List of content:
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Description:
More information can be found here: openIMIS tblClaim resource (FHIR Claim / ClaimResponse)
Note:
ClaimResponse item sequenceLinkId pointing to value from the Claim.item
FHIR resources:
request | |
response |
Fields mapping:
Table legend:
Color | Description |
|---|---|
Mapped - |
the final choice, the most suitable choice | |
Need |
to be found the best place for the field (not mapped currently) | |
Currently not important - not mapped |
MappingMapping:
OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH | Mapping status |
ClaimItemID | PK | - | |||||
ClaimID | FK(tblClaim) | - | This resource is part of FHIR Claim. | ||||
Request | claim.item.category = 'product' | This is not in openIMIS but required in FHIR to differenciate Claim.Items and Claim.Services | mapped | ||||
ItemID | FK(tblItems) | Request | claim.item.service | We can try represent the item as a CodeableConcept (using item code). | OK | mapped | |
ProdID | FK(tblProduct) | Response | We can consider using the claimResponse.insurance. | Not required by external systems | |||
ClaimItemStatus | tinyint | Response | claimResponse.item.adjudication.reason | Default: 1 | The FHIR resource doesn't provide a place for that information but we can consider using the claimResponse.item.adjudication.reason field. | OK | mapped |
Availability | bit | Request | claim.information | The claim.item.informationSequence can be used to join the information with the claim item. | Not required by external systems | ||
QtyProvided | decimal | Request | claim.item.quantity | OK | mapped | ||
QtyApproved | decimal | Response | claimResponse.item.adjudication.value | OK | mapped | ||
PriceAsked | decimal | Request | claim.item.unitPrice | OK | mapped | ||
PriceAdjusted | decimal | Response | claimResponse.item.adjudication.amount | ||||
PriceApproved | decimal | Response | claimResponse.item.adjudication.amount | ||||
PriceValuated | decimal | Response | claimResponse.item.adjudication.amount | ||||
Explanation | ntext | Request | claim.information | The Claim.item.informationLinkId is used to join the explanation and claim item. The explanation isn't used in POST operation because of the uspUpdateClaimFromPhone procedure didn't contain that information. | Check also Claim.item.informationLinkId | mapped | |
Justification | ntext | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join justification and claim item | OK | mapped | |
RejectionReason | smallint | Response | claimResponse.item.adjudication.reason | adjudication.reason contains the rejection code. This is separate adjudication object (with adjudication.category = "rejected_reason") | mapped | ||
ValidityFrom | datetime | - | Audit information. More information can be found here (on page 113): | This information are valuable for OpenIMIS but I probably not required by external systems. | |||
ValidityTo | datetime | - | |||||
LegacyID | int | - | |||||
AuditUserID | int | - | |||||
ValidityFromReview | datetime | Response | I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions. | Not required by external systems | |||
ValidityToReview | datetime | Response | Not required by external systems | ||||
AuditUserIDReview | int | Response | Not required by external systems | ||||
LimitationValue | decimal | Response | claimResponse.item.adjudication.amount | OK | mapped | ||
Limitation | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about Limitation and claim item | |||
PolicyID | int | Response | Not required by external systems | ||||
RemuneratedAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||
DeductableAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||
ExceedCeilingAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||
PriceOrigin | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about PriceOrigin and claim item | Not required by external systems | ||
ExceedCeilingAmountCategory | decimal | - | I don't know when this field is used. | Check [uspProcessSingleClaimStep2] |