FHIR R4 Resource - Claim Response ClaimResponse
OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices
FHIR R4 field | OpenIMIS field | notes | mapping status | |
---|---|---|---|---|
identifier | tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode | Claim 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 | |
totalBenefittotal.amount | tblClaim.Approved | does not exist in R4 | droppedmapped as Money data type | to be mapped |
payment.date | tblClaimed.DateProcessed | mappedopenIMIS 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 |
...