App we have the rejection reason for each Item and Service in a Claim. We should provide these reasons. | mapped | |
| ValidityFrom | datetime | - | Audit information. More information can be found here (on page 113): Web application - Functional Design Specification.pdf | This information are valuable for OpenIMIS but probably not required by external systems. | |||
| ValidityTo | datetime | - | |||||
| LegacyID | int | - | |||||
| AuditUserID | int | - | |||||
| ValidityFromReview | datetime | Response | I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions. | I don't think this information is valuable for external systems. It's only used internally. | |||
| ValidityToReview | datetime | Response | |||||
| AuditUserIDReview | int | Response | |||||
| RowID | timestamp | - | I'm not sure but this is probably some unique value used to distinguish database rows. Probably not useful for external systems. | Not used by external systems. | |||
| HFID | FK(tblHF) | Request | claim.facility - Reference(Location) | Servicing Facility | Could also be Claim.organization | ||
| RunID | FK(tblBatchRun) | - | This is probably useful only for the internal system not for external systems. If needed add the FHIR extension can be considered. | Not used by external systems. | |||
| AuditUserIDSubmit | int | Response | I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions. | ||||
| AuditUserIDProcess | int | Response | |||||
| SubmitStamp | datetime | Response | |||||
| ProcessStamp | datetime | Response | |||||
| Remunerated | decimal | Response | If needed we can create the FHIR extension. | ||||
| GuaranteeId | nvarchar | Request | claim.information.valueString | Additional Data or supporting information | I couldn't find a better place for information about the guarantee Id. The FHIR claim can consider multiple information elements. We can use the information category to distinguish the type of information. | Claim.insurance.preAuthRef | |
| ClaimAdminId | FK(tblClaimAdmin) | Request | claim.enterer - Reference(PractitionerRole) | Author | This information is present in the API token? | ||
| ICDID1 | int | Request | claim.diagnosis | diagnosis 1 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | |
| ICDID2 | int | Request | claim.diagnosis | diagnosis 2 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | |
| ICDID3 | int | Request | claim.diagnosis | diagnosis 3 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | Ok | |
| ICDID4 | int | Request | claim.diagnosis | diagnosis 4 from List of Diagnosis | If ICD is some fixed set of coded value then we can use the CodeableCondept to describe this. The sequence field can be used to create an order of diagnosis. | OK | |
| VisitType | char | Request | claim.type | E - emergency R - referrals O - other "" - select type | OK | ||
| ClaimCategory | char | - | I didn't find the logic related to this field. | I don't think is used externally. |
...
Example JSON representation of content:
FHIR Claim (http://127.0.0.1:8000/api_fhir/Claim/clCode1):
| Code Block |
|---|
{
"resourceType":"Claim",
"billablePeriod":{
"end":"2019-06-12T00:00:00",
"start":"2019-06-01T00:00:00"
},
"created":"2019-06-12T00:00:00",
"diagnosis":[
{
"diagnosisCodeableConcept":{
"coding":[
{
"code":"ICD_CD"
}
]
},
"sequence":1,
"type":[
{
"text":"icd_0"
}
]
}
],
"enterer":{
"reference":"Practitioner/1234abcd"
},
"facility":{
"reference":"Location/12345678"
},
"id":"code",
"identifier":[
{
"type":{
"coding":[
{
"code":"ACSN",
"system":"https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use":"usual",
"value":"E9B13CFA-62D0-4B2C-B08B-477265B1587D"
},
{
"type":{
"coding":[
{
"code":"MR",
"system":"https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use":"usual",
"value":"code"
}
],
"information":[
{
"category":{
"text":"guarantee_id"
},
"sequence":1,
"valueString":"guarantee_id"
},
{
"category":{
"text":"explanation"
},
"sequence":2,
"valueString":"explanation"
},
{
"category":{
"text":"item_explanation"
},
"sequence":3,
"valueString":"item_explanation"
},
{
"category":{
"text":"item_explanation"
},
"sequence":4,
"valueString":"service_explanation"
}
],
"item":[
{
"category":{
"text":"item"
},
"informationLinkId":[
3
],
"quantity":{
"value":4
},
"sequence":1,
"service":{
"text":"iCode"
},
"unitPrice":{
"value":21.1
}
},
{
"category":{
"text":"service"
},
"informationLinkId":[
4
],
"quantity":{
"value":3
},
"sequence":2,
"service":{
"text":"sCode"
},
"unitPrice":{
"value":16.1
}
}
],
"patient":{
"reference":"Patient/TEST_CHF_ID"
},
"total":{
"value":42
},
"type":{
"text":"E"
}
} |
FHIR ClaimResponse (http://127.0.0.1:8000/api_fhir/ClaimResponse/clCode1/):
| Code Block |
|---|
{
"resourceType": "ClaimResponse",
"communicationRequest": [
{
"reference": "CommunicationRequest/F719B223-83A7-44A1-8F21-7B80E5B9FDD0"
}
],
"error": [
{
"code": {
"coding": [
{
"code": "1"
}
]
}
}
],
"id": "code",
"identifier": [
{
"type": {
"coding": [
{
"code": "ACSN",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "E9B13CFA-62D0-4B2C-B08B-477265B1587D"
},
{
"type": {
"coding": [
{
"code": "MR",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "code"
}
],
"item": [
{
"adjudication": [
{
"amount": {
"value": 2
},
"category": {
"text": "general"
},
"reason": {
"coding": [
{
"code": "1",
"system": "passed"
}
]
},
"value": 4
},
{
"category": {
"text": "rejected_reason"
},
"reason": {
"coding": [
{
"code": "1"
}
]
}
}
],
"noteNumber": [
1
],
"sequenceLinkId": 1
},
{
"adjudication": [
{
"amount": {
"value": 4
},
"category": {
"text": "general"
},
"reason": {
"coding": [
{
"code": "2",
"system": "rejected"
}
]
},
"value": 3
},
{
"category": {
"text": "rejected_reason"
},
"reason": {
"coding": [
{
"code": "3"
}
]
}
}
],
"noteNumber": [
2
],
"sequenceLinkId": 2
}
],
"outcome": {
"coding": [
{
"code": "1"
}
],
"text": "rejected"
},
"payment": {
"adjustmentReason": {
"text": "adjustment"
},
"date": "2010-11-16T00:00:00"
},
"processNote": [
{
"number": 1,
"text": "item justification"
},
{
"number": 2,
"text": "service justification"
}
],
"totalBenefit": {
"value": 214.25
}
"request": {
"reference": "Claim/clCode1"
}
} |
...