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13.6.6 13.6.9 Resource Claim - Mappings

Maturity Level : N/A
Responsible Owner: Financial Management icon Work Group Ballot Standards Status : Informative Security Category : Patient Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson

Mappings:

RIM FiveWs Pattern Mapping

Workflow Pattern

RIM Mapping

Mappings for the claim resource. Claim resource (see Mappings to Other Standards for further information & status).

13.6.6.1 13.6.9.1 Mappings for RIM FiveWs Pattern Mapping (http://hl7.org/v3) ( http://hl7.org/fhir/fivews icon )

        responsible         role         qualification     information         sequence         category         code         timing[x]         value[x]         reason     diagnosis         sequence         diagnosis[x]         type         packageCode     procedure         sequence         date         procedure[x]     insurance Coverage         sequence         focal         coverage         businessArrangement         preAuthRef         claimResponse     accident         date         type         location[x]     employmentImpacted     hospitalization     item         sequence         careTeamLinkId         diagnosisLinkId         procedureLinkId         informationLinkId         location[x]         quantity         unitPrice
Claim     identifier     status     type financial.billing
    subType     identifier     use FiveWs.identifier
    patient     status     billablePeriod FiveWs.status
    created     type     enterer FiveWs.class
    insurer     subType     provider FiveWs.class
    organization     use     priority FiveWs.class
    fundsReserve     subject     related         claim FiveWs.subject
        relationship     billablePeriod         reference FiveWs.done[x]
    prescription     created     originalPrescription FiveWs.recorded
    payee     enterer         type FiveWs.author
        resourceType     provider         party FiveWs.source
    referral     facility FiveWs.cause
    careTeam     facility         sequence FiveWs.where[x]
        provider         revenue         category FiveWs.actor
        service         identifier         modifier         programCode FiveWs.identifier
        serviced[x]         factor         net         udi         bodySite         subSite         encounter         detail             sequence             revenue             category             service             modifier             programCode             quantity             unitPrice             factor             net             udi             subDetail                 sequence                 revenue                 category                 service                 modifier                 programCode                 quantity                 unitPrice                 factor                 net FiveWs.done[x]
                udi         location[x]     total FiveWs.where[x]

13.6.6.2 13.6.9.2 Mappings for Workflow Mapping (http://hl7.org/fhir/workflow) Pattern ( http://hl7.org/fhir/workflow icon )

        detail             sequence             revenue             category             service             modifier             programCode             quantity             unitPrice             factor             net             udi             subDetail                 sequence                 revenue
Claim Request
    identifier Request.identifier
    status Request.status
    type     subType     use     patient     subject Request.subject
    billablePeriod     created Request.authoredOn
    enterer     insurer Request.performer
    provider Request.requester.agent     organization Request.requester.onBehalfOf Request.requester
    priority Request.priority
    fundsReserve     related         claim Request.replaces
        relationship         reference     prescription     originalPrescription     payee         type         resourceType         party     referral     facility     careTeam         sequence         provider         responsible         role         qualification     information     supportingInfo Request.supportingInfo
        sequence         category         code         timing[x]         value[x]         reason     diagnosis Request.reasonReference
        sequence         diagnosis[x]         type         packageCode     procedure         sequence         date         procedure[x]     insurance         sequence         focal         coverage         businessArrangement         preAuthRef         claimResponse     accident         date         type         location[x]     employmentImpacted     hospitalization     item         sequence         careTeamLinkId         diagnosisLinkId         procedureLinkId         informationLinkId         revenue         category         service         modifier         programCode         serviced[x]         location[x]         quantity         unitPrice         factor         net         udi         bodySite         identifier         subSite Request.identifier
        encounter Request.context
                category

13.6.9.3 RIM Mapping ( http://hl7.org/v3 icon )                 service                 modifier

                programCode                 quantity Claim                 unitPrice                 factor                 net
                udi     insurance     total Coverage