FHIR R4 Resource - Claim
openIMIS tables mapped - tblClaim , tblClaimItems , tblClaimServices
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FHIR R4 field
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openIMIS field
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notes
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mapping status
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tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode
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Claim can have multiple identifiers. The most important one is mapped from ClaimUUID.
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mapped
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one of [entered, checked, reviewed, valuated] based on tblClaim.ClaimStatus
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entered state by default
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tblClaim.InsureeUUID
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reference to Patient resource
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mapped - mandatory
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tblClaim.DateFrom / tblClaim.DateTo
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DateFrom and DateTo are mapped to a period of time between them
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mapped - mandatory
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tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4
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reference to Condition resource
There is an error with the POST for both versions. When the error is found complete the mapping.
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mapped - mandatory
from fhir to imis not mapped (diagnosis)
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provider
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tblClaim.Adjuster
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to be validated
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not mapped
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tblClaim.Claimed
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mapped as Money data type
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mapped - mandatory
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tblClaim.DateClaimed
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mapped - mandatory
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supportingInfo
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tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation
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information category is distinguishing the type of information
renamed from information (STU3) to supportingInfo (R4)
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mapped
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tblClaim.HFID
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reference to HealthcareService resource
FHIR specification: reference to Location 
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mapped - mandatory
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tblClaim.ClaimAdminId
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reference to Practitioner resource
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mapped
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tblClaim.VisitType
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mapped - mandatory
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item.productOrService
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tblClaimItems.tblItem.ItemCode / tblClaimServices.tblServices.ServiceCode
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actual Code value
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mapped - mandatory
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item.extension.productOrServiceReference
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tblClaimItems.ItemUUID / tblClaimServices.ServiceUUID
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reference to Medication resource if medical item
reference to ActivityDefinition resource if medical service
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mapped
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item.quantity
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tblClaimItems.QtyProvided / tblClaimServices.QtyProvided
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mapped
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item.unitPrice
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tblClaimItems.PriceAsked / tblClaimServices.PriceAsked
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price could differ from the price defined in medical item/service definition
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mapped
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item.category.text
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“service” or “item”
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distinguishing whether mapping is done from tblClaimsServices or tblClaimItems
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mapped - mandatory
Endpoint specification:
Example of endpoint URL:
http://localhost:8000/api_fhir_R4/Claim/
Supported HTTP operation:
POST - used to submit a new claim. List of supported fields can be found in the table which shows the mapping between openIMIS and FHIR and the body has JSON representation (example can be found below).
The response is:OperationOutcome which notice about the failure (list of possible errors);
ClaimResponse which notice about the success.
GET - by default return list of all available resources. To fetch information about a specific object you should add the Claim UUID to URL for instance:
http://localhost:8000/api_fhir_R4/Claim/{ClaimUUID}PUT - the operation currently not supported
DELETE - the operation currently not supported
Module configuration used by the endpoint:
Configuration key | Description | Default value |
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default_audit_user_id | default value which will be used for 'audit_user_id' field | "default_audit_user_id": 1, |
R4_fhir_identifier_type_config | configuration of system and codes used to represent the specific types of identifiers | "R4_fhir_identifier_type_config":{ |
R4_fhir_issue_type_config | configuration of system and codes used to represent the specific types of operation outcome | "R4_fhir_issue_type_config":{ |
R4_fhir_claim_config | configuration of system and codes used to represent the specific types of claim codes | "R4_fhir_claim_config":{ |
Example JSON representation of content:
As in the other resources there is an error and therefore this file is shown.
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| language | json |
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| Code Block |
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{ "resourceType": "Claim", "billablePeriod": { "end": "2019-05-13", "start": "2019-05-13" }, "created": "2019-05-14", "diagnosis": [ { "diagnosisReference": { "reference": "Condition/A03" }, "sequence": 1, "type": [ { "coding": [ { "code": "icd_0" } ] } ] }, { "diagnosisReference": { "reference": "Condition/A01" }, "sequence": 2, "type": [ { "coding": [ { "code": "icd_1" } ] } ] }, { "diagnosisReference": { "reference": "Condition/A02" }, "sequence": 3, "type": [ { "coding": [ { "code": "icd_2" } ] } ] } ], "enterer": { "reference": "Practitioner/BC32112F-9DF2-4F46-AD5D-97727E07CBD7" }, "facility": { "reference": "HealthcareService/50E9ABD9-A826-4071-BFED-F731F5FAFB55" }, "id": "6F6062DB-F912-4FC9-B659-BA9D0032EF99", "identifier": [ { "type": { "coding": [ { "code": "UUID", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "6F6062DB-F912-4FC9-B659-BA9D0032EF99" }, { "type": { "coding": [ { "code": "MR", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "chs123" } ], "item": [ { "category": { "text": "item" }, "extension": [ { "url": "Medication", "valueReference": { "reference": "Medication/369c1437-48ae-4f7a-b8f4-2b8e5d8bdf51" } } ], "productOrService": { "text": "0002" }, "quantity": { "value": 1.0 }, "sequence": 1, "unitPrice": { "currency": "$", "value": 1000.0 } }, { "category": { "text": "item" }, "extension": [ { "url": "Medication", "valueReference": { "reference": "Medication/0dcd4105-acf0-478c-9fc0-de65309ade86" } } ], "productOrService": { "text": "0002" }, "quantity": { "value": 1.0 }, "sequence": 2, "unitPrice": { "currency": "$", "value": 1000.0 } }, { "category": { "text": "item" }, "extension": [ { "url": "Medication", "valueReference": { "reference": "Medication/87211a50-ad85-4fc1-bc76-5b30c24469b7" } } ], "productOrService": { "text": "0002" }, "quantity": { "value": 1.0 }, "sequence": 3, "unitPrice": { "currency": "$", "value": 1000.0 } }, { "category": { "text": "service" }, "extension": [ { "url": "ActivityDefinition", "valueReference": { "reference": "ActivityDefinition/863ab2d2-9519-4f80-bc58-d54fb6e3ba79" } } ], "productOrService": { "text": "M4" }, "quantity": { "value": 1.0 }, "sequence": 4, "unitPrice": { "currency": "$", "value": 21000.0 } }, { "category": { "text": "service" }, "extension": [ { "url": "ActivityDefinition", "valueReference": { "reference": "ActivityDefinition/0f836206-4f8c-4f49-ae4e-19853a590018" } } ], "productOrService": { "text": "M3" }, "quantity": { "value": 1.0 }, "sequence": 5, "unitPrice": { "currency": "$", "value": 21000.0 } }, { "category": { "text": "service" }, "extension": [ { "url": "ActivityDefinition", "valueReference": { "reference": "ActivityDefinition/9a64c4f9-8096-412f-91fc-7c2ffac1c7e7" } } ], "productOrService": { "text": "M6" }, "quantity": { "value": 1.0 }, "sequence": 6, "unitPrice": { "currency": "$", "value": 21000.0 } }, { "category": { "text": "service" }, "extension": [ { "url": "ActivityDefinition", "valueReference": { "reference": "ActivityDefinition/fedc55c6-7cd1-43e8-a266-c107bf059c1b" } } ], "productOrService": { "text": "M2" }, "quantity": { "value": 1.0 }, "sequence": 7, "unitPrice": { "currency": "$", "value": 21000.0 } } ], "patient": { "reference": "Patient/F2EC72C9-7489-45AA-95C5-30D79216E74F" }, "supportingInfo": [ { "category": { "text": "guarantee_id" }, "sequence": 1, "valueString": "sdasdasd" }, { "category": { "text": "explanation" }, "sequence": 2, "valueString": "asdasdasd" } ], "total": { "currency": "$", "value": 87000.0 }, "type": { "text": "E" } } |