FHIR Resource | OpenIMIS database table | notes | mapping status |
|---|---|---|---|
Claim | Request properties are mapped to Claim | ||
ClaimResponse | tblClaim | Response properties are mapped to Claim | |
Coverage | tblPolicy | ||
Patient | tblInsuree | ||
Practitioner | tblClaimAdmin | used to represent base fields of Claim Administrator (without relation with health facility- FHIR Location) | |
PractitionerRole | tblClaimAdmin | used to represent a relation between base ClaimAdmin (FHIR Practitioner) and Health facility (FHIR Location) | |
Location | tblHF / tblLocations | FHIR location.mode field is used to switch between mapping from tblHF and tblLocations | |
EligibilityRequest | EligibilityRequest | ||
CommunicationRequest | tblFeedback |
Claim
ClaimResponse
...
FHIR field
...
OpenIMIS field
...
notes
...
mapping status
...
outcome
...
tblClaim.ClaimStatus
...
payment.adjustmentReason
...
tblClaim.Adjustment
...
totalBenefit
...
tblClaim.Approved
...
payment.date
...
tblClaimed.DateProcessed
...
communicationRequest
...
tblClaim.feedbackId
...
error
...
tblClaim.rejectionReason
...
item.adjudication.reason
...
tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason
...
adjudication.reason contains the rejection code
(with adjudication.category = "rejected_reason")
...
item.adjudication.value
...
tblClaimItems.QtyApproved
...
item.adjudication.amount
...
tblClaimItems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimItems.LimitationValue / tblClaimItems.RemuneratedAmount / tblClaimItems.DeductableAmount / tblClaimItems.ExceedCeilingAmount / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated / tblClaimServices.LimitationValue / tblClaimServices.RemunratedAmount / tblClaimServices.DeductableAmount / tblClaimServices.ExceededCeilingAmount
...
processNote
...
tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.Limitation / tblClaimServices.PriceOrigin
...
claimResponse.item.noteNumber can be used to join information about the mapped field and claim item
Coverage
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
Identifier | PolicyID / PolicyUUID | ||
policyHolder | FamilyID | ||
period | StartDate / ExpiryDate | start date and expiry date are mapped to a period of time between them | |
status | PolicyStatus | ||
contract.valuedItem.net | PolicyValue | ||
grouping | ProdID | ||
contract.agent.actor | OfficerID |
...