Difference between revisions of "ProfessionalClaim FHIR Resource Proposal"
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| + | This page documents an [[:category:Approved FHIR Resource Proposal|Approved]] [[:category:FHIR Resource Proposal|FHIR Resource Proposal]] | ||
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| + | [[Category:FHIR Resource Proposal]] | ||
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==Expected implementations== | ==Expected implementations== | ||
| − | This is a key resource expected by most Healthcare billing implementations where | + | This is a key resource expected by most Healthcare billing implementations where Health care is provided. |
<!--Key resources are justified by CCDA, for resources not deemed "key", what interest is there by implementers in using this particular resource. Provide named implementations if possible - ideally provide multiple independent implementations. --> | <!--Key resources are justified by CCDA, for resources not deemed "key", what interest is there by implementers in using this particular resource. Provide named implementations if possible - ideally provide multiple independent implementations. --> | ||
Latest revision as of 01:30, 8 February 2015
This page documents an Approved FHIR Resource Proposal
Contents
- 1 ProfessionalClaim
- 1.1 Owning committee name
- 1.2 Contributing or Reviewing Work Groups
- 1.3 FHIR Resource Development Project Insight ID
- 1.4 Scope of coverage
- 1.5 RIM scope
- 1.6 Resource appropriateness
- 1.7 Expected implementations
- 1.8 Content sources
- 1.9 Example Scenarios
- 1.10 Resource Relationships
- 1.11 Timelines
- 1.12 gForge Users
ProfessionalClaim
Owning committee name
Contributing or Reviewing Work Groups
- Claims with Attachments
- Patient Administration
FHIR Resource Development Project Insight ID
994
Scope of coverage
The ProfessionalClaim is one of a suite of similar resources (OralClaim, VisionClaim, PharmacyClaim, ProfessionalClaim, InstitutionalClaim) which are used by providers to exchange the financial information, and supporting clinical information, regarding the provision of healthcare goods and services. The primary uses of this resource is to support eClaims, the exchange of proposed or supplied products and services to benefit payors, insurers and national health programs, for treatment payment planning and reimbursement. The primary use is for OutPatient Care billing by providers such as: Medical, Chiropractors, Physiotherapists, Rehab Therapists and other Health care providers both licensed and unlicensed.
The Claim is intended to support:
RIM scope
PaymentRequest (classCode=XACT,moodCode=PRP,RQO)
Resource appropriateness
Claims, and the variants of Pre-Determinations and Pre-Authorizations, are the means through which Providers submit patient rendered services to the Patient's insurers for reimbursement. The reimbursement may or may not be assigned to the Provider. There are generally agreed types of claims based on the class of health discipline and adjudication engines are often segmented along these same lines of: OralHealth, Vision, Pharmacy, Professional (Medical and Chiro,Physio, Rehab - typically outpatient care) and Institutional (Hospital, clinic, etc).
Expected implementations
This is a key resource expected by most Healthcare billing implementations where Health care is provided.
Content sources
Existing normative V3 and V2 specifications, Canadian Specifications, X12
Example Scenarios
Resource Relationships
Refers to Patient, Practitioner, Organization, Coverage, Referral, ClaimResponse. Is referred to by ClaimResponse, ReconciliationResponse, Reversal, Readjudication, PaymentNotice, StatusRequest, FinancialAttachment, InformationCheck, ExplanationOfBenefit and occasionally by a Claim resource.
Timelines
Ready for DSTU 2
gForge Users
paulknapp
