FHIR Resource - Claim Response
OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices
FHIR field | OpenIMIS field | notes | mapping status |
---|
outcome | tblClaim.ClaimStatus | | mapped |
payment.adjustmentReason | tblClaim.Adjustment | | mapped |
totalBenefit | tblClaim.Approved | | mapped |
payment.date | tblClaimed.DateProcessed | | mapped |
communicationRequest | tblClaim.feedbackId | | mapped |
error | tblClaim.rejectionReason | | mapped |
item.adjudication.reason | tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code (with adjudication.category = "rejected_reason") | 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 | only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped |
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 | mapped |
disposition | | | not mapped |
created | TimeUtils.date | current date is taken on the moment of processing claim | mapped |
Endpoint specification:
Example of endpoint URL:
http://127.0.0.1:8000/api_fhir/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/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", |
stu3_fhir_identifier_type_config
| configuration of system and codes used to represent the specific types of identifiers | "stu3_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", }, |
stu3_fhir_claim_config | configuration of system and codes used to represent the specific types of claim codes | "stu3_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", }, |
stu3_fhir_communication_request_config | configuration of system and codes used to represent the specific codes for IMIS feedback attributes | "stu3_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:
...
"resourceType": "ClaimResponse", |
|
"communicationRequest": [ |
|
{
{
"reference": "CommunicationRequest/1" |
|
}
],
{
{ [{
}
]
}
}
],
{
{ [{
"system": "https://hl7.org/fhir/valueset-identifier-type.html" |
|
}
]
},
{
{ [{
"system": "https://hl7.org/fhir/valueset-identifier-type.html" |
|
}
]
},
}
],
{
[{
{ 2},
{},
{ [{
}
]
},
4},
{
{ {
"text": "rejected_reason" |
|
},
{ [{
}
]
}
}
],
[1
],
[
1
],
"sequenceLinkId": 1 |
|
{
[{
{ 4},
{},
{ [{
}
]
},
3},
{
{ {
"text": "rejected_reason" |
|
},
{ [{
}
]
}
}
],
[2
],
[
2
],
"sequenceLinkId": 2 |
|
}
],
[{
}
],
{
"date": "2010-11-16T00:00:00" |
|
{
"text": "item justification" |
|
{
"text": "service justification" |
|
}
],