request

Claim.item

response

ClaimResponse.item

Mapped - the final choice, the most suitable choice

Need to be found the best place for the field (not mapped currently)

Currently not important - not mapped

OpenIMIS field

DB type

Request or response

FHIR field

Description

Note

STPH

Mapping status

ClaimServiceID

PK

-

ClaimID

FK(tblClaim)

-

This resource is part of FHIR claim.

Request

claim.item.category.text = 'service'

This is not in openIMIS but required in FHIR to differenciate Claim.Items and Claim.Services

mapped

ServiceID

FK(tblServices)

Request

claim.item.service

We can try represent the item as a CodeableConcept (using service code).

OK

mapped

ProdID

FK(tblProduct)

Response

We can consider using the claimResponse.insurance.

Not required by external systems 

ClaimServiceStatus

tinyint

Response

Default: 1
1 - passed
2 - rejected

The FHIR resource doesn't provide a place for that information but we can consider using the claimResponse.item.adjudication.reason field.

OK

mapped

QtyProvided

decimal

Request

claim.item.quantity

OK

mapped

QtyApproved

decimal

Response

claimResponse.item.adjudication.value

OK

mapped

PriceAsked

decimal

Request

claim.item.unitPrice

OK

mapped

PriceAdjusted

decimal

Response

claimResponse.item.adjudication.amount

PriceApproved

decimal

Response

claimResponse.item.adjudication.amount

PriceValuated

decimal

Response

claimResponse.item.adjudication.amount

Explanation

ntext

Request

claim.information

The Claim.item.informationLinkId is used to join the explanation and claim item. The explanation isn't used in POST operation because of the uspUpdateClaimFromPhone procedure didn't contain that information.

Check Claim.item.informationLinkId

mapped

Justification

ntext

Response

claimResponse.processNote

claimResponse.item.noteNumber can be used to join justification and claim item

OK

mapped

RejectionReason

smallint

Response

claimResponse.item.adjudication.reason

adjudication.reason contains the rejection code. This is separate adjudication object (with adjudication.category = "rejected_reason")   

Check web_app_vb/IMIS_BL/General.vb#L914

mapped

ValidityFrom

datetime

-

Audit information. More information can be found here (on page 113):
Web application - Functional Design Specification.pdf

This information are valuable for OpenIMIS but I probably not required by external systems.

ValidityTo

datetime

-

LegacyID

int

-

AuditUserID

int

-

ValidityFromReview

datetime

Response

I'm not sure if this information are valuable for external systems. If needed we can try to use the claimResponse.processNote or add the FHIR extensions.

Not required by external systems 

ValidityToReview

datetime

Response

Not required by external systems 

AuditUserIDReview

int

Response

Not required by external systems 

LimitationValue

decimal

Response

claimResponse.item.adjudication.amount

OK

mapped

Limitation

char(1)

Response

claimResponse.processNote

claimResponse.item.noteNumber can be used to join information about Limitation and claim item

PolicyID

int

Response

Not required by external systems 

RemuneratedAmount

decimal

Response

claimResponse.item.adjudication.amount

DeductableAmount

decimal

Response

claimResponse.item.adjudication.amount

ExceedCeilingAmount

decimal

Response

claimResponse.item.adjudication.amount

PriceOrigin

char(1)

Response

claimResponse.processNote

claimResponse.item.noteNumber can be used to join information about PriceOrigin and claim item

Not required by external systems 

ExceedCeilingAmountCategory

decimal

-

I don't know when this field is used.

Check [uspProcessSingleClaimStep2]