...
List of content:
| Table of Contents | ||
|---|---|---|
|
Description:
More information can be found here: openIMIS tblClaim resource (FHIR Claim / ClaimResponse)
FHIR resources:
| request | Claim.item |
| response | ClaimResponse.item |
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 |
Mapping:
| OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH |
| ClaimItemID | PK | - | ||||
| ClaimID | FK(tblClaim) | - | This resource is part of FHIR claim. | |||
| ItemID | FK(tblItems) | Request | claim.item.service | We can try represent the item as a CodeableConcept (using item code). | ||
| ProdID | FK(tblProduct) | Response | We can consider using the claimResponse.insurance. | |||
| ClaimItemStatus | tinyint | Response | Default: 1 1 - passed 2 - rejected | The FHIR resource doesn't provide a place for that information but we can consider using the claimResponse.item.adjudication.reason field. | ||
| Availability | bit | Request | claim.information | The claim.item.informationSequence can be used to join the information with the claim item. | ||
| QtyProvided | decimal | Request | claim.item.quantity | |||
| QtyApproved | decimal | Response | claimResponse.item.adjudication.value | |||
| PriceAsked | decimal | Request | claim.item.unitPrice | |||
| 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.informationSequence can be used to join explanation and claim item | ||
| Justification | ntext | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join justification and claim item | ||
| RejectionReason | smallint | Response | claimResponse.item.adjudication.reason | I didn't find informaition about the RejectionReson codes. | ||
| ValidityFrom | datetime | - | Audit information. More information can be found here (on page 113): https://github.com/openimis/openimis_docs/blob/master/specs/Web%20application%20-%20Functional%20Design%20Specification.pdf | 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. | |||
| ValidityToReview | datetime | Response | ||||
| AuditUserIDReview | int | Response | ||||
| LimitationValue | decimal | Response | claimResponse.item.adjudication.amount | |||
| Limitation | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about Limitation and claim item | ||
| PolicyID | int | Response | ||||
| 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 | ||
| ExceedCeilingAmountCategory | decimal | - | I don't know when this field is used. |