FHIR Resource - Claim Response

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

FHIR field	OpenIMIS field	notes	mapping status
outcome	tblClaim.ClaimStatus		mapped
payment.adjustmentReason	tblClaim.Adjustment		mapped
totalBenefit	tblClaim.Approved		mapped
payment.date	tblClaimed.DateProcessed		mapped
communicationRequest	tblClaim.feedbackId		mapped
error	tblClaim.rejectionReason		mapped
item.adjudication.reason	tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason	adjudication.reason contains the rejection code (with adjudication.category = "rejected_reason")	mapped
item.adjudication.value	tblClaimItems.QtyApproved		mapped
item.adjudication.amount	tblClaimItems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimItems.LimitationValue / tblClaimItems.RemuneratedAmount / tblClaimItems.DeductableAmount / tblClaimItems.ExceedCeilingAmount / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated / tblClaimServices.LimitationValue / tblClaimServices.RemunratedAmount / tblClaimServices.DeductableAmount / tblClaimServices.ExceededCeilingAmount	Monetary amount / value is taken from limitation value by default	only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped
processNote	tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.Limitation / tblClaimServices.PriceOrigin	claimResponse.item.noteNumber can be used to join information about the mapped field and claim item	mapped

Endpoint specification:

Example of endpoint URL:

http://127.0.0.1:8000/api_fhir/ClaimResponse/

Supported HTTP operation:

CREATE - the operation not supported
READ - by default return list of all available resources. To fetch information about a specific object you should add the primary key to URL for instance:
http://127.0.0.1:8000/api_fhir/ClaimResponse/{claimcode}
, where "{claimcode}" is the value of the primary key (claim code in case of that resource). Should be used the GET HTTP method.
UPDATE - 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",
stu3_fhir_identifier_type_config	configuration of system and codes used to represent the specific types of identifiers	"stu3_fhir_identifier_type_config":{ "system":"https://hl7.org/fhir/valueset-identifier-type.html", "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", },
stu3_fhir_claim_config	configuration of system and codes used to represent the specific types of claim codes	"stu3_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":"valuated", "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", },
stu3_fhir_communication_request_config	configuration of system and codes used to represent the specific codes for IMIS feedback attributes	"stu3_fhir_communication_request_config":{ "fhir_care_rendered_code":"care_rendered", "fhir_payment_asked_code":"payment_asked", "fhir_drug_prescribed_code":"drug_prescribed", "fhir_drug_received_code":"drug_received", "fhir_asessment_code":"asessment" }

Example JSON Representation of Content:

{
  "resourceType": "ClaimResponse",
  "communicationRequest": [
    {
      "reference": "CommunicationRequest/1"
    }
  ],
  "error": [
    {
      "code": {
        "coding": [
          {
            "code": "1"
          }
        ]
      }
    }
  ],
  "id": "code",
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "code": "ACSN",
            "system": "https://hl7.org/fhir/valueset-identifier-type.html"
          }
        ]
      },
      "use": "usual",
      "value": 1
    },
    {
      "type": {
        "coding": [
          {
            "code": "MR",
            "system": "https://hl7.org/fhir/valueset-identifier-type.html"
          }
        ]
      },
      "use": "usual",
      "value": "code"
    }
  ],
  "item": [
    {
      "adjudication": [
        {
          "amount": {
            "value": 2
          },
          "category": {
            "text": "general"
          },
          "reason": {
            "coding": [
              {
                "code": "1",
                "system": "passed"
              }
            ]
          },
          "value": 4
        },
        {
          "category": {
            "text": "rejected_reason"
          },
          "reason": {
            "coding": [
              {
                "code": "1"
              }
            ]
          }
        }
      ],
      "noteNumber": [
        1
      ],
      "sequenceLinkId": 1
    },
    {
      "adjudication": [
        {
          "amount": {
            "value": 4
          },
          "category": {
            "text": "general"
          },
          "reason": {
            "coding": [
              {
                "code": "2",
                "system": "rejected"
              }
            ]
          },
          "value": 3
        },
        {
          "category": {
            "text": "rejected_reason"
          },
          "reason": {
            "coding": [
              {
                "code": "3"
              }
            ]
          }
        }
      ],
      "noteNumber": [
        2
      ],
      "sequenceLinkId": 2
    }
  ],
  "outcome": {
    "coding": [
      {
        "code": "1"
      }
    ],
    "text": "rejected"
  },
  "payment": {
    "adjustmentReason": {
      "text": "adjustment"
    },
    "date": "2010-11-16T00:00:00"
  },
  "processNote": [
    {
      "number": 1,
      "text": "item justification"
    },
    {
      "number": 2,
      "text": "service justification"
    }
  ],
  "totalBenefit": {
    "value": 214.25
  }
}

Endpoint specification:

Example of endpoint URL:

Supported HTTP operation:

Module configuration used by the endpoint:

Example JSON Representation of Content:

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