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openIMIS tables mapped - tblClaim, tblClaimItems, tblClaimServices, tblInsuree
FHIR R4 | openIMIS | Notes | Mapping Status | ||||||||||||||||||||||||||||||||||||||
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FHIR R4 Field | CardinalityCard. | Type | openIMIS Field | CardinalityCard. | Type | ||||||||||||||||||||||||||||||||||||
0..* | tblClaim.ClaimID | 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 | |||||||||||||||||||||||||||||||||||||
patient | 1..1 | Reference(Patient)tblClaim. | InsureeUUIDreference to Patient 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.reason | tblClaimItems.ClaimItemStatus / tblClaimItems.Justification / tblClaimItems.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 | .amounttblClaimItems.PriceAsked / tblClaimitems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems. | PriceValuated / tblClaimServices.PriceAsked / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated Monetary amount | / value is taken from limitation value by defaultmapped | 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 | created | TimeUtils.date | current date is taken on the moment of processing claim Should be mapped to ValidityTo for the date of last change? | mapped | request | reference to Claim | mapped | type | tblClaim.VisitType | mapped | status | tblClaim.ReviewStatus | status in [1: “Idle“, 2: “Not Selected”, 4: “Selected for Review”, 8: “Reviewed”, 16: “ByPassed”] | mapped | requestor | tblHF.HealthFacility | reference to HealthcareService resource | mapped | use | “claim” | mapped | “Organisation/openIMIS“ | “openIMIS” from module configuration keytblClaimItems.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 |
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