List of content:
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More information can be found here: openIMIS tblClaim resource (FHIR Claim / ClaimResponse)
Note:
- ClaimResponse item sequenceLinkId pointing to value from the Claim.item
FHIR resources:
request | Claim.item |
response | ClaimResponse.item |
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OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH | Mapping status | |
ClaimServiceID | PK | - | ||||||
ClaimID | FK(tblClaim) | - | This resource is part of FHIR claim. | |||||
Request | claim.item.category.text = 'service' | This is not in openIMIS but required in FHIR to differenciate Claim.Items and Claim.Services | mapped | |||||
ServiceID | FK(tblServices) | Request | claim.item.service | We can try represent the item as a CodeableConcept (using service code). | OK | mapped | ||
ProdID | FK(tblProduct) | Response | We can consider using the claimResponse.insurance. | Not required by external systems | ||||
ClaimServiceStatus | tinyint | Response | 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 | ||
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 claimThe Claim.item. | informationSequence can beinformationLinkId 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 Claim.item.informationLinkId | 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 | I didn't find informaition about the RejectionReson codes.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] |