FHIR Resource | OpenIMIS database table | notes | mapping status |
|---|---|---|---|
Claim | Request properties are mapped to Claim | ||
ClaimResponse | tblClaim | Response properties are mapped to Claim | |
Coverage | tblPolicy | ||
Patient | tblInsuree | ||
Practitioner | tblClaimAdmin | used to represent base fields of Claim Administrator (without relation with health facility- FHIR Location) | |
PractitionerRole | tblClaimAdmin | used to represent a relation between base ClaimAdmin (FHIR Practitioner) and Health facility (FHIR Location) | |
Location | tblHF / tblLocations | FHIR location.mode field is used to switch between mapping from tblHF and tblLocations | |
EligibilityRequest | EligibilityRequest | ||
CommunicationRequest | tblFeedback |
Claim
...
FHIR 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 ClaimCode
...
patient
...
tblClaim.InsureeID
...
billablePeriod
...
tblClaim.DateFrom / tblClaim.DateTo
...
date from and date to are mapped to a period of time between them
...
diagnosis
...
tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4
...
ICDID values are mapped to a list of diagnosis
...
outcome
...
tblClaim.ClaimStatus
...
provider
...
tblClaim.Adjuster
...
total
...
tblClaim.Claimed
...
created
...
tblClaim.DateClaimed
...
information
...
tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation
...
information category is distinguishing the type of information
...
facility
...
tblClaim.HFID
...
enterer
...
tblClaim.ClaimAdminId
...
type
...
tblClaim.VisitType
...
item.service
...
tblClaimItems.ItemId / tblClaimServices.ServiceID
...
claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems
...
item.quantity
...
tblClaimItems.QtyProvided / tblClaimServices.QtyProvided
...
claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems
...
item.unitPrice
...
tblClaimItems.PriceAsked / tblClaimServices.PriceAsked
...
claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems
ClaimResponse
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
outcome | tblClaim.ClaimStatus | ||
payment.adjustmentReason | tblClaim.Adjustment | ||
totalBenefit | tblClaim.Approved | ||
payment.date | tblClaimed.DateProcessed | ||
communicationRequest | tblClaim.feedbackId | ||
error | tblClaim.rejectionReason | ||
item.adjudication.reason | tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code | |
item.adjudication.value | tblClaimItems.QtyApproved | ||
item.adjudication.amount | tblClaimItems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimItems.LimitationValue / tblClaimItems.RemuneratedAmount / tblClaimItems.DeductableAmount / tblClaimItems.ExceedCeilingAmount / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated / tblClaimServices.LimitationValue / tblClaimServices.RemunratedAmount / tblClaimServices.DeductableAmount / tblClaimServices.ExceededCeilingAmount | ||
processNote | tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.Limitation / tblClaimServices.PriceOrigin | claimResponse.item.noteNumber can be used to join information about the mapped field and claim item |
...