Page Comparison

openIMIS Field

Card.

Type

ClaimResponse.identifier

0..*

Identifier

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

ClaimResponse.status

1..1

code

tblClaim.ReviewStatus

0..1

tinyint

status in [1: “Idle“, 2: “Not Selected”, 4: “Selected for Review”, 8: “Reviewed”, 16: “ByPassed”]

Required

mapped

ClaimResponse.type

1..1

CodeableConcept

tblClaim.VisitType

0..1

char(1)

Required

mapped

ClaimResponse.use

1..1

code

N/A

Always value “claim”

Required

mapped

ClaimResponse.patient

1..1

Reference(Patient)

tblClaim.InsureeID → tblInsuree.InsureeUUID

1..1

uniqueidentifier

Reference to Patient resource

Required

mapped

ClaimResponse.created

1..1

dateTime

tblClaim.ValidityFrom

1..1

datetime

Last update datetime. Currently set to current datetime.

Required

not mapped

ClaimResponse.insurer

1..1

Reference(Organization)

N/A

Always value “Organisation/openIMIS“

“openIMIS” can be changed in module configuration

Required

mapped

ClaimResponse.requestor

0..1

Reference(Practitioner | PractitionerRole | Organization)

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 as Money data type

mapped

communicationRequest

tblClaim.feedbackId → tblFeedback.FeedbackUUID

reference to CommunicationRequest resource
Provided only if the User has Claims.Feedback authority (111009)

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
(with adjudication.category = "rejected_reason")

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