FHIR Resources Analysis for OpenIMIS Integration

FHIR Resources Analysis for OpenIMIS Integration

• Insurance coverage details

1.  

   1. Coverage Eligibility Request http://hl7.org/fhir/STU3/eligibilityrequest.html

   2. Coverage Eligibility Response:http://hl7.org/fhir/STU3/eligibilityresponse.html

   3. Coverage http://hl7.org/fhir/STU3/coverage.html

   4. Difference between coverage and coverage eligibility

   5. Version decisions to be made in later meetings : Decision made on version as suggested by Kamil STU3

• Claims Submission

1.  

   1. Claim Request :http://hl7.org/fhir/STU3/claim.html

   2. Different phases of claims request

   3.  

      1. Predetermination

      2. Preauthorization

      3. Claim

   4. Claim Response: http://hl7.org/fhir/STU3/claimresponse.html

   5. Claim Response without Payor details http://hl7.org/fhir/STU3/explanationofbenefit.html

• Claims Tracking

•  

  1. Status Check : Task {code=status}

  2. Cancel Claim processing

  3. Reprocess claims request

  4. Resubmit claims after correcting the errors from the rejected claims
     
     
     

• Financial module http://hl7.org/fhir/STU3/financial-module.html

1.  

   1. Account

   2. Invoice

   3. Payment Notice

   4. Payment Reconciliation

• Batch processing of Claims : eClaimBatches

1.  

   1. eClaimBatches: https://www.hl7.org/fhir/financial-module.html#13.0.13.2

• Relative order of use of financial resources [For reference of insurance flow using fhir ]

1.  

   1. http://hl7.org/fhir/STU3/financial-module.html#order

# Wiki links and References

1. https://wiki.openmrs.org/display/projects/OpenMRS+FHIR+Module

2. https://wiki.openmrs.org/display/projects/FHIR+Module+Enhancements+Project

3. https://wiki.openmrs.org/display/projects/OpenMRS+FHIR+Module+Development%3A+Phase+01

4. https://wiki.openmrs.org/display/projects/FHIR+Resource+List+for+Sync

5. https://wiki.openmrs.org/display/projects/Changes+to+the+FHIR+module