List of content:
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OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH | Mapping status | ||
ClaimItemID | PK | - | |||||||
ClaimID | FK(tblClaim) | - | This resource is part of FHIR Claim. | ||||||
Request | claim.item.category = 'product' | This is not in openIMIS but required in FHIR to differenciate Claim.Items and Claim.Services | mapped | ||||||
ItemID | FK(tblItems) | Request | claim.item.service | We can try represent the item as a CodeableConcept (using item code). | OK | mapped | |||
ProdID | FK(tblProduct) | Response | We can consider using the claimResponse.insurance. | Not required by external systems | |||||
ClaimItemStatus | tinyint | Response | claimResponse.item.adjudication.reason | Default: 1 1 - passed 2 - rejected | The FHIR resource doesn't provide a place for that information but we can consider using the claimResponse.item.adjudication.reason field. | OK | mapped | ||
Availability | bit | Request | claim.information | The claim.item.informationSequence can be used to join the information with the claim item. | Not required by external systems | ||||
QtyProvided | decimal | Request | claim.item.quantity | OK | mapped | ||||
QtyApproved | decimal | Response | claimResponse.item.adjudication.value | OK | mapped | ||||
PriceAsked | decimal | Request | claim.item.unitPrice | OK | mapped | ||||
PriceAdjusted | decimal | Response | claimResponse.item.adjudication.amount | ||||||
PriceApproved | decimal | Response | claimResponse.item.adjudication.amount | ||||||
PriceValuated | decimal | Response | claimResponse.item.adjudication.amount | ||||||
Explanation | ntext | Request | claim.information | The Claim.item.informationLinkId is used to join the explanation and claim item. The explanation isn't used in POST operation because of the uspUpdateClaimFromPhone procedure didn't contain that information. | Check also
| mapped | |||
Justification | ntext | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join justification and claim item | OK | mapped | |||
RejectionReason | smallint | Response | claimResponse.item.adjudication.reason | adjudication.reason contains the rejection code. This is separate adjudication object (with adjudication.category = "rejected_reason") | Check web_app_vb/IMIS_BL/General.vb#L914 | 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 I 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. | Not required by external systems | |||||
ValidityToReview | datetime | Response | Not required by external systems | ||||||
AuditUserIDReview | int | Response | Not required by external systems | ||||||
LimitationValue | decimal | Response | claimResponse.item.adjudication.amount | OK | mapped | ||||
Limitation | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about Limitation and claim item | |||||
PolicyID | int | Response | Not required by external systems | ||||||
RemuneratedAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||||
DeductableAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||||
ExceedCeilingAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||||
PriceOrigin | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about PriceOrigin and claim item | Not required by external systems | ||||
ExceedCeilingAmountCategory | decimal | - | I don't know when this field is used. | Check [uspProcessSingleClaimStep2] |
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