Package | ihe.iti.fais |
Type | CapabilityStatement |
Id | IHE.FAIS.ClaimsManager |
FHIR Version | R4 |
Source | https://profiles.ihe.net/ITI/FAIS/https://build.fhir.org/ig/IHE/ITI.Finance/CapabilityStatement-IHE.FAIS.ClaimsManager.html |
URL | https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.ClaimsManager |
Version | 1.0.1-current |
Status | active |
Date | 2024-07-17 |
Name | IHE_FAIS_ClaimsManager |
Title | IHE FAIS Claims Manager |
Realm | uv |
Authority | ihe |
Description | CapabilityStatement for [Claims Requestor Actor](volume-1.html#claims-manager). The Claims Manager processes claims requests from the Claims Requestor. It follows internal business processes to create the claim that are beyond the scope of this profile. It also responds to claim tracking requests to return the status of the requested claim. |
Kind | requirements |
No resources found
OperationDefinition | |
IHE.FAIS.Claim.Cancel | FAIS Claim $cancel |
IHE.FAIS.Claim.Reprocess | FAIS Claim $reprocess |
IHE.FAIS.Claim.Submit | FAIS Claim $submit |
IHE.FAIS.CoverageEligibilityRequest.Submit | FAIS Coverage Eligibility Request $submit |
StructureDefinition | |
IHE.FAIS.Claim | FAIS Claim Profile |
IHE.FAIS.ClaimResponse | FAIS ClaimResponse Profile |
IHE.FAIS.CoverageEligibilityRequest | FAIS CoverageEligibilityRequest Profile |
IHE.FAIS.CoverageEligibilityResponse | FAIS CoverageEligibilityResponse Profile |
Note: links and images are rebased to the (stated) source
Generated Narrative: CapabilityStatement IHE.FAIS.ClaimsManager
application/fhir+xml
, application/fhir+json
Note to Implementers: FHIR Capabilities
Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.
server
FAIS Claims Manager rovides capability to receive claim submissions and respond to queries for claim responses.
Recommend ATNA, encouraged IHE-IUA or SMART-app-launch
search-system
interaction.The summary table lists the resources that are part of this configuration, and for each resource it lists:
_include
_revinclude
Resource Type | Profile | R | S | U | C | Searches | _include | _revinclude | Operations |
---|---|---|---|---|---|---|---|---|---|
CoverageEligibilityRequest | Supported Profiles FAIS CoverageEligibilityRequest Profile | $submit | |||||||
CoverageEligibilityResponse | Supported Profiles FAIS CoverageEligibilityResponse Profile | y | y | _lastUpdated, _id, status, request, patient, requestor | |||||
Claim | Supported Profiles FAIS Claim Profile | $submit , $cancel , $reprocess | |||||||
ClaimResponse | Supported Profiles FAIS ClaimResponse Profile | y | y | _lastUpdated, _id, status, request, patient, requestor |
FAIS Check Coverage Eligibility transaction [ITI-124]
read
, search-type
.FAIS Check Coverage Eligibility Status transaction [ITI-125]
Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _lastUpdated | date | When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb. |
SHALL | _id | token | Logical id of this artifact |
SHALL | status | token | The status of the response |
SHALL | request | reference | The coverage eligiblity request |
SHALL | patient | reference | The beneficiary |
SHALL | requestor | reference | The provider making the request |
Supports these transactions:
FAIS Track Claim transaction [ITI-129]
Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _lastUpdated | date | When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb. |
SHALL | _id | token | Logical id of this artifact |
SHALL | status | token | The status of the response |
SHALL | request | reference | The coverage eligiblity request |
SHALL | patient | reference | The beneficiary |
SHALL | requestor | reference | The provider making the request |
{ "resourceType": "CapabilityStatement", "id": "IHE.FAIS.ClaimsManager", "text": { "status": "extensions", "div": "<!-- snip (see above) -->" }, "url": "https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.ClaimsManager", "version": "1.0.1-current", "name": "IHE_FAIS_ClaimsManager", "title": "IHE FAIS Claims Manager", "status": "active", "experimental": false, "date": "2024-07-17", "publisher": "IHE IT Infrastructure Technical Committee", "contact": [ { "telecom": [ { "system": "url", "value": "https://www.ihe.net/ihe_domains/it_infrastructure/" } ] }, { "telecom": [ { "system": "email", "value": "iti@ihe.net" } ] }, { "name": "IHE IT Infrastructure Technical Committee", "telecom": [ { "system": "email", "value": "iti@ihe.net" } ] } ], "description": "CapabilityStatement for [Claims Requestor Actor](volume-1.html#claims-manager).\n\nThe Claims Manager processes claims requests from the Claims Requestor. It follows internal business processes to create the claim that are beyond the scope of this profile. It also responds to claim tracking requests to return the status of the requested claim.", "jurisdiction": [ { "coding": [ { "system": "http://unstats.un.org/unsd/methods/m49/m49.htm", "code": "001" } ] } ], "kind": "requirements", "fhirVersion": "4.0.1", "format": [ "application/fhir+xml", "application/fhir+json" ], "rest": [ { "mode": "server", "documentation": "FAIS Claims Manager rovides capability to receive claim submissions and respond to queries for claim responses.", "security": { "description": "Recommend [ATNA](https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html), encouraged [IHE-IUA](https://profiles.ihe.net/ITI/IUA/index.html) or [SMART-app-launch](http://www.hl7.org/fhir/smart-app-launch/)" }, "resource": [ { "type": "CoverageEligibilityRequest", "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityRequest" ], "documentation": "FAIS Check Coverage Eligibility transaction [[ITI-124]](ITI-124.html)", "operation": [ { "name": "submit", "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.CoverageEligibilityRequest.Submit", "documentation": "Submits a coverage eligibility request to check the coverage of a beneficiary. FAIS Check Coverage Eligibility transaction [[ITI-124]](ITI-124.html)." } ] }, { "type": "CoverageEligibilityResponse", "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse" ], "documentation": "FAIS Check Coverage Eligibility Status transaction [[ITI-125]](ITI-125.html)", "interaction": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "code": "read" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "code": "search-type" } ], "searchParam": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "_lastUpdated", "type": "date", "documentation": "When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb." }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "_id", "type": "token", "documentation": "Logical id of this artifact" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "status", "type": "token", "documentation": "The status of the response" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "request", "type": "reference", "documentation": "The coverage eligiblity request" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "patient", "type": "reference", "documentation": "The beneficiary" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "requestor", "type": "reference", "documentation": "The provider making the request" } ] }, { "type": "Claim", "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim" ], "documentation": "Supports these transactions:\n* [Submit Claim [ITI-126]](ITI-126.html)\n* [Cancel Claim [ITI-127]](ITI-127.html)\n* [Re-process Claim [ITI-128]](ITI-128.html)", "operation": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "submit", "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Submit", "documentation": "Submits a claim. FAIS Submit Claim transaction [[ITI-126]](ITI-126.html)." }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "cancel", "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Cancel", "documentation": "Cancels a claim. FAIS Cancel Claim transaction [[ITI-127]](ITI-127.html)." }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "reprocess", "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Reprocess", "documentation": "Re-processes a claim. FAIS Re-process Claim transaction [[ITI-128]](ITI-128.html)." } ] }, { "type": "ClaimResponse", "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse" ], "documentation": "FAIS Track Claim transaction [[ITI-129]](ITI-129.html)", "interaction": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "code": "read" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "code": "search-type" } ], "searchParam": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "_lastUpdated", "type": "date", "documentation": "When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb." }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "_id", "type": "token", "documentation": "Logical id of this artifact" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "status", "type": "token", "documentation": "The status of the response" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "request", "type": "reference", "documentation": "The coverage eligiblity request" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "patient", "type": "reference", "documentation": "The beneficiary" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "name": "requestor", "type": "reference", "documentation": "The provider making the request" } ] } ], "interaction": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation", "valueCode": "SHALL" } ], "code": "search-system" } ] } ] }