Finance and Insurance Service (FAIS)
1.0.1-current - ci-build International flag

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 1.0.1-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

CapabilityStatement: Beneficiary Manager Actor

Official URL: https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.BeneficiaryManager Version: 1.0.1-current
Active as of 2024-07-17 Computable Name: IHE_FAIS_BeneficiaryManager

CapabilityStatement for Beneficiary Manager Actor.

The Beneficiary Manager processes requests from the Beneficiary Requestor actor. It follows internal business processes to enroll beneficiaries from the Beneficiary Requestor that are beyond the scope of this profile and will return the result of the enrollment. It also responds to queries about insurance plans.

Raw OpenAPI-Swagger Definition file | Download

Generated Narrative: CapabilityStatement IHE.FAIS.BeneficiaryManager

IHE FAIS Beneficiary 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 Beneficiary Manager processes requests from the Beneficiary Requestor on Insurance Plans and Enrollment Responses and receives the Enrollment Request submission.

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
InsurancePlanSupported Profiles
  FAIS InsurancePlan Profile		yy_lastUpdated, _id, status, type, name, identifier, administered-by, owned-by, network, coverage-area, benefit-type
EnrollmentRequestSupported Profiles
  FAIS EnrollmentRequest Profile		$submit
EnrollmentResponseSupported Profiles
  FAIS EnrollmentResponse Profile		yy_lastUpdated, _id, status, request

Resource Conformance: SHALL InsurancePlan

Core FHIR Resource
InsurancePlan
Reference Policy
Interaction summary
  • SHALL support read, search-type.

Supported Profiles

FAIS InsurancePlan Profile

Documentation

FAIS Query Insurance Plan transaction [ITI-121]

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 Insurance Plan

SHALLtypetoken

The type of the Insurance Plan

SHALLnamestring

The name of the Insurance Plan

SHALLidentifiertoken

The business identifiers of the Insurance Plan

SHALLadministered-byreference

Who administers the Insurance Plan

SHALLowned-byreference

Who owns the Insurance Plan

SHOULDnetworkreference

The Insurance Plan network

SHOULDcoverage-areareference

The Insurance Plan coverage area

SHOULDbenefit-typetoken

The Insurance Plan type of benefit

 

Resource Conformance: supported EnrollmentRequest

Core FHIR Resource
EnrollmentRequest
Reference Policy
Interaction summary

    Supported Profiles

    FAIS EnrollmentRequest Profile

    Documentation

    FAIS Enroll Beneficiary transaction [ITI-122]

    Extended Operations
    ConformanceOperationDocumentation
    SHALL$submit

    Submits an enrollment request to enroll a new beneficiary with the request coverage. FAIS Enroll Beneficiary transaction [ITI-122]

    Resource Conformance: SHALL EnrollmentResponse

    Core FHIR Resource
    EnrollmentResponse
    Reference Policy
    Interaction summary
    • SHALL support read, search-type.

    Supported Profiles

    FAIS EnrollmentResponse Profile

    Documentation

    FAIS Check Enrollment Status transaction [ITI-123]

    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 enrollment request