...
| Code Block | ||||
|---|---|---|---|---|
| ||||
{
"resourceType": "Claim",
"id": "claim_uuidclaimUuid",
"extension": [
{
"url": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/resource-date-created",
"valueDateTime": "20192020-1101-05T1631T10:4304:1149+01:00"
},
{
"url": "https://purl.org/elab/fhir/StructureDefinition/Creator-crew-version1",
"valueString": "admin"
}
],
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "https://hl7.org/fhir/valueset-identifier-type.html",
"code": "ACSN"
}
]
},
"value": "claim_uuidclaimExternalId"
},
{
"use": "usual",
"type": {
"coding": [
{
"system": "https://hl7.org/fhir/valueset-identifier-type.html",
"code": "MR"
}
]
},
"value": "claimCodeclaimUuid"
}
],
"type": {
"text": "Claim Visit_type Type"
},
"patient": {
"id": "patient_uuidpatientUuid",
"reference": "Patient/patient_uuidexternal_id",
"identifier": {
"id": "patient_uuidpatientUuid"
},
"display": "some given name some family name(Identifier:patient_uuidpatientUuid)"
},
"billablePeriod": {
"start": "20192020-1101-05T1631T10:4304:1149+01:00",
"end": "20192020-1101-05T1631T10:4304:1149+01:00"
},
"created": "20192020-1101-05T1631T10:4304:1149+01:00",
"enterer": {
"reference": "Practitioner/provider_uuidexternalId",
"display": "null(Identifier:null)"
},
"provider": {
"reference": "Practitioner/externalId",
"display": "Super Usernull(Identifier:Testnull)"
},
"facility": {
"id": "location_uuidlocationUuid",
"reference": "Location/location_uuidlocationExternalId",
"display": "location_nameRio Bravo, [location_tag]"
},
"information": [
{
"category": {
"text": "guarantee_id"
},
"valueString": "guaranteeID"
},
{
"category": {
"text": "explanation"
},
"valueString": "explaination"
},
], "diagnosis": [
{
"idsequence": "diagnosis_uuid"3,
"diagnosisCodeableConceptcategory": {
"codingtext": ["item_explanation"
},
{
"valueString": "item explanation"
}
],
"systemdiagnosis": "http://www.pih.org/",[
{
"codeid": "pih_codediagnosisUuid",
"diagnosisCodeableConcept": {
}, "coding": [
{
"system": "http://snomedwww.pih.infoorg/snp",
"code": "snowmed_code7127"
},
{
"system": "http://cielsnomed.orginfo/snp",
"code": "ciel_code61462000"
},
{
"system": "http://hl7ciel.org/fhir/sid/icd-10",
"code": "icd-19_code160148"
},
{
"system": "http://openmrshl7.org/fhir/sid/icd-10",
"code": "diagnosis_uuid",B53.8"
},
"display": "Malaria, confirmed" {
} ]"system": "http://snomed.info/snp",
"textcode": "Diagnosis name"2931005"
},
} ], {
"total": { "value": 1234567890.21 } }
|
ClaimResponse Resource
...
uuid
...
| firstline | 1 |
|---|---|
| title | Sample ClaimResponse |
InsuranceClaimDiagnosis → claim.diagnosis
FHIR resources:
The diagnosis is a part of the FHIR Claim resource.
...
InsuranceClaimItem → Claim.item / ClaimResponse.item
FHIR resources:
- Claim.item - http://hl7.org/fhir/STU3/claim.html
- ClaimResponse.item - http://hl7.org/fhir/STU3/claimresponse.html
...
| Code Block | ||
|---|---|---|
| ||
{ "resourceType": "ClaimResponse", "id": "claim_uuid", "identifier": [ "system": "https://www.e-imo.com/releases/problem-it", "code": "1527785" }, { "system": "http://openmrs.org", "code": "160148AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "display": "Malaria, confirmed" } ], "text": "Malaria, confirmed" }, "type": [ { "text": "http://www.pih.org/" }, { "text": "http://snomed.info/snp" }, { "text": "http://ciel.org" }, { "text": "http://hl7.org/fhir/sid/icd-10" }, { "text": "http://snomed.info/snp" }, { "text": "https://www.e-imo.com/releases/problem-it" }, { "text": "http://openmrs.org" } ] } ], "item": [ { "informationLinkId": [ 3 ], "category": { "usetext": "usual"service" }, "typeservice": { "coding": [ { "systemcode": "https://hl7.org/fhir/valueset-identifier-type.html",serviceExternalId" } "code": "ACSN" ], } "text": "serviceExternalId" ] }, "valuequantity": "claim_uuid"{ }, "value": {5 "use": "usual"}, "typeunitPrice": { "codingvalue": [21000 } { } ], "systemtotal": "https://hl7.org/fhir/valueset-identifier-type.html",{ "code"value": "MR"105000 } ] }, "value": "claim_code" } ], "created": "2019-11-05T17:00:29+01:00", "request": { "reference": "Claim/8a589dc9-435f-4453-957a-31106cf0d932" }, "outcome": { "coding |
ClaimResponse Resource
| OpenMRS field | FHIR field | Note |
|---|---|---|
| claimCode | claimResponse.identifier | Claim number |
uuid | Unique uuid code | |
| adjustment | claimResponse.payment.adjustment | The contents of the adjustment message (getting from response) |
| approvedTotal | claimResponse.totalBenefit | Total benefit payable for the Claim |
| dateProcessed | claimResponse.created | Date of processing claim |
| rejectionReason | claimResponse.error | Optional rejection reason message |
| status | claimResponse.processNote | Information about current claim status |
| uuid | claimResponse.communicationRequest - Reference(Claim) | Request for additional information |
| Code Block | ||
|---|---|---|
| ||
{ "resourceType": "ClaimResponse", "id": "claimUuid", "identifier": [ { "codeuse": "2usual", }"type": { ], "textcoding": "ENTERED"[ }, "error": [ { "code": { "codingsystem": ["https://hl7.org/fhir/valueset-identifier-type.html", { "code": "error_codeACSN" } ], }, "textvalue": "error_codeexternalIdentifier" }, } { } ], "totalBenefit": { "value": 1234567890.21 }, "payment": { "adjustmentReason": { "text": "adjustment reason" }, "date": "2019-11-05" }, "communicationRequest": [ { "reference": "CommunicationRequest/claim_uuid" } ] }"use": "usual", "type": { "coding": [ { "system": "https://hl7.org/fhir/valueset-identifier-type.html", "code": "MR" } ] }, "value": "claimUuid" } ], "created": "2020-01-31T11:16:20+01:00", "request": { "reference": "Claim/claimUuid" }, "outcome": { "coding": [ { "code": "2" } ], "text": "ENTERED" }, "disposition": "20e5e68e-c4ce-4812-95b7-3179fd3eac57", "error": [ { "code": { "coding": [ { "code": "errorCode" } ], "text": "errorCode" } } ], "totalBenefit": { "value": 1234567890.21 }, "payment": { "adjustmentReason": { "text": "adjustmentReason" }, "date": "2020-01-31" }, "communicationRequest": [ { "reference": "CommunicationRequest/communicationRequestId" } ] } |
InsuranceClaimDiagnosis → claim.diagnosis
FHIR resources:
The diagnosis is a part of the FHIR Claim resource.
| OpenMRS field | FHIR field | Request or response | Note |
|---|---|---|---|
| concept | claim.diagnosis | Request | The value of concept which describe the diagnosis |
| claim | The claim which is connect with the diagnosis; not mapped because this is part of FHIR claim resource |
InsuranceClaimItem → Claim.item / ClaimResponse.item
FHIR resources:
- Claim.item - http://hl7.org/fhir/STU3/claim.html
- ClaimResponse.item - http://hl7.org/fhir/STU3/claimresponse.html
| OpenMRS field | FHIR field | Request or response | Note |
|---|---|---|---|
| quantityProvided | claim.item.quantity | Request | Information about the amount of requested items |
| quantityApproved | claimResponse.item.adjudication.value | Response | Information about the amount of approved items |
| priceApproved | claimResponse.item.adjudication.amount | Response | The approved price |
| priceAsked | claim.item.unitPrice | Request | The requested price. The value is determined based on value of price attribute from related ProvidedItem. |
| explanation | claim.information | Request | Optional additional information for claimed item |
| justification | claimResponse.processNote | Response | Optional additional information for claimed item (getting from response) |
| rejectionReason | claimResponse.item.adjudication.reason | Response | Optional rejection reason message |
| item | claim.item.service | Request | The related item. The related ProvidedItem provides the value of the product code which is entered into claim.item.service. |
| claim | see above | The related claim | |
| status | claimResponse.item.adjudication.reason / extension | Response | The related status for claimed item |
InsurancePolicy → Coverage
...