FHIR R4 Resource - Claim

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
status	one of [entered, checked, reviewed, valuated] based on tblClaim.ClaimStatus	entered state by default
patient	tblClaim.InsureeUUID	reference to Patient resource	mapped - mandatory
billablePeriod	tblClaim.DateFrom / tblClaim.DateTo	DateFrom and DateTo are mapped to a period of time between them	mapped - mandatory
diagnosis	tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4	reference to Condition resource There is an error with the POST for both versions. When the error is found complete the mapping.	mapped - mandatory from fhir to imis not mapped (diagnosis)
provider	tblClaim.Adjuster	to be validated	not mapped
total	tblClaim.Claimed	mapped as Money data type	mapped - mandatory
created	tblClaim.DateClaimed		mapped - mandatory
supportingInfo	tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation	information category is distinguishing the type of information renamed from information (STU3) to supportingInfo (R4)	mapped
facility	tblClaim.HFID	reference to HealthcareService resource FHIR specification: reference to Location	mapped - mandatory
enterer	tblClaim.ClaimAdminId	reference to Practitioner resource	mapped
type	tblClaim.VisitType		mapped - mandatory
item.productOrService	tblClaimItems.tblItem.ItemCode / tblClaimServices.tblServices.ServiceCode	actual Code value	mapped - mandatory
item.extension.productOrServiceReference	tblClaimItems.ItemUUID / tblClaimServices.ServiceUUID	reference to Medication resource if medical item reference to ActivityDefinition resource if medical service	mapped
item.quantity	tblClaimItems.QtyProvided / tblClaimServices.QtyProvided		mapped
item.unitPrice	tblClaimItems.PriceAsked / tblClaimServices.PriceAsked	price could differ from the price defined in medical item/service definition	mapped
item.category.text	“service” or “item”	distinguishing whether mapping is done from tblClaimsServices or tblClaimItems	mapped - mandatory
provider	tblClaimAdmin.ClaimAdminUUID	reference to PractitionerRole resource	mapped for db tool reason
priority	code = “normal”	CodeableConcept	mapped for db tool reason
use	“claim”		mapped for db tool reason
status	“active”		mapped for db tool reason
claim.insurance.focal	True		mapped for db tool reason
claim.insurance.sequence	0		mapped for db tool reason
claim.insurance.coverage	tblPolicy.PolicyUUID	reference to Coverage resource	mapped for db tool reason

Endpoint specification:

Example of endpoint URL:

http://localhost:8000/api_fhir_r4/Claim/

Supported HTTP operation:

POST - used to submit a new claim. List of supported fields can be found in the table which shows the mapping between openIMIS and FHIR and the body has JSON representation (example can be found below).
The response is:
- OperationOutcome which notice about the failure (list of possible errors);
- ClaimResponse which notice about the success.
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://localhost:8000/api_fhir_r4/Claim/{ClaimUUID}
PUT - the operation currently not supported
DELETE - the operation currently not supported

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,
R4_fhir_identifier_type_config	configuration of system and codes used to represent the specific types of identifiers	"R4_fhir_identifier_type_config":{ "system":"https://hl7.org/fhir/valueset-identifier-type.html", "fhir_code_for_imis_db_uuid_type":"UUID", "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", "fhir_code_for_imis_location_code_type":"LC", "fhir_code_for_imis_diagnosis_code_type":"DC", "fhir_code_for_imis_item_code_type":"IC", "fhir_code_for_imis_service_code_type":"SC", },
R4_fhir_issue_type_config	configuration of system and codes used to represent the specific types of operation outcome	"R4_fhir_issue_type_config":{ "fhir_code_for_exception":"exception", "fhir_code_for_not_found":"not-found", "fhir_code_for_informational":"informational" },
R4_fhir_claim_config	configuration of system and codes used to represent the specific types of claim codes	"R4_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":"evaluated", "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:

As in the other resources there is an error and therefore this file is shown.

{
    "resourceType": "Claim",
    "billablePeriod": {
        "end": "2018-10-03",
        "start": "2018-10-03"
    },
    "created": "2018-10-03",
    "diagnosis": [
        {
            "diagnosisReference": {
                "reference": "Condition/A02"
            },
            "sequence": 1,
            "type": [
                {
                    "coding": [
                        {
                            "code": "icd_0"
                        }
                    ]
                }
            ]
        }
    ],
    "enterer": {
        "reference": "Practitioner/6F480233-5A7B-4034-8107-17B419E32498"
    },
    "facility": {
        "reference": "HealthcareService/D61C869B-F184-4CAE-B61B-0AD52DDE2354"
    },
    "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"
        }
    ],
    "insurance": [
        {
            "coverage": {
                "reference": "Coverage/28D8DF61-890E-4B1C-A66F-BE02208C99D4"
            },
            "focal": true,
            "sequence": 0
        }
    ],
    "item": [
        {
            "category": {
                "text": "item"
            },
            "extension": [
                {
                    "url": "Medication",
                    "valueReference": {
                        "reference": "Medication/6e07535d-04ba-4d8f-aa26-f066cf6020e8"
                    }
                }
            ],
            "productOrService": {
                "text": "0182"
            },
            "quantity": {
                "value": 2.0
            },
            "sequence": 1,
            "unitPrice": {
                "currency": "$",
                "value": 10.0
            }
        },
        {
            "category": {
                "text": "service"
            },
            "extension": [
                {
                    "url": "ActivityDefinition",
                    "valueReference": {
                        "reference": "ActivityDefinition/751911e2-3a69-4623-90b9-cabd991836ba"
                    }
                }
            ],
            "productOrService": {
                "text": "A1"
            },
            "quantity": {
                "value": 1.0
            },
            "sequence": 2,
            "unitPrice": {
                "currency": "$",
                "value": 400.0
            }
        },
        {
            "category": {
                "text": "service"
            },
            "extension": [
                {
                    "url": "ActivityDefinition",
                    "valueReference": {
                        "reference": "ActivityDefinition/17a9a5b5-8d86-46af-bcbb-da18ce05c04b"
                    }
                }
            ],
            "productOrService": {
                "text": "I113"
            },
            "quantity": {
                "value": 1.0
            },
            "sequence": 3,
            "unitPrice": {
                "currency": "$",
                "value": 1250.0
            }
        }
    ],
    "patient": {
        "reference": "Patient/1D464C09-5334-407F-9882-14C097B89BBD"
    },
    "priority": {
        "coding": [
            {
                "code": "normal"
            }
        ]
    },
    "provider": {
        "reference": "PractitionerRole/6F480233-5A7B-4034-8107-17B419E32498"
    },
    "status": "active",
    "total": {
        "currency": "$",
        "value": 1670.0
    },
    "type": {
        "text": "O"
    },
    "use": "claim"
}

Endpoint specification:

Example of endpoint URL:

Supported HTTP operation:

Module configuration used by the endpoint:

Example JSON representation of content:

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FHIR R4 - Claim

Endpoint specification:

Example of endpoint URL:

Supported HTTP operation:

Module configuration used by the endpoint:

Example JSON representation of content:

Did you encounter a problem or do you have a suggestion?

Please contact our Service Desk