FHIR - ClaimResponse

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 } }

 

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