FHIR R4 Resource - ClaimResponse
OpenIMIS openIMIS tables mapped - tblClaim, tblClaimItems, tblClaimServices, tblInsuree
FHIR R4 | fieldOpenIMIS field | notes | mapping status | identifieropenIMIS | Notes | Mapping Status | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
FHIR R4 Field | Card. | Type | openIMIS Field | Card. | Type | ||||||||
0..* | tblClaim.ClaimID | / tblClaim.ClaimUUID / tblClaim.ClaimCodeClaim can have multiple identifiers. The most important one is mapped from ClaimUUID. | mapped ? | ||||||||||
patient | tblClaim.InsureeUUID | reference to Patient resource | mapped ? | ||||||||||
outcome | tblClaim.ClaimStatus | changed from CodeableConcept to code | mapped | payment.adjustmentReason | tblClaim.Adjustment | mapped | |||||||
total.category.code | string “benefit” | returning the benefit amount | to be mapped | ||||||||||
total.amount | tblClaim.Approved | mapped as Money data type | to be mapped | ||||||||||
payment.date | tblClaimed.DateProcessed | openIMIS doesn’t specify any payment date. Payment is done from external systems. | to be removed | ||||||||||
communicationRequest | tblClaim.feedbackId | reference to CommunicationRequest resource | to be mapped | error.code.coding.code | tblClaim.rejectionReason | mapped | error.code.text | tblClaim.rejectionReason as primary language text | to be mapped | ||||
item.adjudication.reason | tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code | mapped | item.adjudication.value | tblClaimItems.QtyApproved | mapped | |||||||
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 | Monetary amount / value is taken from limitation value by default This the openIMIS field considered here depends on the status of the claims. | only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped | ||||||||||
processNote.text | 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 | mapped - to be checked | disposition | not mapped | ||||||||
created | TimeUtils.date | current date is taken on the moment of processing claim | mapped |
Endpoint specification:
Example of endpoint URL:
http://localhost:8000/api_fhir_R4/ClaimResponse/
Supported HTTP operation:
CREATE - the operation not supported
READ - by default return list of all available resources. To fetch information about a specific object you should add the primary key to URL for instance:
http://127.0.0.1:8000/api_fhir_R4/ClaimResponse/{claimcode}
, where "{claimcode}" is the value of the primary key (claim code in case of that resource). Should be used the GET HTTP method.UPDATE - the operation not supported
DELETE - the operation not supported
Module configuration used by the endpoint:
...
Configuration key
...
Description
...
Default value
...
iso_date_format
...
iso format used for FHIR date representation
...
"iso_date_format": "%Y-%m-%d",
...
iso_datetime_format
...
iso format used for FHIR datetime representation
...
"iso_datetime_format": "%Y-%m-%dT%H:%M:%S",
R4_fhir_identifier_type_config
...
configuration of system and codes used to represent the specific types of identifiers
...
"R4_fhir_identifier_type_config":{
"system":"https://hl7.org/fhir/valueset-identifier-type.html",
"fhir_code_for_imis_db_id_type":"ACSN",
"fhir_code_for_imis_chfid_type":"SB",
"fhir_code_for_imis_passport_type":"PPN",
"fhir_code_for_imis_facility_id_type":"FI",
"fhir_code_for_imis_claim_admin_code_type":"FILL",
"fhir_code_for_imis_claim_code_type":"MR",
},
...
R4_fhir_claim_config
...
configuration of system and codes used to represent the specific types of claim codes
...
"R4_fhir_claim_config":{
"fhir_claim_information_guarantee_id_code":"guarantee_id",
"fhir_claim_information_explanation_code":"explanation",
"fhir_claim_item_explanation_code":"item_explanation",
"fhir_claim_item_code":"item",
"fhir_claim_service_code":"service",
"fhir_claim_status_rejected_code":"rejected",
"fhir_claim_status_entered_code":"entered",
"fhir_claim_status_checked_code":"checked",
"fhir_claim_status_processed_code":"processed",
"fhir_claim_status_valuated_code":"valuated",
"fhir_claim_item_status_code":"claim_item_status",
"fhir_claim_item_status_passed_code":"passed",
"fhir_claim_item_status_rejected_code":"rejected",
"fhir_claim_item_general_adjudication_code":"general",
"fhir_claim_item_rejected_reason_adjudication_code":"rejected_reason",
},
...
R4_fhir_communication_request_config
...
configuration of system and codes used to represent the specific codes for IMIS feedback attributes
...
"R4_fhir_communication_request_config":{
"fhir_care_rendered_code":"care_rendered",
"fhir_payment_asked_code":"payment_asked",
"fhir_drug_prescribed_code":"drug_prescribed",
"fhir_drug_received_code":"drug_received",
"fhir_asessment_code":"asessment"
}
Example JSON Representation of Content:
As in the other resources there is an error and therefore this file is shown.
Code Block | 1..1 | int | Claim database Primary Key | mapped | |||
---|---|---|---|---|---|---|---|
tblClaim.ClaimUUID | 1..1 | uniqueidentifier | Claim UUID | mapped | |||
tblClaim.ClaimCode | 1..1 | nvarchar(8) | Claim Code - unique per HF | mapped | |||
1..1 | tblClaim.ReviewStatus | 0..1 | tinyint | status in [1: “Idle“, 2: “Not Selected”, 4: “Selected for Review”, 8: “Reviewed”, 16: “ByPassed”] Required | mapped | ||
1..1 | tblClaim.VisitType | 0..1 | char(1) | Required | mapped | ||
1..1 | N/A | Always value “claim” Required | mapped | ||||
1..1 | tblClaim.InsureeID → tblInsuree.InsureeUUID | 1..1 | uniqueidentifier | Reference to Patient resource Required | mapped | ||
1..1 | tblClaim.ValidityFrom | 1..1 | datetime | Last update datetime. Currently set to current datetime. Required | not mapped | ||
1..1 | N/A | Always value “Organisation/openIMIS“ “openIMIS” can be changed in module configuration Required | mapped | ||||
0..1 | tblHF.HealthFacility | reference to HealthcareService resource | mapped | ||||
outcome | tblClaim.ClaimStatus | changed from CodeableConcept to code | mapped | ||||
payment.adjustmentReason | tblClaim.Adjustment | mapped | |||||
total | [tblClaim.Approved, tblClaim.Valuated, tblClaim.Reinsured, tblClaim.Claimed] | List of total cost per claim status. Details in category in amount. | mapped | ||||
total.category.code | 2: Claimed | 4: Checked | 8: Processed/Reviewed | 16: Valuated | based on the tblClaim.ClaimStatus | mapped | ||||
total.amount | tblClaim.Approved / tblClaim.Valuated / tblClaim.Reinsured / tblClaim.Claimed | returning the benefit amount | mapped | ||||
communicationRequest | tblClaim.feedbackId → tblFeedback.FeedbackUUID | reference to CommunicationRequest resource | mapped | ||||
error.code.coding.code | tblClaim.rejectionReason | mapped | |||||
error.code.text | tblClaim.rejectionReason as primary language text | to be mapped | |||||
item.adjudication.category | Claim.ReviewStatus value represented by the adjudication value. | 2: Claimed | 4: Checked | 8: Processed/Reviewed | 16: Valuated | mapped | ||||
item.adjudication.reason | tblClaimItems.ClaimItemStatus / tblClaimItems.Justification / tblClaimItems.RejectionReason / tblClaimServices.ClaimServiceStatus / tblClaimServices.Justification / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code | mapped | ||||
item.adjudication.value | tblClaimItems.QtyProvided / tblClaimitems.QtyApproved / tblClaimServices.QtyProvided / tblClaimServices.QtyApproved | mapped | |||||
item.adjudication.amount | tblClaimItems.PriceAsked / tblClaimitems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimServices.PriceAsked / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated | Monetary amount / value is taken from limitation value by default The openIMIS field considered here depends on the status of the claims. | mapped | ||||
processNote.text | tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.PriceOrigin | claimResponse.item.noteNumber can be used to join information about the mapped field and claim item | mapped | ||||
disposition | not mapped | ||||||
request | reference to Claim | mapped | |||||
extension.valuePeriod.billablePeriod | tblClaim.DateFrom / tblClaim.DateTo | DateFrom and DateTo are mapped to a period of time between them | mapped - mandatory | ||||
extension.valueReference.diagnosis | tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4 | reference to Condition resource | mapped - mandatory |
Endpoint specification:
Example of endpoint URL:
http://localhost:8000/api_fhir_r4/ClaimResponse/
Supported HTTP operation:
POST - the operation not supported
GET - by default return list of all available resources. To fetch information about a specific object you should add the Claim UUID to URL for instance:
http://127.0.0.1:8000/api_fhir_r4/ClaimResponse/{ClaimUUID}PUT - the operation not supported
DELETE - the operation not supported
Module configuration used by the endpoint:
Configuration key | Description | Default value |
---|---|---|
iso_date_format | iso format used for FHIR date representation | "iso_date_format": "%Y-%m-%d", |
iso_datetime_format | iso format used for FHIR datetime representation | "iso_datetime_format": "%Y-%m-%dT%H:%M:%S", |
R4_fhir_identifier_type_config | configuration of system and codes used to represent the specific types of identifiers | "R4_fhir_identifier_type_config":{ |
R4_fhir_claim_config | configuration of system and codes used to represent the specific types of claim codes | "R4_fhir_claim_config":{ |
R4_fhir_communication_request_config | configuration of system and codes used to represent the specific codes for IMIS feedback attributes | "R4_fhir_communication_request_config":{ |
Example JSON Representation of Content:
As in the other resources there is an error and therefore this file is shown.
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