XIG: CapabilityStatement/IHE.FAIS.ClaimsManager

FHIR IG Statistics: CapabilityStatement/IHE.FAIS.ClaimsManager

Package	ihe.iti.fais
Resource 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

Resources that use this resource

No resources found

Resources that this resource uses

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

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CapabilityStatement IHE.FAIS.ClaimsManager

IHE FAIS Claims Manager

Implementation Guide Version: 1.0.1-current
FHIR Version: 4.0.1
Supported Formats: application/fhir+xml, application/fhir+json
Supported Patch Formats:
Published on: 2024-07-17
Published by: IHE IT Infrastructure Technical Committee

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.

FHIR RESTful Capabilities

Mode: `server`

FAIS Claims Manager rovides capability to receive claim submissions and respond to queries for claim responses.

Security

Recommend ATNA, encouraged IHE-IUA or SMART-app-launch

Summary of System-wide Interactions

SHALL support the search-systeminteraction.

Capabilities by Resource/Profile

Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

The relevant profiles (if any)
The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
The required, recommended, and some optional search parameters (if any).
The linked resources enabled for _include
The other resources enabled for _revinclude
The operations on the resource (if any)

Resource Type	Profile	R	S	Searches	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

Resource Conformance: supported CoverageEligibilityRequest

Core FHIR Resource
CoverageEligibilityRequest

Reference Policy

Interaction summary

Supported Profiles

FAIS CoverageEligibilityRequest Profile

Documentation

FAIS Check Coverage Eligibility transaction [ITI-124]

Extended Operations

Conformance	Operation	Documentation
SHALL	$submit	Submits a coverage eligibility request to check the coverage of a beneficiary. FAIS Check Coverage Eligibility transaction [ITI-124].

Resource Conformance: SHALL CoverageEligibilityResponse

Core FHIR Resource
CoverageEligibilityResponse

Reference Policy

Interaction summary

SHALL support read, search-type.

Supported Profiles

FAIS CoverageEligibilityResponse Profile

Documentation

FAIS Check Coverage Eligibility Status transaction [ITI-125]

Search Parameters

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

Resource Conformance: supported Claim

Core FHIR Resource
Claim

Reference Policy

Interaction summary

Supported Profiles

FAIS Claim Profile

Documentation

Supports these transactions:

Submit Claim [ITI-126]

Cancel Claim [ITI-127]

Re-process Claim [ITI-128]

Extended Operations

Conformance	Operation	Documentation
SHALL	$submit	Submits a claim. FAIS Submit Claim transaction [ITI-126].
SHALL	$cancel	Cancels a claim. FAIS Cancel Claim transaction [ITI-127].
SHALL	$reprocess	Re-processes a claim. FAIS Re-process Claim transaction [ITI-128].

Resource Conformance: SHALL ClaimResponse

Core FHIR Resource
ClaimResponse

Reference Policy

Interaction summary

SHALL support read, search-type.

Supported Profiles

FAIS ClaimResponse Profile

Documentation

FAIS Track Claim transaction [ITI-129]

Search Parameters

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

Source

{
  "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"
        }
      ]
    }
  ]
}

FHIR IG Statistics: CapabilityStatement/IHE.FAIS.ClaimsManager

Resources that use this resource

Resources that this resource uses

Narrative

IHE FAIS Claims Manager

FHIR RESTful Capabilities

Mode: server

Capabilities by Resource/Profile

Summary

Resource Conformance: supported CoverageEligibilityRequest

Resource Conformance: SHALL CoverageEligibilityResponse

Resource Conformance: supported Claim

Resource Conformance: SHALL ClaimResponse

Source

Mode: `server`