openIMIS FHIR R4 Implementation Guide
1.0.0 - ci-build

openIMIS FHIR R4 Implementation Guide - Local Development build (v1.0.0). See the Directory of published versions

Claiming Use Case

In this use case, a Point of Service (PoS) is submitting a claim.

The following code systems are involved in this workflow:

  • diagnosis list configured in openIMIS (ICD10 level 1 diagnosis is provided as an example)

The following resources are involved in this workflow:

  • ActivityDefinition for the reference to the medical service
  • Medication for the reference to the medical item
  • Practitioner for the reference to the Claim Administrator submitting the claim
  • Organization for the reference to the Health Facility providing the medical services and items

The process is done in two steps:

  1. Synchronization of the openIMIS configuration referenced by the necessary resources.
  2. Posting the Patients (members of the family), Group (the family) and Contract (enrolment information).

<?xml version=”1.0” encoding=”UTF-8” standalone=”no”?>PoSPoSHIMHIMopenIMISopenIMISGet openIMIS configurationloop[for CodeSystem in (diagnosis)]1GET CodeSystem2GET CodeSystem3Read configurationfrom DB4HTTP 200 CodeSystem5HTTP 200 CodeSystemloop[for Resource in (ActivityDefinition, Medication, Practitioner@CA, Organization@HF)]6GET Resource7GET Resource8Read Resourcefrom DB9HTTP 200 Resource10HTTP 200 ResourceEnquire Workflow (Get Patient's Coverage)Submit Claim11POST Claim12POST Claim13Create Claim14Run rule-based checks15HTTP 200 ClaimResponse16HTTP 200 ClaimResponse