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FHIR STU3 Resource - Claim

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

FHIR STU3 field

openIMIS field

Notes

Status

Identifier

tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode

Claim can have multiple identifiers. The most important one is mapped from ClaimCode

ClaimID and ClaimCode mapped

patient

tblClaim.InsureeID

mapped

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

date from and date to are mapped to a period of time between them

mapped

diagnosis

tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4

ICDID values are mapped to a list of diagnosis

mapped

provider

tblClaim.Adjuster

not mapped

claimCode

dateFrom

dateTo

total

tblClaim.Claimed

mapped

created

tblClaim.DateClaimed

mapped

information

tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation

information category is distinguishing the type of information

mapped

facility

tblClaim.HFID

mapped

enterer

tblClaim.ClaimAdminId

mapped

type

tblClaim.VisitType

mapped

item.service

tblClaimItems.ItemId / tblClaimServices.ServiceID

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.quantity

tblClaimItems.QtyProvided / tblClaimServices.QtyProvided

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.unitPrice

tblClaimItems.PriceAsked / tblClaimServices.PriceAsked

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

Endpoint specification:

Example of endpoint URL:

...

  • CREATE - used to submitting the claim. The FHIR claim representation is converted to python ClaimSubmit (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L38 ) which is used by the python claim service. 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:

  • READ - by default return list of all available resources. To fetch information about a specific object you should add the primary key to URL for instance:
    http://127.0.0.1:8000/api_fhir/Claim/{claimcode}
    , where "{claimcode}" is the value of the primary key (claim code in case of that resource). Should be used the GET HTTP method.

  • UPDATE - the operation currently not supported

  • DELETE - the operation currently not supported

Module configuration used by the endpoint:

Configuration key

Description

Default value

default_audit_user_id

default value which will be used for 'audit_user_id' field

"default_audit_user_id": 1,

stu3_fhir_identifier_type_config

configuration of system and codes used to represent the specific types of identifiers

"stu3_fhir_identifier_type_config":{
"system":"https://hl7.org/fhir/valueset-identifier-type.html",
"fhir_code_for_imis_db_id_type":"ACSN",
"fhir_code_for_imis_chfid_type":"SB",
"fhir_code_for_imis_passport_type":"PPN",
"fhir_code_for_imis_facility_id_type":"FI",
"fhir_code_for_imis_claim_admin_code_type":"FILL",
"fhir_code_for_imis_claim_code_type":"MR",

},

stu3_fhir_issue_type_config

configuration of system and codes used to represent the specific types of operation outcome

"stu3_fhir_issue_type_config":{
"fhir_code_for_exception":"exception",
"fhir_code_for_not_found":"not-found",
"fhir_code_for_informational":"informational"
},

stu3_fhir_claim_config

configuration of system and codes used to represent the specific types of claim codes

"stu3_fhir_claim_config":{
"fhir_claim_information_guarantee_id_code":"guarantee_id",
"fhir_claim_information_explanation_code":"explanation",
"fhir_claim_item_explanation_code":"item_explanation",
"fhir_claim_item_code":"item",
"fhir_claim_service_code":"service",
"fhir_claim_status_rejected_code":"rejected",
"fhir_claim_status_entered_code":"entered",
"fhir_claim_status_checked_code":"checked",
"fhir_claim_status_processed_code":"processed",
"fhir_claim_status_valuated_code":"valuated",
"fhir_claim_item_status_code":"claim_item_status",
"fhir_claim_item_status_passed_code":"passed",
"fhir_claim_item_status_rejected_code":"rejected",
"fhir_claim_item_general_adjudication_code":"general",
"fhir_claim_item_rejected_reason_adjudication_code":"rejected_reason",

},

Example JSON representation of content:

...