FHIR STU3 Claim

FHIR STU3 Resource - Claim

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

FHIR STU3 field

openIMIS field

Notes

Status

FHIR STU3 field

openIMIS field

Notes

Status

Identifier

tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode

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

ClaimID and ClaimCode mapped

patient

tblClaim.InsureeID

 

mapped

billablePeriod

tblClaim.DateFrom / tblClaim.DateTo

date from and date to are mapped to a period of time between them

mapped

diagnosis

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

ICDID values are mapped to a list of diagnosis

mapped

provider

tblClaim.Adjuster

 

not mapped

claimCode

 

 

 

dateFrom

 

 

 

dateTo

 

 

 

 

 

 

 

total

tblClaim.Claimed

 

mapped

created

tblClaim.DateClaimed

 

mapped

information

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

information category is distinguishing the type of information

mapped

facility

tblClaim.HFID

 

mapped

enterer

tblClaim.ClaimAdminId

 

mapped

type

tblClaim.VisitType

 

mapped

item.service

tblClaimItems.ItemId / tblClaimServices.ServiceID

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.quantity

tblClaimItems.QtyProvided / tblClaimServices.QtyProvided

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

item.unitPrice

tblClaimItems.PriceAsked / tblClaimServices.PriceAsked

claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems

mapped

Endpoint specification:

Example of endpoint URL:

http://127.0.0.1:8000/api_fhir/Claim/

Supported HTTP operation:

Module configuration used by the endpoint:

Configuration key

Description

Default value

Configuration key

Description

Default value

default_audit_user_id

default value which will be used for 'audit_user_id' field

"default_audit_user_id": 1,

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_issue_type_config

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

"stu3_fhir_issue_type_config":{
"fhir_code_for_exception":"exception",
"fhir_code_for_not_found":"not-found",
"fhir_code_for_informational":"informational"
},

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",

},

Example JSON representation of content:

 

{ "resourceType": "Claim", "billablePeriod": { "end": "2019-06-12T00:00:00", "start": "2019-06-01T00:00:00" }, "created": "2019-06-12T00:00:00", "diagnosis": [ { "diagnosisCodeableConcept": { "coding": [ { "code": "ICD_CD" } ] }, "sequence": 1, "type": [ { "text": "icd_0" } ] } ], "enterer": { "reference": "Practitioner/1234abcd" }, "facility": { "reference": "Location/12345678" }, "id": "code", "identifier": [ { "type": { "coding": [ { "code": "MR", "system": "https://hl7.org/fhir/valueset-identifier-type.html" } ] }, "use": "usual", "value": "code" } ], "information": [ { "category": { "text": "guarantee_id" }, "sequence": 1, "valueString": "guarantee_id" }, { "category": { "text": "explanation" }, "sequence": 2, "valueString": "explanation" }, { "category": { "text": "item_explanation" }, "sequence": 3, "valueString": "item_explanation" }, { "category": { "text": "item_explanation" }, "sequence": 4, "valueString": "service_explanation" } ], "item": [ { "category": { "text": "item" }, "informationLinkId": [ 3 ], "quantity": { "value": 4 }, "sequence": 1, "service": { "text": "iCode" }, "unitPrice": { "value": 21.1 } }, { "category": { "text": "service" }, "informationLinkId": [ 4 ], "quantity": { "value": 3 }, "sequence": 2, "service": { "text": "sCode" }, "unitPrice": { "value": 16.1 } } ], "patient": { "reference": "Patient/TEST_CHF_ID" }, "total": { "value": 42 }, "type": { "text": "E" } }

 

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