FHIR Resources Analysis for OpenIMIS Integration

FHIR Resources Analysis for OpenIMIS Integration

• Insurance coverage details

1. Coverage Eligibility Request http://hl7.org/fhir/STU3/eligibilityrequest.html
2. Coverage Eligibility Response:http://hl7.org/fhir/STU3/eligibilityresponse.html
3. Coverage http://hl7.org/fhir/STU3/coverage.html
4. Difference between coverage and coverage eligibility
5. Version decisions to be made in later meetings : Decision made on version as suggested by Kamil STU3

• Claims Submission

1. Claim Request :http://hl7.org/fhir/STU3/claim.html
2. Different phases of claims request
1. Predetermination
2. Preauthorization
3. Claim
3. Claim Response: http://hl7.org/fhir/STU3/claimresponse.html
4. Claim Response without Payor details http://hl7.org/fhir/STU3/explanationofbenefit.html

• Claims Tracking
1. Status Check : Task {code=status}
2. Cancel Claim processing
3. Reprocess claims request
4. Resubmit claims after correcting the errors from the rejected claims
   
   
• Financial module http://hl7.org/fhir/STU3/financial-module.html

1. Account
2. Invoice
3. Payment Notice
4. Payment Reconciliation

• Batch processing of Claims : eClaimBatches

1. eClaimBatches: https://www.hl7.org/fhir/financial-module.html#13.0.13.2

• Relative order of use of financial resources [For reference of insurance flow using fhir ]

1. http://hl7.org/fhir/STU3/financial-module.html#order

# Wiki links and References

1. https://wiki.openmrs.org/display/projects/OpenMRS+FHIR+Module
2. https://wiki.openmrs.org/display/projects/FHIR+Module+Enhancements+Project
3. https://wiki.openmrs.org/display/projects/OpenMRS+FHIR+Module+Development%3A+Phase+01
4. https://wiki.openmrs.org/display/projects/FHIR+Resource+List+for+Sync
5. https://wiki.openmrs.org/display/projects/Changes+to+the+FHIR+module