List of content:
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. | |||||
Request | claim.item.category = 'product' | This is not in openIMIS but required in FHIR to differenciate Claim.Items and Claim.Services | ||||||
ItemID | FK(tblItems) | Request | claim.item.service | We can try represent the item as a CodeableConcept (using item code). | OK | |||
ProdID | FK(tblProduct) | Response | We can consider using the claimResponse.insurance. | Not required by external systems | ||||
ClaimItemStatus | tinyint | Response | claimResponse.item.adjudication.reason | 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. | OK | ||
Availability | bit | Request | claim.information | The claim.item.informationSequence can be used to join the information with the claim item. | Not required by external systems | |||
QtyProvided | decimal | Request | claim.item.quantity | OK | ||||
QtyApproved | decimal | Response | claimResponse.item.adjudication.value | OK | ||||
PriceAsked | decimal | Request | claim.item.unitPrice | OK | ||||
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 | Check also
| |||
Justification | ntext | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join justification and claim item | OK | |||
RejectionReason | smallint | Response | claimResponse.item.adjudication.reason | I didn't find informaition about the RejectionReson codes. | Check web_app_vb/IMIS_BL/General.vb#L914 | |||
ValidityFrom | datetime | - | Audit information. More information can be found here (on page 113): Web application -Functional Design Specification.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. | Not required by external systems | ||||
ValidityToReview | datetime | Response | Not required by external systems | |||||
AuditUserIDReview | int | Response | Not required by external systems | |||||
LimitationValue | decimal | Response | claimResponse.item.adjudication.amount | OK | ||||
Limitation | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about Limitation and claim item | ||||
PolicyID | int | Response | Not required by external systems | |||||
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 | Not required by external systems | |||
ExceedCeilingAmountCategory | decimal | - | I don't know when this field is used. | Check [uspProcessSingleClaimStep2] |