FHIR Resource - Claim Response

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

FHIR field	OpenIMIS field	notes	mapping status

FHIR field	OpenIMIS field	notes	mapping status
outcome	tblClaim.ClaimStatus		mapped
payment.adjustmentReason	tblClaim.Adjustment		mapped
totalBenefit	tblClaim.Approved		mapped
payment.date	tblClaimed.DateProcessed		mapped
communicationRequest	tblClaim.feedbackId		mapped
error	tblClaim.rejectionReason		mapped
item.adjudication.reason	tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason	adjudication.reason contains the rejection code (with adjudication.category = "rejected_reason")	mapped
item.adjudication.value	tblClaimItems.QtyApproved		mapped
item.adjudication.amount	tblClaimItems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimItems.LimitationValue / tblClaimItems.RemuneratedAmount / tblClaimItems.DeductableAmount / tblClaimItems.ExceedCeilingAmount / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated / tblClaimServices.LimitationValue / tblClaimServices.RemunratedAmount / tblClaimServices.DeductableAmount / tblClaimServices.ExceededCeilingAmount	Monetary amount / value is taken from limitation value by default	only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped
processNote	tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.Limitation / tblClaimServices.PriceOrigin	claimResponse.item.noteNumber can be used to join information about the mapped field and claim item	mapped
disposition			not mapped
created	TimeUtils.date	current date is taken on the moment of processing claim	mapped

Endpoint specification:

Example of endpoint URL:

http://127.0.0.1:8000/api_fhir/ClaimResponse/

Supported HTTP operation:

CREATE - the operation not supported
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/ClaimResponse/{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 not supported
DELETE - the operation not supported

Module configuration used by the endpoint:

Configuration key	Description	Default value

Configuration key	Description	Default value
iso_date_format	iso format used for FHIR date representation	"iso_date_format": "%Y-%m-%d",
iso_datetime_format	iso format used for FHIR datetime representation	"iso_datetime_format": "%Y-%m-%dT%H:%M:%S",
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_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", },
stu3_fhir_communication_request_config	configuration of system and codes used to represent the specific codes for IMIS feedback attributes	"stu3_fhir_communication_request_config":{ "fhir_care_rendered_code":"care_rendered", "fhir_payment_asked_code":"payment_asked", "fhir_drug_prescribed_code":"drug_prescribed", "fhir_drug_received_code":"drug_received", "fhir_asessment_code":"asessment" }

Example JSON Representation of Content:

{
  "resourceType": "ClaimResponse",
  "communicationRequest": [
    {
      "reference": "CommunicationRequest/1"
    }
  ],
  "error": [
    {
      "code": {
        "coding": [
          {
            "code": "1"
          }
        ]
      }
    }
  ],
  "id": "code",
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "code": "ACSN",
            "system": "https://hl7.org/fhir/valueset-identifier-type.html"
          }
        ]
      },
      "use": "usual",
      "value": 1
    },
    {
      "type": {
        "coding": [
          {
            "code": "MR",
            "system": "https://hl7.org/fhir/valueset-identifier-type.html"
          }
        ]
      },
      "use": "usual",
      "value": "code"
    }
  ],
  "item": [
    {
      "adjudication": [
        {
          "amount": {
            "value": 2
          },
          "category": {
            "text": "general"
          },
          "reason": {
            "coding": [
              {
                "code": "1",
                "system": "passed"
              }
            ]
          },
          "value": 4
        },
        {
          "category": {
            "text": "rejected_reason"
          },
          "reason": {
            "coding": [
              {
                "code": "1"
              }
            ]
          }
        }
      ],
      "noteNumber": [
        1
      ],
      "sequenceLinkId": 1
    },
    {
      "adjudication": [
        {
          "amount": {
            "value": 4
          },
          "category": {
            "text": "general"
          },
          "reason": {
            "coding": [
              {
                "code": "2",
                "system": "rejected"
              }
            ]
          },
          "value": 3
        },
        {
          "category": {
            "text": "rejected_reason"
          },
          "reason": {
            "coding": [
              {
                "code": "3"
              }
            ]
          }
        }
      ],
      "noteNumber": [
        2
      ],
      "sequenceLinkId": 2
    }
  ],
  "outcome": {
    "coding": [
      {
        "code": "1"
      }
    ],
    "text": "rejected"
  },
  "payment": {
    "adjustmentReason": {
      "text": "adjustment"
    },
    "date": "2010-11-16T00:00:00"
  },
  "processNote": [
    {
      "number": 1,
      "text": "item justification"
    },
    {
      "number": 2,
      "text": "service justification"
    }
  ],
  "totalBenefit": {
    "value": 214.25
  }
}

openIMIS

FHIR - ClaimResponse

Endpoint specification:

Example of endpoint URL:

Supported HTTP operation:

Module configuration used by the endpoint:

Example JSON Representation of Content:

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