Identifieridentifier

tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode

Claim can have multiple identifiers. The most important one is mapped from ClaimCodeClaimUUID.

ClaimID and ClaimCode mapped

patient

tblClaim.InsureeIDInsureeUUID

reference to Patient resource

mapped - mandatory

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

date from and date to are mapped to a period of time between them

mapped - mandatory

diagnosis

tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4

ICDID values are mapped to a list of diagnosis

mappedreference to Condition resource

to be mapped - mandatory

provider

tblClaim.Adjuster

to be validated

not mapped

claimCode

dateFrom

dateTo

total

tblClaim.Claimed

mapped as Money data type

mapped - mandatory

created

tblClaim.DateClaimed

mapped - mandatory

supportingInfo

tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation

information category is distinguishing the type of information

renamed from information (STU3) to supportingInfo (R4)

mapped

facility

tblClaim.HFID

reference to Location resource

mapped - mandatory

enterer

tblClaim.ClaimAdminId

reference to Practitioner resource

mapped

type

tblClaim.VisitType

mapped - mandatory

item.productOrService

tblClaimItems.ItemId / tblClaimServices.ServiceID

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

renamed from service to productOrService

mappedServiceId
=>
tblItems.ItemCode / tblServices.ServiceCode

reference to Medication resource if medical item
reference to ActivityDefinition resource if medical service

to be mapped - mandatory

item.quantity

tblClaimItems.QtyProvided / tblClaimServices.QtyProvidedclaim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.unitPrice

tblClaimItems.PriceAsked / tblClaimServices.PriceAskedclaim.

price could differ from the price defined in medical item/service definition

mapped

item.category.text is

“service” or “item”

distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped - mandatory