List of content:
Description:
The EligibilityRequest can be used via a provider to checks for valid insurance coverage (to fetch information about the Patient (IMIS Insuree) eligibility). More info: http://hl7.org/fhir/STU3/financial-module.html#order
In the current version are mapped fields required by uspServiceItemEnquiry database stored procedure (SP) which is used by python EligibilityService (link).
Only the HTTP POST the method is currently exposed because of EligibilityRequest haven't database model representation and it is impossible to fetch information about specific EligibilityRequest.
The endpoint expects the FHIR EligibilityRequest representation as a body of the POST request and will return the EligibilityResponse as an outcome.
FHIR resource:
Fields mapping:
Table legend:
| Color | Description |
|---|---|
| Mapped - the final choice, the most suitable choice | |
| Need to be found the best place for the field (not mapped currently) | |
| Currently not important - not mapped |
EligibilityRequest mapping:
The FHIR EligibilityRequest mapping covers all field required by the OpenIMIS EligibilityRequest (link)
| OpenIMIS field | FHIR field | Note | STPH | Mapping status |
| CHFID | patient | A reference which helps determine the specific insuree (perhaps we can base only on patient chfid). | mapped | |
| ServiceCode | benefitCategory | The concept used t represent the service code | mapped | |
| ItemCode | benefitSubCategory | The concept used t represent the item code | ItemCode should be on the same level as ServiceCode In FHIR v4, the EligibilityRequest has been change to CoverageEligibilityRequest and has multiple items with same level. | mapped |
EligibilityRequest strategy change is mapped depending on the configuration set in openimis-be-api_fhir_py/api_fhir/apps.py file
:
"stu3_fhir_eligibility_config": {
"fhir_serializer": "EligibilityRequestSerializer",
"fhir_item_code": "item",
"fhir_service_code": "service",
"fhir_total_admissions_code": "total_admissions",
"fhir_total_visits_code": "total_visits",
"fhir_total_consultations_code": "total_consultations",
"fhir_total_surgeries_code": "total_surgeries",
"fhir_total_deliveries_code": "total_deliveries",
"fhir_total_antenatal_code": "total_antenatal",
"fhir_consultation_amount_code": "consultation_amount",
"fhir_surgery_amount_code": "surgery_amount",
"fhir_delivery_amount_code": "delivery_amount",
"fhir_hospitalization_amount_code": "hospitalization_amount",
"fhir_antenatal_amount_code": "antenatal_amount",
"fhir_service_left_code": "service_left",
"fhir_item_left_code": "item_left",
"fhir_is_item_ok_code": "is_item_ok",
"fhir_is_service_ok_code": "is_service_ok",
"fhir_balance_code": "balance",
"fhir_balance_default_category": "medical",
"fhir_active_policy_status": ("A",)
},
In "stu3_fhir_eligibility_config" field, fhir_serializer need to be set that determines the ElibilityRequest strategy.
"EligibilityRequestSerializer" is a default fhir_serializer.
EligibilityResponse mapping:
see subpage: EligibilityResponse
Endpoint specification:
Example of endpoint URL:
http://127.0.0.1:8000/api_fhir/EligibilityRequest/
Supported HTTP operation:
CREATE - used to request
EligibilityService. The FHIR representation is converted to OpenIMIS pythonEligibilityRequest(link) which is used by theEligibilityService(link). List of supported fields can be found in the table which shows the mapping between OpenIMIS and FHIR. Should be used the POST HTTP method and the body as JSON representation (example can be found below).Note:
The
EligibilityServiceis used to process the request (link).- The FHIR
EligibilityResponsewill be returned as the outcome.. Example of the outcome can be found below.
- READ - the operation currently not supported
- UPDATE - 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, |
| stu3_fhir_eligibility_config | configuration of system and codes used to represent the specific codes used by eligibility endpoint | "stu3_fhir_eligibility_config":{ "fhir_item_code":"item", "fhir_service_code":"service", "fhir_total_admissions_code":"total_admissions", "fhir_total_visits_code":"total_visits", "fhir_total_consultations_code":"total_consultations", "fhir_total_surgeries_code":"total_surgeries", "fhir_total_deliveries_code":"total_deliveries", "fhir_total_antenatal_code":"total_antenatal", "fhir_consultation_amount_code":"consultation_amount", "fhir_surgery_amount_code":"surgery_amount", "fhir_delivery_amount_code":"delivery_amount", "fhir_hospitalization_amount_code":"hospitalization_amount", "fhir_antenatal_amount_code":"antenatal_amount", "fhir_service_left_code":"service_left", "fhir_item_left_code":"item_left", "fhir_is_item_ok_code":"is_item_ok", "fhir_is_service_ok_code":"is_service_ok" } |
Example JSON representation of content:
EligibilityRequest:
{
"resourceType": "EligibilityRequest",
"patient": {
"reference": "Patient/chfid"
},
"benefitCategory": {
"coding": [
{
"code": "service"
}
],
"text": "service_code"
},
"benefitSubCategory": {
"coding": [
{
"code": "item"
}
],
"text": "item_code"
}
}
EligibilityResponse:
{
"resourceType": "EligibilityResponse",
"insurance": [
{
"benefitBalance": [
{
"category": {
"text": "total_admissions"
},
"financial": [
{
"allowedUnsignedInt": 1
}
]
},
{
"category": {
"text": "total_visits"
},
"financial": [
{
"allowedUnsignedInt": 3
}
]
},
{
"category": {
"text": "total_consultations"
},
"financial": [
{
"allowedUnsignedInt": 23
}
]
},
{
"category": {
"text": "total_surgeries"
},
"financial": [
{
"allowedUnsignedInt": 5
}
]
},
{
"category": {
"text": "total_deliveries"
},
"financial": [
{
"allowedUnsignedInt": 2
}
]
},
{
"category": {
"text": "total_antenatal"
},
"financial": [
{
"allowedUnsignedInt": 11
}
]
},
{
"category": {
"text": "consultation_amount"
},
"financial": [
{
"allowedMoney": {
"value": 123.21
}
}
]
},
{
"category": {
"text": "surgery_amount"
},
"financial": [
{
"allowedMoney": {
"value": 12.11
}
}
]
},
{
"category": {
"text": "delivery_amount"
},
"financial": [
{
"allowedMoney": {
"value": 26.0
}
}
]
},
{
"category": {
"text": "hospitalization_amount"
},
"financial": [
{
"allowedMoney": {
"value": 42.0
}
}
]
},
{
"category": {
"text": "antenatal_amount"
},
"financial": [
{
"allowedMoney": {
"value": 59.14
}
}
]
},
{
"category": {
"text": "service_left"
},
"financial": [
{
"allowedUnsignedInt": 12
}
]
},
{
"category": {
"text": "item_left"
},
"financial": [
{
"allowedUnsignedInt": 1
}
]
},
{
"category": {
"text": "is_service_ok"
},
"excluded": false
},
{
"category": {
"text": "is_item_ok"
},
"excluded": true
}
]
}
]
}