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FHIR IG Statistics: CapabilityStatement/IHE.FAIS.ClaimsManager

Packageihe.iti.fais
TypeCapabilityStatement
IdIHE.FAIS.ClaimsManager
FHIR VersionR4
Sourcehttps://profiles.ihe.net/ITI/FAIS/https://build.fhir.org/ig/IHE/ITI.Finance/CapabilityStatement-IHE.FAIS.ClaimsManager.html
URLhttps://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.ClaimsManager
Version1.0.1-current
Statusactive
Date2024-07-17
NameIHE_FAIS_ClaimsManager
TitleIHE FAIS Claims Manager
Realmuv
Authorityihe
DescriptionCapabilityStatement 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.
Kindrequirements

Resources that use this resource

No resources found


Resources that this resource uses

OperationDefinition
IHE.FAIS.Claim.CancelFAIS Claim $cancel
IHE.FAIS.Claim.ReprocessFAIS Claim $reprocess
IHE.FAIS.Claim.SubmitFAIS Claim $submit
IHE.FAIS.CoverageEligibilityRequest.SubmitFAIS Coverage Eligibility Request $submit
StructureDefinition
IHE.FAIS.ClaimFAIS Claim Profile
IHE.FAIS.ClaimResponseFAIS ClaimResponse Profile
IHE.FAIS.CoverageEligibilityRequestFAIS CoverageEligibilityRequest Profile
IHE.FAIS.CoverageEligibilityResponseFAIS 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 TypeProfileRSUCSearches_include_revincludeOperations
CoverageEligibilityRequestSupported Profiles
  FAIS CoverageEligibilityRequest Profile
$submit
CoverageEligibilityResponseSupported Profiles
  FAIS CoverageEligibilityResponse Profile
yy_lastUpdated, _id, status, request, patient, requestor
ClaimSupported Profiles
  FAIS Claim Profile
$submit, $cancel, $reprocess
ClaimResponseSupported Profiles
  FAIS ClaimResponse Profile
yy_lastUpdated, _id, status, request, patient, requestor

Resource Conformance: supported CoverageEligibilityRequest

Core FHIR Resource
CoverageEligibilityRequest
Reference Policy
Interaction summary

    Documentation

    FAIS Check Coverage Eligibility transaction [ITI-124]

    Extended Operations
    ConformanceOperationDocumentation
    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.

    Documentation

    FAIS Check Coverage Eligibility Status transaction [ITI-125]

    Search Parameters
    ConformanceParameterTypeDocumentation
    SHALL_lastUpdateddate

    When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.

    SHALL_idtoken

    Logical id of this artifact

    SHALLstatustoken

    The status of the response

    SHALLrequestreference

    The coverage eligiblity request

    SHALLpatientreference

    The beneficiary

    SHALLrequestorreference

    The provider making the request

     

    Resource Conformance: supported Claim

    Core FHIR Resource
    Claim
    Reference Policy
    Interaction summary

      Supported Profiles

      FAIS Claim Profile

      Extended Operations
      ConformanceOperationDocumentation
      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
      ConformanceParameterTypeDocumentation
      SHALL_lastUpdateddate

      When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.

      SHALL_idtoken

      Logical id of this artifact

      SHALLstatustoken

      The status of the response

      SHALLrequestreference

      The coverage eligiblity request

      SHALLpatientreference

      The beneficiary

      SHALLrequestorreference

      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"
              }
            ]
          }
        ]
      }