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 | |
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 |
Coverage
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
Identifier | PolicyID / PolicyUUID | ||
policyHolder | FamilyID | ||
period | StartDate / ExpiryDate | ||
status | PolicyStatus | ||
contract.valuedItem.net | PolicyValue | ||
grouping | ProdID | ||
contract.agent.actor | OfficerID |
Patient
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
Identifier | InsureeID / CHFID / passport / TypeOfId | ||
RelatedPerson | FamilyID | ||
name | LastName / OtherNames | ||
birthDate | DOB | ||
gender | Gender | ||
maritalStatus | Marital | ||
RelatedPerson.Relationship | IsHead | ||
telecom | Phone / Email | ||
photo | PhotoID | ||
photo.creation | PhotoDate | ||
managingOrganization | HFID | ||
address | CurrentAddress / GeoLocation |
Practitioner
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
identifier | claimAdminID / claimAdminCode | ||
name | LastName / OtherNames | ||
birthDate | DOB | ||
telecom | Phone / EmailId |
Location
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
Identifier | tblHF.HfId / tblHF.HFCode / tblLocations.LocationId / tblLocations.LocationCode | ||
name | tblHF.HFName / tblLocatons.LocationName | ||
type | tblHF.HFLevel / tblLocations.LocationType | ||
Address | tblHF.HFAddress | ||
partOfReference | tblHF.LocationId / tblLocations.ParentLocationId | ||
telecom | tblHF.Phone / tblHF.Fax / tblHF.eMail |
EligibilityRequest
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
patient | CHFID | ||
benefitCategory | ServiceCode | ||
benefitSubCategory | ItemCode |
EligibilityResponse
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
patient | eligibility_request | ||
insurance.benefitBalance.financial.allowedUnsignedInt | prod_id / total_admissions_left / total_visits_left / total-consultations_left / total_surgeries_left / total_deliveries_left / total_antenatals_left / service_left / item_left | ||
insurance.benefitBalance.financial.allowedMoney | consultation_amount_left / surgery_amount_left / delivery_amount_left / hospitalization_amount_left / antenatal_amount_left | ||
insurance.benefitBalance.excluded | is_item_ok / is_service_ok |
CommunicationRequest
FHIR field | OpenIMIS field | notes | mapping status |
|---|---|---|---|
identifier | feedbackId | ||
reasonCode | CareRendered / PaymentAsked / DrugPrescribed / DrugReceived / Assessment | ||
occurrenceDateTime | feedBackDate |