FHIR R4 - CoverageEligibilityResponse

FHIR R4 Resource - CoverageEligibilityResponse

OpenIMIS table - https://openimis.atlassian.net/wiki/spaces/OP/pages/814153821

FHIR R4 field	OpenIMIS field	notes	mapping status

FHIR R4 field	OpenIMIS field	notes	mapping status
patient	eligibility_request		not mapped
insurance.item.benefit.allowedUnsignedInt	prod_id / total_admissions_left / total_visits_left / total-consultations_left / total_surgeries_left / total_deliveries_left / total_antenatals_left / service_left / item_left	item field contains all the information mapped to all listed fields benefitBalance is redefined as item and financial as item.benefit	mapped
insurance.item.benefit.allowedMoney	consultation_amount_left / surgery_amount_left / delivery_amount_left / hospitalization_amount_left / antenatal_amount_left	item field contains all the information mapped to all listed fields benefitBalance is redefined as item and financial as item.benefit	mapped
insurance.item.excluded	is_item_ok / is_service_ok	item field contains all the information mapped to all listed fields	mapped

Example JSON representation of content:

{
  "resourceType": "CoverageEligibilityResponse",
  "status": "active",
  "purpose": [
    "benefits"
  ],
  "patient": {
    "reference": "Patient/070707070"
  },
  "created": "2021-09-28",
  "request": {
    "reference": "CoverageEligibilityRequest"
  },
  "outcome": "complete",
  "insurer": {
    "reference": "openIMIS"
  },
  "insurance": [
    {
      "item": [
        {
          "category": {
            "text": "total_admissions"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "total_visits"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "total_consultations"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "total_surgeries"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "total_deliveries"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "total_antenatal"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "consultation_amount"
          },
          "benefit": [
            {
              "allowedMoney": {
                "value": 0
              }
            }
          ]
        },
        {
          "category": {
            "text": "surgery_amount"
          },
          "benefit": [
            {
              "allowedMoney": {
                "value": 0
              }
            }
          ]
        },
        {
          "category": {
            "text": "delivery_amount"
          },
          "benefit": [
            {
              "allowedMoney": {
                "value": 0
              }
            }
          ]
        },
        {
          "category": {
            "text": "hospitalization_amount"
          },
          "benefit": [
            {
              "allowedMoney": {
                "value": 0
              }
            }
          ]
        },
        {
          "category": {
            "text": "antenatal_amount"
          },
          "benefit": [
            {
              "allowedMoney": {
                "value": 0
              }
            }
          ]
        },
        {
          "category": {
            "text": "service_left"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "item_left"
          },
          "benefit": [
            {
              "allowedUnsignedInt": 0
            }
          ]
        },
        {
          "category": {
            "text": "is_service_ok"
          },
          "excluded": false
        },
        {
          "category": {
            "text": "is_item_ok"
          },
          "excluded": false
        }
      ]
    }
  ]
}

openIMIS

FHIR R4 - CoverageEligibilityResponse

Example JSON representation of content:

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