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During the FHIR Connectathon #9 in Paris the focus will be on the creation and exchange of FHIR based eClaims. The testing scenarios shown below form the core of the "Financial" test track. There are three test scenarios:
 
During the FHIR Connectathon #9 in Paris the focus will be on the creation and exchange of FHIR based eClaims. The testing scenarios shown below form the core of the "Financial" test track. There are three test scenarios:
−
#Submit a Claim via REST (Create), Retrieve a Claim Response (Get)
+
#Submit a Claim via REST (Create), Retrieve a ClaimResponse (Get)
 
#Submit a Claim via WSI Web Services and Receive a ClaimResponse
 
#Submit a Claim via WSI Web Services and Receive a ClaimResponse
−
#Retrieve deferred ClaimResponse via PendedRequest
+
#Retrieve deferred ClaimResponse via ProcessRequest
−
You may select one or more of these testing scenarios - whatever appeals to you most given your particular context. We encourage you to create generic tests, but the only tests which can be assured are those using the sample resources provided here.
+
You may select one or more of these testing scenarios - whatever appeals to you most given your particular context. We encourage you to create generic tests, but the only tests which can be assured are those using sample resources based on the data provided here.
  
−
==Mapping HL7 version 2 to FHIR==
+
==Scenarios==
−
One of the main use-cases for mapping will be to populate a FHIR Resource Repository using data derived from a HL7 version 2 message feeds. The FHIR Specification details some of the [http://hl7-fhir.github.io/comparison-v2.html differences between HL7v2 and FHIR], and contains a partial mapping of resources to HL7 version 2 (e.g. [http://hl7.org/fhir/2015May/observation-mappings.html observation resource]). This test track will focus on the most commonly used HL7v2 trigger events, i.e. ADT and ORU.
 
−
 
−
The wording below distinguishes between three kinds of actors:
 
−
*FHIR Client: a software application that has the capability to create/assemble FHIR based requests.
 
−
*FHIR Server: a software application with the capability to receive and process FHIR based requests. The server need not have a stiorage capability for FHIR resources.
 
−
**A ''Messaging Enabled FHIR Server'' is a kind of FHIR server which supports the messaging interoperability paradigm. Note that none of the FHIR Servers currently available for testing falls into this category.
 
−
*Transformation Agent: the software component that transforms HL7v2 to FHIR and/or vice versa. The role of Transformation Agent will be combined with that of a FHIR client and/or a FHIR Server.
 
  
−
===ADT Query===
+
All Claim submission examples will be for Oral Health, Dental, claims submitted using the subset of service codes provided below. You are free to trial Pre-determinations and Pre-Authorizations, Claims with use=proposed or use=exploratory. Testing samples are also limited to a single insurance coverage.
−
Demographics and visit query according to IHE ITI specs ([http://www.ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol2a.pdf IHE ITI Volume 2a], section 3.22 "Patient Demographics and Visit Query").
 
−
#Test for ''Transformation Agent / FHIR Client'':
 
−
#*Determine (e.g. by querying the FHIR server) the ID of a patient which has an active encounter on a particular FHIR server. Edit the HL7v2.5 query example to include that identifier.
 
−
#*Process/read a HL7v2.5 QBP^ZV1 query, send corresponding query to FHIR server, transform response to HL7 v2.5 RSP^ZV2.
 
−
#*Determine the ID of a patient which doesn't have an active encounter; edit the HL7v2.5 query example to include that identifier and retest the transformation/request process.
 
−
#*Determine the ID of a patient which doesn't exist; edit the HL7v2.5 query example to include that identifier and retest the transformation/request process.
 
−
#Notes:
 
−
#*We'll ignore any HL7 v2 extensions right now (notably Z-segments).
 
−
#*All QPD-3 options, as well as QPD-8 (as documented in the IHE specification) SHALL be supported.
 
−
#*See [ftp://ftp.ihe.net/DocumentPublication/Archive/ITInfrastructure/2014/Published/IHE_ITI_Suppl_PDQm_Rev1.0_PC_2014-06-06.pdf PDQm] for the IHE PDQm proposal based on FHIR which may act as guidance.
 
−
#Example/test messages:
 
  
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||''timestamp''||QBP^ZV1^QBP_Q21|''controlId''|P|2.5
+
===Submit a Claim via REST, Retrieve a ClaimResponse===
−
QPD|Q22^IHE PDQ Query^HL70471|''queryId''|@PID.5.1.1^Smith~@PID.8^F|||||
+
The FHIR Client will construct a Claim having either already submitted the supporting resources or with the supporting resources provided within the Claim as contained resources.  
−
RCP|I||R|
 
  
−
Example notes: QPD-8 is left empty on purpose, returning patient-encounters for all identity domains.
+
To obtain the ClaimResponse for the submitted Claim the client with perform a GET on ClaimResponse with search parameters which may be expected to select the intended response.  
  
−
===ADT===
+
===Submit a Claim via WSI Web Services and Receive a ClaimResponse===
−
Hl7v2.5 ADT messages: process a sequence comprised of A31, A01, A02, A08, A03 trigger events. The sequence A31-A01-A02 will contain 2 allergies, A08 drops one allergy (A08 and A03 only contain 2 allergies).  
+
The FHIR Client will construct a Claim with the supporting information provided within the Claim as contained resources. The response to the Claim will be an OperationOutcome if the Claim cannot be understood or a ClaimResponse if it can.
  
−
#Test for ''Transformation Agent / FHIR Client'':
+
If the priority=deferred then a ClaimResponse containing only errors or acknowledgement detail will be returned. The ClaimResponse containing adjudication details can be obtained later as the response to a ProcessRequest (action=poll) resource, for example:
−
#*(easy option, assumes that the FHIR Server supports Messaging) - process/read this sequence of HL7v2.5 messages, transform each of them to a FHIR Message, send FHIR messages to FHIR Server.
+
*<nowiki>[base]/ClaimResponse?request.identifier=http://happyvalley.com/claim|1500</nowiki>
−
#**Determine what the most appropriate 'focal resource(s)' should be that should be referenced in messageHeader.data
 
−
#*(difficult option, assumes that the FHIR server only supports REST) - process/read this sequence of HL7v2.5 messages, transform each of them into a series of FHIR resources, query/update/delete resources on the FHIR Server.
 
−
#**The ''Transformation agent'' will have to detect that one allergy has been dropped from the message -compared to the previous message about the same patient and encounter-, and that an allergy has to be deleted.
 
−
#**A provenance resource SHOULD be created to document the fact that certain resources were sourced from a single message
 
−
#**You SHOULD populate the text option in the generated resources
 
−
#**Patient, encounter and allergies SHALL be transformed into identified FHIR resources, other resources MAY be either contained or identified. 
 
−
#Test for ''Messaging Enabled FHIR server'':
 
−
#*If the FHIR Server supports Messaging it should be able to detect 'information which has been removed from a snapshot'
 
−
#**Tt will have to detect that one allergy has been dropped from the message -compared to the previous message about the same patient and encounter-, and that an allergy has to be deleted
 
−
#Notes:
 
−
#*We'll ignore any HL7 v2 extensions right now (notably Z-segments)
 
−
#*Given that all messages (in this test scenario) are sent by one and the same source system the use of HL7v2 'update mode' and nulls can be ignored.
 
−
#*See [http://fhirblog.com/2015/03/18/more-fhir-messaging-adt-messages/ David hay's blog] for his reflections on this kind of mapping.
 
−
#Test messages:
 
−
#*In order to avoid too many identifier clashes when various systems would store translations of the message below, you should replace all items shown in ''Italics'' (e.g. controlID, NHS_Number, LocalPatId, VisitNumber, etc.) with your own identifiers.
 
  
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||20150501115930||ADT^A31|''controlID''|P|2.5
+
===Retrieve deferred ClaimResponse via ProcessRequest===
−
EVN|A31|20150501115930|
+
Submission of a ProcessRequest (action=poll) resource which contains a reference to the previously submitted claim via WSI Web Services will result in the return of the ClaimResponse containing the adjudicated results of the previously submitted Claim.
−
PID|1||''NHS_Number''^10^^NHS^NH~''LocalPatId''^^^TCPAS^MR||Kennedy^Ann^F^^Ms^^L||19280524^Y|F|||22 Stable Road^Whitstable^Kent^^CR5 1EL^^^^P||277543^PRN|||U||
+
<nowiki>
−
PV1|1|N|
+
<ProcessRequest xmlns="http://hl7.org/fhir">
−
AL1|1|DA|1605^acetaminophen^L|MO|Muscle Pain~hair loss
+
  <contained>
−
AL1|2|DA|1558^Oxycodone^L|MO|Muscle Pain~hair loss
+
    <Claim>
−
AL1|3|MA|2221^Peanuts^L|SV|Anaphylactic Shock
+
      <id value="claim-1"/>
−
 
+
      <identifier>
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||20150502090000||ADT^A01|''controlID''|P|2.5
+
          <system value="http://happyvalley.com/claim"/>
−
EVN|A01|20150502090000|
+
          <value value="1500"/>
−
PID|1||''NHS_Number''^10^^NHS^NH~''LocalPatId''^^^TCPAS^MR||Kennedy^Ann^F^^Ms^^L||19280524^Y|F|||22 Stable Road^Whitstable^Kent^^CR5 1EL^^^^P||277543^PRN|||U||
+
      </identifier>
−
NK1|1|Kennedy^Joe|FTH|||+44 201 12345678||
+
    </Claim>
−
PV1||I|INT^0001^02^GENHOS||||0100^ANDERSON,CARL|0148^ADDISON,JAMES||SUR|||||||0148^ANDERSON,CARL|S|''VisitNumber''^^^GENHOS|A|||||||||||||||||||GENHOS|||||20150502090000|
+
  </contained>
−
AL1|1|DA|1605^acetaminophen^L|MO|Muscle Pain~hair loss
+
  <text>
−
AL1|2|DA|1558^Oxycodone^L|MO|Muscle Pain~hair loss
+
    <status value="generated"/>
−
AL1|3|MA|2221^Peanuts^L|SV|Anaphylactic Shock
+
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
−
 
+
  </text>
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||20150502103420||ADT^A02|''controlID''|P|2.5
+
  <action value="poll"/>
−
EVN|A01|20150502103420|
+
  <identifier>
−
PID|1||''NHS_Number''^10^^NHS^NH~''LocalPatId''^^^TCPAS^MR||Kennedy^Ann^F^^Ms^^L||19280524^Y|F|||22 Stable Road^Whitstable^Kent^^CR5 1EL^^^^P||277543^PRN|||U||
+
    <system value="http://happyvalley.com/processrequest"/>
−
NK1|1|Kennedy^Joe|FTH|||+44 201 12345678||
+
    <value value="111"/>
−
PV1||I|SUR^0005^01^GENHOS|||INT^0001^02^GENHOS|0500^DVORAK,PETR|0148^ADDISON,JAMES||SUR|||||||0148^ANDERSON,CARL|S|''VisitNumber''^^^GENHOS|A|||||||||||||||||||GENHOS|||||20150502090000|
+
  </identifier>
−
AL1|1|DA|1605^acetaminophen^L|MO|Muscle Pain~hair loss
+
  <created value="2015-04-16"/>
−
AL1|2|DA|1558^Oxycodone^L|MO|Muscle Pain~hair loss
+
  <organization>
−
AL1|3|MA|2221^Peanuts^L|SV|Anaphylactic Shock
+
    <reference value="Organization/1"/>
−
 
+
  </organization>
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||20150502105810||ADT^A08|''controlID''|P|2.5
+
  <request>
−
EVN|A08|20150502105810|
+
    <reference value="#claim-1"/>
−
PID|1||''NHS_Number''^10^^NHS^NH~''LocalPatId''^^^TCPAS^MR||Kennedy^Ann^F^^Ms^^L||19280524^Y|F|||22 Stable Road^Whitstable^Kent^^CR5 1EL^^^^P||277543^PRN|||U||
+
  </request>
−
NK1|1|Kennedy^Joseph|FTH|||+44 201 12345678||
+
  <include>ClaimResponse</include>
−
PV1||I|SUR^0005^01^GENHOS|||INT^0001^02^GENHOS|0500^DVORAK,PETER|0148^ADDISON,JAMES||SUR|||||||0148^ANDERSON,CARL|S|''VisitNumber''^^^GENHOS|A|||||||||||||||||||GENHOS|||||20150502090000|
+
</ProcessRequest></nowiki>
−
AL1|1|DA|1605^acetaminophen^L|MO|Muscle Pain~hair loss
 
−
AL1|2|MA|2221^Peanuts^L|SV|Anaphylactic Shock
 
−
 
 
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||20150502100000||ADT^A03|''controlID''|P|2.5
 
−
EVN|A03|20150502100000|
 
−
PID|1||''NHS_Number''^10^^NHS^NH~''LocalPatId''^^^TCPAS^MR||Kennedy^Ann^F^^Ms^^L||19280524^Y|F|||22 Stable Road^Whitstable^Kent^^CR5 1EL^^^^P||277543^PRN|||U||
 
−
NK1|1|Kennedy^Joseph|FTH|||+44 201 12345678||
 
−
PV1||I|SUR^0005^01^GENHOS|||INT^0001^02^GENHOS|0500^DVORAK,PETER|0148^ADDISON,JAMES||SUR|||||||0148^ANDERSON,CARL|S|''VisitNumber''^^^GENHOS|A|||||||||||||||||||GENHOS|||||20150502090000|20150502100000|
 
−
AL1|1|DA|1605^acetaminophen^L|MO|Muscle Pain~hair loss
 
−
AL1|2|MA|2221^Peanuts^L|SV|Anaphylactic Shock
 
−
 
 
−
===Lab Results===
 
−
HL7v2.5 Lab results: a sequence comprised of ORU temporary result, and ORU final result. Chem tests.
 
−
 
 
−
#Test for ''Transformation Agent / FHIR Client'':
 
−
#*(easy option, assumes that the FHIR Server supports Messaging) - process/read this sequence of HL7v2.5 messages, transform each of them to a FHIR Message, send FHIR messages to FHIR Server.
 
−
#**Determine what the most appropriate 'focal resource(s)' should be that should be referenced in messageHeader.data.
 
−
#**If OBX-21 hasn't been valued (it doesn't even exist in Hl7 v2.5) the OBX shoudl be turned into a contained resource.
 
−
#*(difficult option, assumes that the FHIR server only supports REST) - process/read this sequence of HL7v2.5 messages, transform each of them into a series of FHIR resources, query/update/delete resources on the FHIR Server.
 
−
#**This requires updating of existing resources, which is a challenge in that there are no unique resource.ids in HL7 v2.
 
−
#**A provenance resource SHOULD be created to document the fact that certain resources were sourced from a single message
 
−
#**The following policy applies: given that the Lab system isn't the 'master' when it comes to data OTHER than the actual results (ORC/OBR/OBX/SPM/SAC/..) all other data should be considered to be references (to e.g. patient/encounter) only.
 
−
#**Patient, encounter and order/observations related resources SHOULD be identified FHIR resources (as far as possible), other resources MAY be either contained or identified.
 
−
#**You SHOULD populate the text option in the generated resources
 
−
#Notes:
 
−
#*We'll ignore any HL7 v2 extensions right now (notably Z-segments)
 
−
#*Given that all messages (in this test scenario) are sent by one and the same source system the use of HL7v2 'update mode' and nulls can be ignored.
 
−
#*See [http://www.ringholm.com/docs/04350_mapping_HL7v2_FHIR.htm this whitepaper] for a discussion of an example this type of mapping.
 
−
#Test messages:
 
−
#*In order to avoid too many identifier clashes when various systems would store translations of the message below, you should replace all items shown in Italics (e.g. controlID, LocalPatientId, SpecimenId, PlacerOrderNumber, etc.) with your own identifiers.
 
−
 
 
−
MSH|^~\&|''SomeSystem''||''TransformationAgent''||201410060645||ORU^R01|182|T|2.5||
 
−
PID|1||''LocalPatientId''^^^AMC^PI||van den Berg-Meijer&&Meijer&van den&Berg^A^P^^^^L||19601012|F|||Prinsengracht 22&Prinsengracht&22^22^Amsterdam^^1200 PJ^^M||020 555366^PRN^PH|||M||
 
−
OBR|1|''PlacerOrderNumber''|''FillerOrderNumber''|85027^Hemogram and platelet count, automated^CPT4||||||^COLLECT^JOHN|P|||||^URO^^^^DR||||||201410060644|||P|||||||&CYTO&JANE^201410060929
 
−
OBX|1|NM|11156-7^LEUKOCYTES^LN||||||||I|
 
−
OBX|2|NM|11273-0^ERYTHROCYTES^LN||4.06|tera.l-1||N|||P|||201410060627
 
−
OBX|3|NM|20509-6^HEMOGLOBIN^LN||||||||I|
 
−
OBX|4|NM|20570-8^HEMATOCRIT^LN||40.1|%||N|||P|||201410060830
 
−
OBX|5|NM|11125-2^PLATELETS^LN||221|giga.l-1||N|||F|||201410060830
 
−
SPM|1|''SpecimenID''||BLD|||||||P||||||201410060535|201410060821||Y||||||1
 
−
OBR|2|''PlacerOrderNumber2''|''FillerOrderNumber2''|85009^Differential WBC Count, buffy coat^CPT4||||||^COLLECT^JOHN|P|||||^URO^^^^DR||||||201410060929|||P|||||||&CYTO&JANE^201410060929
 
−
OBX|1|NM|23761-0^NEUTROPHILS/100 LEUKOCYTES^LN||72|%||N|||P|||201410060627
 
−
OBX|2|NM|26450-7^EOSINOPHILS/100 LEUKOCYTES^LN||2|%||N|||P|||201410060627
 
−
OBX|3|NM|26478-8^LYMPHOCYTES/100 LEUKOCYTES^LN||20|%||N|||P|||201410060627
 
−
OBX|4|NM|26485-3^MONOCYTES/100 LEUKOCYTES^LN||6|%||N|||P|||201410060627
 
−
OBX|5|NM|30180-4^BASOPHILS/100 LEUKOCYTES^LN||0|%||N|||P|||201410060627
 
−
SPM|1|''SpecimenID''||BLD|||||||P||||||201410060535|201410060821||Y||||||1
 
−
 
 
−
..and the final result (and yes, we did switch the order of the OBRs as well as the OBXs, to ensure you have no depencies on the segment sequence.)
 
  
 
==Sample Data==
 
==Sample Data==
  
−
===Patients===
+
===Claims===
  
 
{|border="1" cellpadding="2" cellspacing="0"
 
{|border="1" cellpadding="2" cellspacing="0"
−
| width="30%" colspan="1" aligh="left" style="background:#f0f0f0;"|'''Field'''
+
| width="30%" colspan="1" align="left" style="background:#f0f0f0;"|'''Field'''
 
| width="35%" colspan="1" align="left" style="background:#f0f0f0;"|'''Patient #1 Claim'''
 
| width="35%" colspan="1" align="left" style="background:#f0f0f0;"|'''Patient #1 Claim'''
 
| width="35%" colspan="1" align="left" style="background:#f0f0f0;"|'''Patient #2 Claim'''
 
| width="35%" colspan="1" align="left" style="background:#f0f0f0;"|'''Patient #2 Claim'''
Line 166: Line 83:
 
||Birthdate
 
||Birthdate
 
||1973-04-14
 
||1973-04-14
−
||
+
||1993-06-24
 
|-
 
|-
 
||Exceptions
 
||Exceptions
 
||
 
||
−
||
+
||Full-time student (Code 1) at Rozdale University
 
|-
 
|-
 
||Address
 
||Address
 
||1234 Any Street
 
||1234 Any Street
 
Menlo Park, California 90123
 
Menlo Park, California 90123
−
||
+
||1 Landingpad Lane
 +
Loma Linda, California 90310
 
|-
 
|-
 
||Dentist
 
||Dentist
 
||Dr. Darryl Dentist (# 904563)
 
||Dr. Darryl Dentist (# 904563)
−
||
+
Happy Valley Clinic (# 1535)
 +
||Dr. Phil Amolar (# 678543)
 +
Happy Valley Clinic (# 1535)
 
|-
 
|-
 
||Referral
 
||Referral
 
||Practitioner (# 720415)
 
||Practitioner (# 720415)
 
Reason: Rampant decay (Code 7)
 
Reason: Rampant decay (Code 7)
 +
||
 +
|-
 +
||Insurance
 +
||The Benefit Company (BINN# 654123)
 +
Certificate: A7G345, Policy: 123YHT56
 +
SubSection: 35 Dependent: 01
 +
Relationship: Self
 +
||Health Management Corp (BINN# 564378)
 +
Certificate: RF98765 Policy: GALACTIC
 +
Dependent: 04 Relationship: Child
 +
Frank Robinson born 1953-05-14
 +
|-
 +
|colspan="3" style="background:#f0f0f0;"|Service Code, Fee, Tooth Surface, Lab#1 Code, Lab#1 Fee, Lab#2 Code, Lab#2 Fee
 +
|-
 +
||Service #1
 +
||1102, $65.00
 +
||1101, $55.00
 +
|-
 +
||Service #2
 +
||21211, $105.00, 21, L
 +
||2102, $730.00
 +
|-
 +
||Service #3
 +
||27211, $900.00, 22, , 99111, $250.00
 +
||21211, $105, 21, L
 +
|-
 +
||Service #4
 +
||
 +
||21212, $200.00, 42, DI
 +
|-
 +
||Service #5
 +
||
 +
||11101, $135.00
 
|}
 
|}
  
 +
===Services===
  
−
 
+
{|border="1" cellpadding="2" cellspacing="0"
−
{|border="1" cellpadding="2" cellspacing="0"  
+
| width="30%" colspan="1" align="left" style="background:#f0f0f0;"|'''Code'''
−
| width="50%" colspan="2" align="left" style="background:#f0f0f0;"|'''HL7 ITS Meeting Minutes'''
+
| width="35%" colspan="1" align="left" style="background:#f0f0f0;"|'''Description'''
−
| width="50%" colspan="2" align="left" style="background:#f0f0f0;"|'''Date: 2015-01-06'''
+
| width="10%" colspan="1" align="right" style="background:#f0f0f0;"|'''Fee'''
 +
|-
 +
||1101
 +
||Exam, comp, primary
 +
|width="10%" align="right" |55.00
 +
|-
 +
||1102
 +
||Exam, comp, mixed
 +
|width="10%" align="right" |60.00
 +
|-
 +
||1103
 +
||Exam, comp, permanent
 +
|width="10%" align="right" |65.00
 +
|-
 +
||1201
 +
||Exam, comp, primary
 +
|width="10%" align="right" |45.00
 +
|-
 +
||1205
 +
||Exam, emergency
 +
|width="10%" align="right" |75.00
 +
|-
 +
||2101
 +
||Radiograph, series (12)
 +
|width="10%" align="right" |530.00
 +
|-
 +
||2102
 +
||Radiograph, series (16)
 +
|width="10%" align="right" |730.00
 +
|-
 +
||2141
 +
||Radiograph, bytewing
 +
|width="10%" align="right" |530.00
 +
|-
 +
||2601
 +
||Radiograph, panoramic
 +
|width="10%" align="right"|420.00
 
|-
 
|-
−
| width="50%" colspan="2" align="left"|'''Facilitator''': Paul Knapp
+
||11101
−
| width="50%" colspan="2" align="left"|'''Note taker(s)''': Andy Stechishin
+
||Polishing, 1 unit
 +
|width="10%" align="right"|35.00
 
|-
 
|-
−
| border="4" cellpadding="1" colspan="4" style="background:#f0f0f0;"|
+
||11102
 +
||Polishing, 2 unit
 +
|width="10%" align="right"|70.00
 
|-
 
|-
−
| border="1" width="10%" cellpadding="2" colspan="1" align="center"|'''Present'''
+
||11103
−
|align="left" width="40%"| '''Name'''
+
||Polishing, 3 unit
−
|align="center" width="10%"|'''Init'''
+
|width="10%" align="right"|105.00
−
|align="left" width="40%"|'''Affiliation'''
 
 
|-
 
|-
−
|align="center"| &times; || Paul Knapp ||align="center"| PK || Knapp Consulting
+
||11104
 +
||Polishing, 4 unit
 +
|width="10%" align="right"|135.00
 
|-
 
|-
−
|align="center"| &times; || Dale Nelson ||align="center"| DN || Lantana
+
||21211
 +
||Amalgam, 1 surface
 +
|width="10%" align="right"|105.00
 
|-
 
|-
−
|align="center"| &times; || Andy Stechishin ||align="center"| AS || CANA Software &amp; Services
+
||21212
 +
||Amalgam, 2 surface
 +
|width="10%" align="right"|200.00
 
|-
 
|-
−
|align="center"| &times; ||Brian Pech ||align="center"| BP || Kaiser-Permanente
+
||27211
 +
||Crown, PFM
 +
|width="10%" align="right"|900.00
 
|-
 
|-
−
|align="center"| &times; ||  David Booth || DB || Hawaii Resource Group
+
||99111
 +
||Lab, commercial
 +
|width="10%" align="right"|250.00
 
|-
 
|-
−
|align="center"| &times; ||  Grahame Grieve || GG || Health Intersections
+
||99333
−
|-
+
||Lab, in office
−
|colspan="4" style="background:#f0f0f0;"|
+
|width="10%" align="right"|200.00
 
|-
 
|-
−
|colspan="4" |'''Quorum Requirements Met: '''Yes
+
||99555
 +
||Lab, Expense
 +
|width="10%" align="right"|0.00
 
|}
 
|}

Latest revision as of 07:06, 22 April 2015

During the FHIR Connectathon #9 in Paris the focus will be on the creation and exchange of FHIR based eClaims. The testing scenarios shown below form the core of the "Financial" test track. There are three test scenarios:

  1. Submit a Claim via REST (Create), Retrieve a ClaimResponse (Get)
  2. Submit a Claim via WSI Web Services and Receive a ClaimResponse
  3. Retrieve deferred ClaimResponse via ProcessRequest

You may select one or more of these testing scenarios - whatever appeals to you most given your particular context. We encourage you to create generic tests, but the only tests which can be assured are those using sample resources based on the data provided here.

Scenarios

All Claim submission examples will be for Oral Health, Dental, claims submitted using the subset of service codes provided below. You are free to trial Pre-determinations and Pre-Authorizations, Claims with use=proposed or use=exploratory. Testing samples are also limited to a single insurance coverage.

Submit a Claim via REST, Retrieve a ClaimResponse

The FHIR Client will construct a Claim having either already submitted the supporting resources or with the supporting resources provided within the Claim as contained resources.

To obtain the ClaimResponse for the submitted Claim the client with perform a GET on ClaimResponse with search parameters which may be expected to select the intended response.

Submit a Claim via WSI Web Services and Receive a ClaimResponse

The FHIR Client will construct a Claim with the supporting information provided within the Claim as contained resources. The response to the Claim will be an OperationOutcome if the Claim cannot be understood or a ClaimResponse if it can.

If the priority=deferred then a ClaimResponse containing only errors or acknowledgement detail will be returned. The ClaimResponse containing adjudication details can be obtained later as the response to a ProcessRequest (action=poll) resource, for example:

  • [base]/ClaimResponse?request.identifier=http://happyvalley.com/claim|1500

Retrieve deferred ClaimResponse via ProcessRequest

Submission of a ProcessRequest (action=poll) resource which contains a reference to the previously submitted claim via WSI Web Services will result in the return of the ClaimResponse containing the adjudicated results of the previously submitted Claim. 

<ProcessRequest xmlns="http://hl7.org/fhir">
  <contained>
    <Claim>
       <id value="claim-1"/>
       <identifier>
          <system value="http://happyvalley.com/claim"/>
          <value value="1500"/>
       </identifier>
    </Claim>
  </contained>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <action value="poll"/>
  <identifier>
    <system value="http://happyvalley.com/processrequest"/>
    <value value="111"/>
  </identifier>
  <created value="2015-04-16"/>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <request>
    <reference value="#claim-1"/>
  </request>
  <include>ClaimResponse</include>
</ProcessRequest>

Sample Data

Claims

Field Patient #1 Claim Patient #2 Claim
Claim Number 1500 1501
Processing Priority Normal Normal
Claim Type Oral Health Oral Health
Name John M. Smith (Usual) Judy F. Robinson (Usual)
Gender M F
Birthdate 1973-04-14 1993-06-24
Exceptions Full-time student (Code 1) at Rozdale University
Address 1234 Any Street

Menlo Park, California 90123

1 Landingpad Lane

Loma Linda, California 90310

Dentist Dr. Darryl Dentist (# 904563)

Happy Valley Clinic (# 1535)

Dr. Phil Amolar (# 678543)

Happy Valley Clinic (# 1535)

Referral Practitioner (# 720415)

Reason: Rampant decay (Code 7)

Insurance The Benefit Company (BINN# 654123)

Certificate: A7G345, Policy: 123YHT56 SubSection: 35 Dependent: 01 Relationship: Self

Health Management Corp (BINN# 564378)

Certificate: RF98765 Policy: GALACTIC Dependent: 04 Relationship: Child Frank Robinson born 1953-05-14

Service Code, Fee, Tooth Surface, Lab#1 Code, Lab#1 Fee, Lab#2 Code, Lab#2 Fee
Service #1 1102, $65.00 1101, $55.00
Service #2 21211, $105.00, 21, L 2102, $730.00
Service #3 27211, $900.00, 22, , 99111, $250.00 21211, $105, 21, L
Service #4 21212, $200.00, 42, DI
Service #5 11101, $135.00

Services

Code Description Fee
1101 Exam, comp, primary 55.00
1102 Exam, comp, mixed 60.00
1103 Exam, comp, permanent 65.00
1201 Exam, comp, primary 45.00
1205 Exam, emergency 75.00
2101 Radiograph, series (12) 530.00
2102 Radiograph, series (16) 730.00
2141 Radiograph, bytewing 530.00
2601 Radiograph, panoramic 420.00
11101 Polishing, 1 unit 35.00
11102 Polishing, 2 unit 70.00
11103 Polishing, 3 unit 105.00
11104 Polishing, 4 unit 135.00
21211 Amalgam, 1 surface 105.00
21212 Amalgam, 2 surface 200.00
27211 Crown, PFM 900.00
99111 Lab, commercial 250.00
99333 Lab, in office 200.00
99555 Lab, Expense 0.00
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