FHIR R4 Resource - ClaimResponse
openIMIS tables mapped - tblClaim, tblClaimItems, tblClaimServices, tblInsuree
FHIR R4 | openIMIS | Notes | Mapping Status | ||||
|---|---|---|---|---|---|---|---|
FHIR R4 Field | Card. | Type | openIMIS Field | Card. | Type | ||
0..* | tblClaim.ClaimID | 1..1 | int | Claim database Primary Key | mapped | ||
tblClaim.ClaimUUID | 1..1 | uniqueidentifier | Claim UUID | mapped | |||
tblClaim.ClaimCode | 1..1 | nvarchar(8) | Claim Code - unique per HF | mapped | |||
1..1 | tblClaim.ReviewStatus | 0..1 | tinyint | status in [1: “Idle“, 2: “Not Selected”, 4: “Selected for Review”, 8: “Reviewed”, 16: “ByPassed”] Required | mapped | ||
1..1 | tblClaim.VisitType | 0..1 | char(1) | Required | mapped | ||
1..1 | N/A | Always value “claim” Required | mapped | ||||
1..1 | tblClaim.InsureeID → tblInsuree.InsureeUUID | 1..1 | uniqueidentifier | Reference to Patient resource Required | mapped | ||
1..1 | tblClaim.ValidityFrom | 1..1 | datetime | Last update datetime. Currently set to current datetime. Required | not mapped | ||
1..1 | N/A | Always value “Organisation/openIMIS“ “openIMIS” can be changed in module configuration Required | mapped | ||||
0..1 | tblHF.HealthFacility | reference to HealthcareService resource | mapped | ||||
outcome | tblClaim.ClaimStatus | changed from CodeableConcept to code | mapped | ||||
payment.adjustmentReason | tblClaim.Adjustment | mapped | |||||
total | [tblClaim.Approved, tblClaim.Valuated, tblClaim.Reinsured, tblClaim.Claimed] | List of total cost per claim status. Details in category in amount. | mapped | ||||
total.category.code | 2: Claimed | 4: Checked | 8: Processed/Reviewed | 16: Valuated | based on the tblClaim.ClaimStatus | mapped | ||||
total.amount | tblClaim.Approved / tblClaim.Valuated / tblClaim.Reinsured / tblClaim.Claimed | returning the benefit amount | mapped | ||||
communicationRequest | tblClaim.feedbackId → tblFeedback.FeedbackUUID | 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.Justification / tblClaimItems.RejectionReason / tblClaimServices.ClaimServiceStatus / tblClaimServices.Justification / tblClaimServices.RejectionReason | adjudication.reason contains the rejection code | mapped | ||||
item.adjudication.value | tblClaimItems.QtyProvided / tblClaimitems.QtyApproved / tblClaimServices.QtyProvided / tblClaimServices.QtyApproved | mapped | |||||
item.adjudication.amount | tblClaimItems.PriceAsked / tblClaimitems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimServices.PriceAsked / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated | Monetary amount / value is taken from limitation value by default The openIMIS field considered here depends on the status of the claims. | mapped | ||||
processNote.text | tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.PriceOrigin | claimResponse.item.noteNumber can be used to join information about the mapped field and claim item | mapped | ||||
disposition | not mapped | ||||||
request | reference to Claim | mapped | |||||
extension.valuePeriod.billablePeriod | tblClaim.DateFrom / tblClaim.DateTo | DateFrom and DateTo are mapped to a period of time between them | mapped - mandatory | ||||
extension.valueReference.diagnosis | tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4 | reference to Condition resource | mapped - mandatory | ||||
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",
"created": "2020-07-27",
"extension": [
{
"url": "billablePeriod",
"valuePeriod": {
"end": "2018-09-23",
"start": "2018-09-23"
}
},
{
"url": "icd_0",
"valueReference": {
"reference": "Condition/A50"
}
}
],
"id": "CFB1B205-5C7C-4F78-BDC3-824E832E0DD1",
"identifier": [
{
"type": {
"coding": [
{
"code": "UUID",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "CFB1B205-5C7C-4F78-BDC3-824E832E0DD1"
},
{
"type": {
"coding": [
{
"code": "MR",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "UPDH0001"
}
],
"insurer": {
"reference": "Organization/openIMIS"
},
"item": [
{
"adjudication": [
{
"amount": {
"currency": "$",
"value": 40.0
},
"category": {
"coding": [
{
"code": "1"
}
],
"text": "rejected"
},
"reason": {
"coding": [
{
"code": "10"
}
]
},
"value": 1.0
}
],
"extension": [
{
"url": "Medication",
"valueReference": {
"reference": "Medication/3321fa00-a93e-4ebd-99e2-ad02827f5042"
}
}
],
"itemSequence": 1
},
{
"adjudication": [
{
"amount": {
"currency": "$",
"value": 650.0
},
"category": {
"coding": [
{
"code": "2"
}
],
"text": "entered"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
},
{
"amount": {
"currency": "$",
"value": 650.0
},
"category": {
"coding": [
{
"code": "4"
}
],
"text": "checked"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
},
{
"category": {
"coding": [
{
"code": "8"
}
],
"text": "processed"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
},
{
"category": {
"coding": [
{
"code": "16"
}
],
"text": "valuated"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
}
],
"extension": [
{
"url": "ActivityDefinition",
"valueReference": {
"reference": "ActivityDefinition/90cbb870-3d86-458a-b88f-e0ce1a6cceef"
}
}
],
"itemSequence": 2,
"noteNumber": [
1
]
},
{
"adjudication": [
{
"amount": {
"currency": "$",
"value": 650.0
},
"category": {
"coding": [
{
"code": "2"
}
],
"text": "entered"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
},
{
"amount": {
"currency": "$",
"value": 650.0
},
"category": {
"coding": [
{
"code": "4"
}
],
"text": "checked"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
},
{
"category": {
"coding": [
{
"code": "8"
}
],
"text": "processed"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
},
{
"category": {
"coding": [
{
"code": "16"
}
],
"text": "valuated"
},
"reason": {
"coding": [
{
"code": "0"
}
],
"text": ""
},
"value": 1.0
}
],
"extension": [
{
"url": "ActivityDefinition",
"valueReference": {
"reference": "ActivityDefinition/8612375f-d7ad-4237-b01a-cc9f3ca1871c"
}
}
],
"itemSequence": 3,
"noteNumber": [
2
]
}
],
"outcome": "valuated",
"patient": {
"reference": "Patient/F678F7B7-34B3-4D5E-8274-DD416080DD71"
},
"processNote": [
{
"number": 1,
"text": "P"
},
{
"number": 2,
"text": "P"
}
],
"request": {
"reference": "Claim/CFB1B205-5C7C-4F78-BDC3-824E832E0DD1"
},
"requestor": {
"reference": "HealthcareService/9D438CCA-F1DE-4951-AE50-F138AF49E98E"
},
"status": "ByPassed",
"total": [
{
"amount": {
"currency": "$",
"value": 21690.0
},
"category": {
"coding": [
{
"code": "submitted",
"display": "Submitted Amount",
"system": "http://terminology.hl7.org/CodeSystem/adjudication.html"
}
],
"text": "Claimed"
}
},
{
"amount": {
"currency": "$",
"value": 21000.0
},
"category": {
"coding": [
{
"code": "benefit",
"display": "Benefit Amount",
"system": "http://terminology.hl7.org/CodeSystem/adjudication.html"
}
],
"text": "Approved"
}
}
],
"type": {
"text": "R"
},
"use": "claim"
}
|