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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 | [tblClaim.Approved, tblClaim.Valuated, tblClaim.Reinsured, tblClaim.Claimed] | List of total cost per claim status. Details in category in amount. | |
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.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.amount | tblClaimItems.PriceAdjusted / tblClaimitems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimServices.PriceAdjusted / 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 | ||
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 key | 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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