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 | string “benefit” | returning the benefit amount | mapped |
total.amount | tblClaim.Approved tblClaim.Valuated tblClaim.Reinsured tblClaim.Claimed | mapped as Money data type | mapped |
payment.date | tblClaimed.DateProcessed | openIMIS doesn’t specify any payment date. Payment is done from external systems. | removed |
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.RejectionReason / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code | mapped |
item.adjudication.value | tblClaimItems.QtyApproved | mapped | |
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 The openIMIS field considered here depends on the status of the claims. | only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped |
processNote.text | 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 | mapped - to be checked |
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 |
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/858A706A-A6BF-48DC-998D-30EFDAF8EDD2" } ], "created": "2020-07-01", "id": "858A706A-A6BF-48DC-998D-30EFDAF8EDD2", "identifier": [ { "type": { "coding": [ { "code": "UUID", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "858A706A-A6BF-48DC-998D-30EFDAF8EDD2" }, { "type": { "coding": [ { "code": "MR", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "CID00001" } ], "outcome": { "coding": [ { "code": "2" } ], "text": "entered" }, "patient": { "reference": "Patient/1D464C09-5334-407F-9882-14C097B89BBD" }, "request": { "reference": "Claim/858A706A-A6BF-48DC-998D-30EFDAF8EDD2" }, "total": [ { "amount": { "currency": "$", "value": 1670.0 }, "category": { "coding": [ { "code": "claimed", "system": "http://terminology.hl7.org/CodeSystem/adjudication.html" } ] } } ] } |