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FHIR Resource - Claim

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

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

ClaimID and ClaimCode mapped

patient

tblClaim.InsureeID

mapped

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

date from and date to are mapped to a period of time between them

mapped

diagnosis

tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4

ICDID values are mapped to a list of diagnosis

mapped

provider

tblClaim.Adjuster

not mapped

claimCode

dateFrom

dateTo

total

tblClaim.Claimed

mapped

created

tblClaim.DateClaimed

mapped

information

tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation

information category is distinguishing the type of information

mapped

facility

tblClaim.HFID

mapped

enterer

tblClaim.ClaimAdminId

mapped

type

tblClaim.VisitType

mapped

item.service

tblClaimItems.ItemId / tblClaimServices.ServiceID

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.quantity

tblClaimItems.QtyProvided / tblClaimServices.QtyProvided

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.unitPrice

tblClaimItems.PriceAsked / tblClaimServices.PriceAsked

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

Endpoint specification:

Example of endpoint URL:

http://127.0.0.1:8000/api_fhir/Claim/

Supported HTTP operation:

Module configuration used by the endpoint:

Configuration key

Description

Default value

default_audit_user_id

default value which will be used for 'audit_user_id' field

"default_audit_user_id": 1,

stu3_fhir_identifier_type_config

configuration of system and codes used to represent the specific types of identifiers

"stu3_fhir_identifier_type_config":{
"system":"https://hl7.org/fhir/valueset-identifier-type.html",
"fhir_code_for_imis_db_id_type":"ACSN",
"fhir_code_for_imis_chfid_type":"SB",
"fhir_code_for_imis_passport_type":"PPN",
"fhir_code_for_imis_facility_id_type":"FI",
"fhir_code_for_imis_claim_admin_code_type":"FILL",
"fhir_code_for_imis_claim_code_type":"MR",

},

stu3_fhir_issue_type_config

configuration of system and codes used to represent the specific types of operation outcome

"stu3_fhir_issue_type_config":{
"fhir_code_for_exception":"exception",
"fhir_code_for_not_found":"not-found",
"fhir_code_for_informational":"informational"
},

stu3_fhir_claim_config

configuration of system and codes used to represent the specific types of claim codes

"stu3_fhir_claim_config":{
"fhir_claim_information_guarantee_id_code":"guarantee_id",
"fhir_claim_information_explanation_code":"explanation",
"fhir_claim_item_explanation_code":"item_explanation",
"fhir_claim_item_code":"item",
"fhir_claim_service_code":"service",
"fhir_claim_status_rejected_code":"rejected",
"fhir_claim_status_entered_code":"entered",
"fhir_claim_status_checked_code":"checked",
"fhir_claim_status_processed_code":"processed",
"fhir_claim_status_valuated_code":"valuated",
"fhir_claim_item_status_code":"claim_item_status",
"fhir_claim_item_status_passed_code":"passed",
"fhir_claim_item_status_rejected_code":"rejected",
"fhir_claim_item_general_adjudication_code":"general",
"fhir_claim_item_rejected_reason_adjudication_code":"rejected_reason",

},

Example JSON representation of content:

{

"resourceType": "Claim",

"billablePeriod": {

"end": "2019-06-12T00:00:00",

"start": "2019-06-01T00:00:00"

},

"created": "2019-06-12T00:00:00",

"diagnosis": [

{

"diagnosisCodeableConcept": {

"coding": [

{

"code": "ICD_CD"

}

]

},

"sequence": 1,

"type": [

{

"text": "icd_0"

}

]

}

],

"enterer": {

"reference": "Practitioner/1234abcd"

},

"facility": {

"reference": "Location/12345678"

},

"id": "code",

"identifier": [

{

"type": {

"coding": [

{

"code": "MR",

"system": "https://hl7.org/fhir/valueset-identifier-type.html"

}

]

},

"use": "usual",

"value": "code"

}

],

"information": [

{

"category": {

"text": "guarantee_id"

},

"sequence": 1,

"valueString": "guarantee_id"

},

{

"category": {

"text": "explanation"

},

"sequence": 2,

"valueString": "explanation"

},

{

"category": {

"text": "item_explanation"

},

"sequence": 3,

"valueString": "item_explanation"

},

{

"category": {

"text": "item_explanation"

},

"sequence": 4,

"valueString": "service_explanation"

}

],

"item": [

{

"category": {

"text": "item"

},

"informationLinkId": [

3

],

"quantity": {

"value": 4

},

"sequence": 1,

"service": {

"text": "iCode"

},

"unitPrice": {

"value": 21.1

}

},

{

"category": {

"text": "service"

},

"informationLinkId": [

4

],

"quantity": {

"value": 3

},

"sequence": 2,

"service": {

"text": "sCode"

},

"unitPrice": {

"value": 16.1

}

}

],

"patient": {

"reference": "Patient/TEST_CHF_ID"

},

"total": {

"value": 42

},

"type": {

"text": "E"

}

}

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