FHIR STU3 Resource - Claim

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

FHIR STU3 field	openIMIS field	Notes	Status
Identifier	tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode	Claim can have multiple identifiers. The most important one is mapped from ClaimCode	ClaimID and ClaimCode mapped
patient	tblClaim.InsureeID		mapped
billablePeriod	tblClaim.DateFrom / tblClaim.DateTo	date from and date to are mapped to a period of time between them	mapped
diagnosis	tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4	ICDID values are mapped to a list of diagnosis	mapped
provider	tblClaim.Adjuster		not mapped
claimCode
dateFrom
dateTo

total	tblClaim.Claimed		mapped
created	tblClaim.DateClaimed		mapped
information	tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation	information category is distinguishing the type of information	mapped
facility	tblClaim.HFID		mapped
enterer	tblClaim.ClaimAdminId		mapped
type	tblClaim.VisitType		mapped
item.service	tblClaimItems.ItemId / tblClaimServices.ServiceID	claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems	mapped
item.quantity	tblClaimItems.QtyProvided / tblClaimServices.QtyProvided	claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems	mapped
item.unitPrice	tblClaimItems.PriceAsked / tblClaimServices.PriceAsked	claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems	mapped

Endpoint specification:

Example of endpoint URL:

http://127.0.0.1:8000/api_fhir/Claim/

Supported HTTP operation:

CREATE - used to submitting the claim. The FHIR claim representation is converted to python ClaimSubmit (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L38 ) which is used by the python claim service. 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 claim service is used to process the request (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L146 ).
- The response is (example of the outcome can be found below)
  - OperationOutcome which notice about the failure (list of possible errors);
  - ClaimResponse which notice about the success
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/Claim/{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 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_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_issue_type_config	configuration of system and codes used to represent the specific types of operation outcome	"stu3_fhir_issue_type_config":{ "fhir_code_for_exception":"exception", "fhir_code_for_not_found":"not-found", "fhir_code_for_informational":"informational" },
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", },

Example JSON representation of content:

{
	"resourceType": "Claim",
	"billablePeriod": {
		"end": "2019-06-12T00:00:00",
		"start": "2019-06-01T00:00:00"
	},
	"created": "2019-06-12T00:00:00",
	"diagnosis": [
		{
			"diagnosisCodeableConcept": {
				"coding": [
					{
						"code": "ICD_CD"
					}
				]
			},
			"sequence": 1,
			"type": [
				{
					"text": "icd_0"
				}
			]
		}
	],
	"enterer": {
		"reference": "Practitioner/1234abcd"
	},
	"facility": {
		"reference": "Location/12345678"
	},
	"id": "code",
	"identifier": [
		{
			"type": {
				"coding": [
					{
						"code": "MR",
						"system": "https://hl7.org/fhir/valueset-identifier-type.html"
					}
				]
			},
			"use": "usual",
			"value": "code"
		}
	],
	"information": [
		{
			"category": {
				"text": "guarantee_id"
			},
			"sequence": 1,
			"valueString": "guarantee_id"
		},
		{
			"category": {
				"text": "explanation"
			},
			"sequence": 2,
			"valueString": "explanation"
		},
		{
			"category": {
				"text": "item_explanation"
			},
			"sequence": 3,
			"valueString": "item_explanation"
		},
		{
			"category": {
				"text": "item_explanation"
			},
			"sequence": 4,
			"valueString": "service_explanation"
		}
	],
	"item": [
		{
			"category": {
				"text": "item"
			},
			"informationLinkId": [
				3
			],
			"quantity": {
				"value": 4
			},
			"sequence": 1,
			"service": {
				"text": "iCode"
			},
			"unitPrice": {
				"value": 21.1
			}
		},
		{
			"category": {
				"text": "service"
			},
			"informationLinkId": [
				4
			],
			"quantity": {
				"value": 3
			},
			"sequence": 2,
			"service": {
				"text": "sCode"
			},
			"unitPrice": {
				"value": 16.1
			}
		}
	],
	"patient": {
		"reference": "Patient/TEST_CHF_ID"
	},
	"total": {
		"value": 42
	},
	"type": {
		"text": "E"
	}
}