Finance and Insurance Service (FAIS), published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.0.1-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.Finance/ and changes regularly. See the Directory of published versions

Finance and Insurance Service

Official URL: https://profiles.ihe.net/ITI/FAIS/ImplementationGuide/ihe.iti.fais				Version: 0.0.1-current
Draft as of 2024-03-26				Computable Name: IHE_ITI_FAIS

The Finance and Insurance Service (FAIS) stores, categorizes, and facilitates the administration of centralized claims and finance related data to care provision to patients within the HIE. The service receives claims/financial data from Point of Service applications (including financing applications acting as a point of service interface outside of other PoS systems) and curates the management of them.

Organization of This Guide

This guide is organized into the following sections:

1. Volume 1:
   1. Introduction
   2. Actors, Transactions, and Content
   3. Actor Options
   4. Actor Required Groupings
   5. Overview
   6. Security Considerations
   7. Cross Profile Considerations
2. Volume 2: Transaction Detail
   1. 3.YY1 Enroll Beneficiary [ITI-YY1]
   2. 3.YY2 Query Beneficiary [ITI-YY2]
   3. 3.YY3 Check Coverage Eligibility [ITI-YY3]
   4. 3.YY4 Submit Claim [ITI-YY4]
   5. 3.YY5 Track Claim [ITI-YY5]
3. Other
   1. Test Plan
   2. Changes to Other IHE Specifications
   3. Download and Analysis

See also the Table of Contents and the index of Artifacts defined as part of this implementation guide.

Conformance Expectations

IHE uses the normative words: SHALL, SHOULD, and MAY according to standards conventions.

Must Support

The use of mustSupport in StructureDefinition profiles equivalent to the IHE use of R2 as defined in Appendix Z.

mustSupport of true - only has a meaning on items that are minimal cardinality of zero (0), and applies only to the source actor populating the data. The source actor shall populate the elements marked with MustSupport, if the concept is supported by the actor, a value exists, and security and consent rules permit. The consuming actors should handle these elements being populated or being absent/empty. Note that sometimes mustSupport will appear on elements with a minimal cardinality greater than zero (0), this is due to inheritance from a less constrained profile.