FHIR R4 Resource - Claim

OpenIMIS tables mapped - tblClaim, tblClaimItems , tblClaimServices

FHIR R4 field	OpenIMIS field	notes	mapping status
identifier	tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode	Claim can have multiple identifiers. The most important one is mapped from ClaimUUID.	mapped
patient	tblClaim.InsureeUUID	reference to Patient resource	mapped - mandatory
billablePeriod	tblClaim.DateFrom / tblClaim.DateTo	date from and date to are mapped to a period of time between them	mapped - mandatory
diagnosis	tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4	reference to Condition resource	to be mapped - mandatory
provider	tblClaim.Adjuster	to be validated	not mapped
total	tblClaim.Claimed	mapped as Money data type	mapped - mandatory
created	tblClaim.DateClaimed		mapped - mandatory
supportingInfo	tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation	information category is distinguishing the type of information renamed from information (STU3) to supportingInfo (R4)	mapped
facility	tblClaim.HFID	reference to Location resource	mapped - mandatory
enterer	tblClaim.ClaimAdminId	reference to Practitioner resource	mapped
type	tblClaim.VisitType		mapped - mandatory
item.productOrService	tblClaimItems.ItemId / tblClaimServices.ServiceId => tblItems.ItemCode / tblServices.ServiceCode	reference to Medication resource if medical item reference to ActivityDefinition resource if medical service	to be mapped - mandatory
item.quantity	tblClaimItems.QtyProvided / tblClaimServices.QtyProvided		mapped
item.unitPrice	tblClaimItems.PriceAsked / tblClaimServices.PriceAsked	price could differ from the price defined in medical item/service definition	mapped
item.category.text	“service” or “item”	distinguishing whether mapping is done from tblClaimsServices or tblClaimItems	mapped - mandatory

Endpoint specification:

Example of endpoint URL:

http://localhost:8000/api_fhir_R4/Claim/

Supported HTTP operation:

CREATE - used to submitting the claim. The FHIR claim representation is converted to python ClaimSubmit (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L38 ) which is used by the python claim service. List of supported fields can be found in the table which shows the mapping between OpenIMIS and FHIR. Should be used the POST HTTP method and the body as JSON representation (example can be found below).
Note:
- The claim service is used to process the request (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L146 ).
- The response is (example of the outcome can be found below)
  - OperationOutcome which notice about the failure (list of possible errors);
  - ClaimResponse which notice about the success
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://localhost:8000/api_fhir_R4/Claim/{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 currently not supported
DELETE - the operation currently not supported

Module configuration used by the endpoint:

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,
R4_fhir_identifier_type_config	configuration of system and codes used to represent the specific types of identifiers	"R4_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", },
R4_fhir_issue_type_config	configuration of system and codes used to represent the specific types of operation outcome	"R4_fhir_issue_type_config":{ "fhir_code_for_exception":"exception", "fhir_code_for_not_found":"not-found", "fhir_code_for_informational":"informational" },
R4_fhir_claim_config	configuration of system and codes used to represent the specific types of claim codes	"R4_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:

As in the other resources there is an error and therefore this file is shown.

{
    "resourceType": "OperationOutcome",
    "issue": [
        {
            "code": "exception",
            "details": {
                "text": "Missing `resourceType` attribute"
            },
            "severity": "fatal"
        }
    ]
}

Endpoint specification:

Example of endpoint URL:

Supported HTTP operation:

Module configuration used by the endpoint:

Example JSON representation of content:

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FHIR R4 - Claim

Endpoint specification:

Example of endpoint URL:

Supported HTTP operation:

Module configuration used by the endpoint:

Example JSON representation of content:

Did you encounter a problem or do you have a suggestion?

Please contact our Service Desk