FHIR R4 Resource - ClaimResponse
OpenIMIS tables mapped - tblClaim, tblClaimItems, tblClaimServices
FHIR R4 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 ClaimUUID. | mapped |
patient | tblClaim.InsureeUUID | reference to Patient resource | mapped |
outcome | tblClaim.ClaimStatus | changed from CodeableConcept to code | mapped |
payment.adjustmentReason | tblClaim.Adjustment | mapped | |
total.category.code | based on the state: Approved, Valuated, Reinsured, Claimed | returning the benefit amount | mapped |
total.amount | tblClaim.Approved / tblClaim.Valuated / tblClaim.Reinsured / tblClaim.Claimed | mapped as Money data type | mapped |
communicationRequest | tblClaim.feedbackId | reference to CommunicationRequest resource | mapped |
error.code.coding.code | tblClaim.rejectionReason | mapped | |
error.code.text | tblClaim.rejectionReason as primary language text | to be mapped | |
item.adjudication.reason | tblClaimItems.ClaimItemStatus / tblClaimItems.Justification / tblClaimItems.RejectionReason / tblClaimServices.ClaimServiceStatus / tblClaimServices.Justification / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code | mapped |
item.adjudication.value | tblClaimItems.QtyProvided / tblClaimitems.QtyApproved / tblClaimServices.QtyProvided / tblClaimServices.QtyApproved | mapped | |
item.adjudication.amount | tblClaimItems.PriceAdjusted / tblClaimitems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimServices.PriceAdjusted / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated | Monetary amount / value is taken from limitation value by default The openIMIS field considered here depends on the status of the claims. | mapped |
processNote.text | tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.PriceOrigin | claimResponse.item.noteNumber can be used to join information about the mapped field and claim item | mapped |
disposition | not mapped | ||
created | TimeUtils.date | current date is taken on the moment of processing claim Should be mapped to ValidityTo for the date of last change? | mapped |
request | reference to Claim | mapped | |
type | tblClaim.VisitType | mapped | |
status | tblClaim.ReviewStatus | status in [1: “Idle“, 2: “Not Selected”, 4: “Selected for Review”, 8: “Reviewed”, 16: “ByPassed”] | not mapped |
requestor | tblHF.HealthFacility | reference to HealthcareService resource | not mapped |
use | “claim” | mapped | |
“Organisation/openIMIS“ | “openIMIS” from module configuration key | not mapped |
Endpoint specification:
Example of endpoint URL:
http://localhost:8000/api_fhir_R4/ClaimResponse/
Supported HTTP operation:
POST - the operation not supported
GET - by default return list of all available resources. To fetch information about a specific object you should add the Claim UUID to URL for instance:
http://127.0.0.1:8000/api_fhir_R4/ClaimResponse/{ClaimUUID}PUT - the operation not supported
DELETE - the operation not supported
Module configuration used by the endpoint:
Configuration key | Description | Default value |
---|---|---|
iso_date_format | iso format used for FHIR date representation | "iso_date_format": "%Y-%m-%d", |
iso_datetime_format | iso format used for FHIR datetime representation | "iso_datetime_format": "%Y-%m-%dT%H:%M:%S", |
R4_fhir_identifier_type_config | configuration of system and codes used to represent the specific types of identifiers | "R4_fhir_identifier_type_config":{ |
R4_fhir_claim_config | configuration of system and codes used to represent the specific types of claim codes | "R4_fhir_claim_config":{ |
R4_fhir_communication_request_config | configuration of system and codes used to represent the specific codes for IMIS feedback attributes | "R4_fhir_communication_request_config":{ |
Example JSON Representation of Content:
As in the other resources there is an error and therefore this file is shown.
{ "resourceType": "ClaimResponse", "communicationRequest": [ { "reference": "CommunicationRequest/6991F219-A4F0-4DD7-A5E6-4A63C48C1E61" } ], "created": "2020-07-11", "id": "6991F219-A4F0-4DD7-A5E6-4A63C48C1E61", "identifier": [ { "type": { "coding": [ { "code": "UUID", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "6991F219-A4F0-4DD7-A5E6-4A63C48C1E61" }, { "type": { "coding": [ { "code": "MR", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "test1231" } ], "insurer": { "reference": "HealthcareService/FABA2038-0E24-4557-B1BD-08584C48FA0D" }, "item": [ { "adjudication": [ { "amount": { "currency": "$", "value": 10.0 }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } }, { "amount": { "currency": "$", "value": 10.0 }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } }, { "amount": { "currency": "$" }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } }, { "amount": { "currency": "$", "value": 100.0 }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } } ], "extension": [ { "url": "Medication", "valueReference": { "reference": "Medication/25bace1d-89a9-4e06-a87f-40bb45fb3485" } } ], "itemSequence": 1, "noteNumber": [ 1 ] }, { "adjudication": [ { "amount": { "currency": "$", "value": 400.0 }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } }, { "amount": { "currency": "$", "value": 400.0 }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } }, { "amount": { "currency": "$" }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } }, { "amount": { "currency": "$", "value": 400.0 }, "category": { "coding": [ { "code": "16" } ], "text": "valuated" }, "reason": { "coding": [ { "code": "0" } ] } } ], "extension": [ { "url": "ActivityDefinition", "valueReference": { "reference": "ActivityDefinition/7dfb7acb-6c62-4065-9aa6-8e708665bb3c" } } ], "itemSequence": 2, "noteNumber": [ 2 ] } ], "outcome": "valuated", "patient": { "reference": "Patient/8CD74B9F-7641-421B-A108-C5DB610BE9FD" }, "processNote": [ { "number": 1, "text": "P" }, { "number": 2, "text": "P" } ], "request": { "reference": "Claim/6991F219-A4F0-4DD7-A5E6-4A63C48C1E61" }, "status": "completed", "total": [ { "amount": { "currency": "$", "value": 500.0 }, "category": { "coding": [ { "code": "A", "display": "Approved", "system": "http://terminology.hl7.org/CodeSystem/adjudication.html" } ], "text": "Valuated < Reinsured < Approved < Claimed" } }, { "amount": { "currency": "$", "value": 500.0 }, "category": { "coding": [ { "code": "C", "display": "Claimed", "system": "http://terminology.hl7.org/CodeSystem/adjudication.html" } ], "text": "Valuated < Reinsured < Approved < Claimed" } } ], "type": { "text": "O" }, "use": "claim" } |