identifier

tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode

Claim can have multiple identifiers. The most important one is mapped from ClaimUUID.

mapped

status

one of [entered, checked, reviewed, valuated] based on tblClaim.ClaimStatus

entered state by default

patient

tblClaim.InsureeUUID

reference to Patient resource

mapped - mandatory

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

DateFrom and DateTo are mapped to a period of time between them

mapped - mandatory

diagnosis

tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4

reference to Condition resource

There is an error with the POST for both versions. When the error is found complete the mapping.

mapped - mandatory

from fhir to imis not mapped (diagnosis)

provider

tblClaim.Adjuster

to be validated

not mapped

total

tblClaim.Claimed

mapped as Money data type

mapped - mandatory

created

tblClaim.DateClaimed

mapped - mandatory

supportingInfo

tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation

information category is distinguishing the type of information
renamed from information (STU3) to supportingInfo (R4)

mapped

ClaimAttachment

see Claim Attachment section

facility

tblClaim.HFID

reference to HealthcareService resource
FHIR specification: reference to Location

mapped - mandatory

enterer

tblClaim.ClaimAdminId

reference to Practitioner resource

mapped

type

tblClaim.VisitType

mapped - mandatory

item.productOrService

tblClaimItems.tblItem.ItemCode / tblClaimServices.tblServices.ServiceCode

actual Code value

mapped - mandatory

item.extension.productOrServiceReference

tblClaimItems.ItemUUID / tblClaimServices.ServiceUUID

reference to Medication resource if medical item
reference to ActivityDefinition resource if medical service

mapped

item.quantity

tblClaimItems.QtyProvided / tblClaimServices.QtyProvided

mapped

item.unitPrice

tblClaimItems.PriceAsked / tblClaimServices.PriceAsked

price could differ from the price defined in medical item/service definition

mapped

item.category.text

“service” or “item”

distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped - mandatory

provider

tblClaimAdmin.ClaimAdminUUID

reference to PractitionerRole resource

mapped for db tool reason

priority

code = “normal”

CodeableConcept

mapped for db tool reason

use

“claim”

mapped for db tool reason

status

“active”

mapped for db tool reason

claim.insurance.focal

True

mapped for db tool reason

claim.insurance.sequence

0

mapped for db tool reason

claim.insurance.coverage

tblPolicy.PolicyUUID

reference to Coverage resource

mapped for db tool reason

default_audit_user_id

default value which will be used for 'audit_user_id' field

"default_audit_user_id": 1,

R4_fhir_identifier_type_config

configuration of system and codes used to represent the specific types of identifiers

"R4_fhir_identifier_type_config":{
"system":"https://hl7.org/fhir/valueset-identifier-type.html",
"fhir_code_for_imis_db_uuid_type":"UUID",
"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",
"fhir_code_for_imis_location_code_type":"LC",
"fhir_code_for_imis_diagnosis_code_type":"DC",
"fhir_code_for_imis_item_code_type":"IC",
"fhir_code_for_imis_service_code_type":"SC",
},

R4_fhir_issue_type_config

configuration of system and codes used to represent the specific types of operation outcome

"R4_fhir_issue_type_config":{
"fhir_code_for_exception":"exception",
"fhir_code_for_not_found":"not-found",
"fhir_code_for_informational":"informational"
},

R4_fhir_claim_config

configuration of system and codes used to represent the specific types of claim codes

"R4_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":"evaluated",
"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",
"fhir_claim_organization_code":"openIMIS",
“fhir_claim_allowed_mime_types_regex”: ['text\/.*', 'image\/png', 'image\/jpe?g', 'application\/msword', '.*doc.*']
},

claim.supportingInfo

One element for each attachment.

claim.supportingInfo.category

coding.code must always be “attachment”.
Mandatory

claim.supportingInfo.valueAttachment

The content of the attachment.
Mandatory

claim.supportingInfo.valueAttachment.contentType

ClaimAttachment.mime

The document mime type (e.g. application/pdf, image/jpeg)
Based on regex, default list ['text\/.*', 'image\/png', 'image\/jpe?g', 'application\/msword', '.*doc.*']. Can be extended through module configuration.
Mandatory

claim.supportingInfo.valueAttachment.data

ClaimAttachment.document

The attachment content data as base64. Not available for GET ALL Claims.
Mandatory

claim.supportingInfo.valueAttachment.hash

N/A

Only for POST Claim. SHA-1 hash value of the data as base64 to validate the data. If missing, data is not validated.
optional

claim.supportingInfo.valueAttachment.title

ClaimAttachment.filename

Filename
Mandatory

claim.supportingInfo.valueAttachment.creation

ClaimAttachment.date

Date attachment was created. If missing, current date and time.
optional