List of content:

Description:

The EligibilityRequest can be used via a provider to checks for valid insurance coverage (to fetch information about the Patient (IMIS Insuree) eligibility). More info: http://hl7.org/fhir/STU3/financial-module.html#order

In the current version are mapped fields required by uspServiceItemEnquiry database stored procedure (SP) which is used by python EligibilityService (link).

Only the HTTP POST the method is currently exposed because of EligibilityRequest haven't database model representation and it is impossible to fetch information about specific EligibilityRequest.

The endpoint expects the FHIR EligibilityRequest representation as a body of the POST request and will return the EligibilityResponse as an outcome.

FHIR resource:

EligibilityRequest

Fields mapping:

Table legend:

EligibilityRequest mappingEligibilityRequest mapping:

The FHIR EligibilityRequest FHIR EligibilityRequest mapping covers all field required by the OpenIMIS EligibilityRequest OpenIMIS EligibilityRequest (link)

EligibilityRequest strategy change is mapped depending on the configuration set in openimis-be-api_fhir_py/api_fhir/apps.py file

:

"stu3_fhir_eligibility_config": {
        "fhir_serializer": "EligibilityRequestSerializer",
        "fhir_item_code": "item",
        "fhir_service_code": "service",
        "fhir_total_admissions_code": "total_admissions",
        "fhir_total_visits_code": "total_visits",
        "fhir_total_consultations_code": "total_consultations",
        "fhir_total_surgeries_code": "total_surgeries",
        "fhir_total_deliveries_code": "total_deliveries",
        "fhir_total_antenatal_code": "total_antenatal",
        "fhir_consultation_amount_code": "consultation_amount",
        "fhir_surgery_amount_code": "surgery_amount",
        "fhir_delivery_amount_code": "delivery_amount",
        "fhir_hospitalization_amount_code": "hospitalization_amount",
        "fhir_antenatal_amount_code": "antenatal_amount",
        "fhir_service_left_code": "service_left",
        "fhir_item_left_code": "item_left",
        "fhir_is_item_ok_code": "is_item_ok",
        "fhir_is_service_ok_code": "is_service_ok",
        "fhir_balance_code": "balance",
        "fhir_balance_default_category": "medical",
        "fhir_active_policy_status": ("A",)
    },

In "stu3_fhir_eligibility_config" field, fhir_serializer need to be set that determines the ElibilityRequest strategy.

"EligibilityRequestSerializer" is a default fhir_serializer.

...

Supported HTTP operation:

• CREATE - used to request EligibilityService. The FHIR representation is converted to OpenIMIS python EligibilityRequest (link) which is used by the EligibilityService (link). List of supported fields can be found in the table which shows the mapping between OpenIMIS and FHIR. Should be used the POST HTTP method and the body as JSON representation (example can be found below). 

  Note:

  • The EligibilityService is used to process the request (link).

  • The FHIR EligibilityResponse will be returned as the outcome.. Example of the outcome can be found below.

• READ - the operation currently not supported

• UPDATE - the operation currently not supported

• DELETE - the operation currently not supported

Module configuration used by the endpoint: 

Example JSON representation of content:

EligibilityRequest:

{
    "resourceType": "EligibilityRequest",
    "patient": {
        "reference": "Patient/chfid"
    },
    "benefitCategory": {
    	"coding": [
                    {
                        "code": "service"
                    }
                ],
        "text": "service_code"
    },
    "benefitSubCategory": {
    	"coding": [
                    {
                        "code": "item"
                    }
                ],
        "text": "item_code"
    }
}

...