List of content:
Description:
More information can be found here: openIMIS tblClaim resource (FHIR Claim / ClaimResponse)
Note:
- ClaimResponse item sequenceLinkId pointing to value from the Claim.item
FHIR resources:
| request | Claim.item |
| response | ClaimResponse.item |
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 |
Mapping:
| OpenIMIS field | DB type | Request or response | FHIR field | Description | Note | STPH | Mapping status | ||
| ClaimItemID | PK | - | |||||||
| ClaimID | FK(tblClaim) | - | This resource is part of FHIR Claim. | ||||||
| Request | claim.item.category = 'product' | This is not in openIMIS but required in FHIR to differenciate Claim.Items and Claim.Services | mapped | ||||||
| ItemID | FK(tblItems) | Request | claim.item.service | We can try represent the item as a CodeableConcept (using item code). | OK | mapped | |||
| ProdID | FK(tblProduct) | Response | We can consider using the claimResponse.insurance. | Not required by external systems | |||||
| ClaimItemStatus | tinyint | Response | claimResponse.item.adjudication.reason | Default: 1 1 - passed 2 - rejected | The FHIR resource doesn't provide a place for that information but we can consider using the claimResponse.item.adjudication.reason field. | OK | mapped | ||
| Availability | bit | Request | claim.information | The claim.item.informationSequence can be used to join the information with the claim item. | Not required by external systems | ||||
| QtyProvided | decimal | Request | claim.item.quantity | OK | mapped | ||||
| QtyApproved | decimal | Response | claimResponse.item.adjudication.value | OK | mapped | ||||
| PriceAsked | decimal | Request | claim.item.unitPrice | OK | mapped | ||||
| PriceAdjusted | decimal | Response | claimResponse.item.adjudication.amount | ||||||
| PriceApproved | decimal | Response | claimResponse.item.adjudication.amount | ||||||
| PriceValuated | decimal | Response | claimResponse.item.adjudication.amount | ||||||
| Explanation | ntext | Request | claim.information | The Claim.item.informationLinkId is used to join the explanation and claim item. The explanation isn't used in POST operation because of the uspUpdateClaimFromPhone procedure didn't contain that information. | Check also
| mapped | |||
| Justification | ntext | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join justification and claim item | OK | mapped | |||
| RejectionReason | smallint | Response | claimResponse.item.adjudication.reason | adjudication.reason contains the rejection code. This is separate adjudication object (with adjudication.category = "rejected_reason") | Check web_app_vb/IMIS_BL/General.vb#L914 | mapped | |||
| ValidityFrom | datetime | - | Audit information. More information can be found here (on page 113): Web application -Functional Design Specification.pdf | This information are valuable for OpenIMIS but I probably not required by external systems. | |||||
| ValidityTo | datetime | - | |||||||
| LegacyID | int | - | |||||||
| AuditUserID | int | - | |||||||
| ValidityFromReview | datetime | Response | I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions. | Not required by external systems | |||||
| ValidityToReview | datetime | Response | Not required by external systems | ||||||
| AuditUserIDReview | int | Response | Not required by external systems | ||||||
| LimitationValue | decimal | Response | claimResponse.item.adjudication.amount | OK | mapped | ||||
| Limitation | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about Limitation and claim item | |||||
| PolicyID | int | Response | Not required by external systems | ||||||
| RemuneratedAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||||
| DeductableAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||||
| ExceedCeilingAmount | decimal | Response | claimResponse.item.adjudication.amount | ||||||
| PriceOrigin | char(1) | Response | claimResponse.processNote | claimResponse.item.noteNumber can be used to join information about PriceOrigin and claim item | Not required by external systems | ||||
| ExceedCeilingAmountCategory | decimal | - | I don't know when this field is used. | Check [uspProcessSingleClaimStep2] | |||||