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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 (with adjudication.category = "rejected_reason") | |
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
| Monetary amount / value is taken from limitation value by default | |
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 | |
Example JSON Representation of Content:
FHIR ClaimResponse:
{
"resourceType": "ClaimResponse",
"communicationRequest": [
{
"reference": "CommunicationRequest/1"
}
],
"error": [
{
"code": {
"coding": [
{
"code": "1"
}
]
}
}
],
"id": "code",
"identifier": [
{
"type": {
"coding": [
{
"code": "ACSN",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": 1
},
{
"type": {
"coding": [
{
"code": "MR",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "code"
}
],
"item": [
{
"adjudication": [
{
"amount": {
"value": 2
},
"category": {
"text": "general"
},
"reason": {
"coding": [
{
"code": "1",
"system": "passed"
}
]
},
"value": 4
},
{
"category": {
"text": "rejected_reason"
},
"reason": {
"coding": [
{
"code": "1"
}
]
}
}
],
"noteNumber": [
1
],
"sequenceLinkId": 1
},
{
"adjudication": [
{
"amount": {
"value": 4
},
"category": {
"text": "general"
},
"reason": {
"coding": [
{
"code": "2",
"system": "rejected"
}
]
},
"value": 3
},
{
"category": {
"text": "rejected_reason"
},
"reason": {
"coding": [
{
"code": "3"
}
]
}
}
],
"noteNumber": [
2
],
"sequenceLinkId": 2
}
],
"outcome": {
"coding": [
{
"code": "1"
}
],
"text": "rejected"
},
"payment": {
"adjustmentReason": {
"text": "adjustment"
},
"date": "2010-11-16T00:00:00"
},
"processNote": [
{
"number": 1,
"text": "item justification"
},
{
"number": 2,
"text": "service justification"
}
],
"totalBenefit": {
"value": 214.25
}
}
|