Finance and Insurance Service (FAIS)
1.0.1-current - ci-build
Finance and Insurance Service (FAIS)
1.0.1-current - ci-build
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
| Active as of 2024-07-17 |
{
"resourceType" : "CapabilityStatement",
"id" : "IHE.FAIS.ClaimsManager",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CapabilityStatement IHE.FAIS.ClaimsManager</b></p><a name=\"IHE.FAIS.ClaimsManager\"> </a><a name=\"hcIHE.FAIS.ClaimsManager\"> </a><a name=\"IHE.FAIS.ClaimsManager-en-US\"> </a><h2 id=\"title\">IHE FAIS Claims Manager</h2><ul><li>Implementation Guide Version: 1.0.1-current </li><li>FHIR Version: 4.0.1 </li><li>Supported Formats: <code>application/fhir+xml</code>, <code>application/fhir+json</code></li><li>Supported Patch Formats: </li><li>Published on: 2024-07-17 </li><li>Published by: IHE IT Infrastructure Technical Committee </li></ul><blockquote class=\"impl-note\"><p><strong>Note to Implementers: FHIR Capabilities</strong></p><p>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.</p></blockquote><h2 id=\"rest\">FHIR RESTful Capabilities</h2><div class=\"panel panel-default\"><div class=\"panel-heading\"><h3 id=\"mode1\" class=\"panel-title\">Mode: <code>server</code></h3></div><div class=\"panel-body\"><div><p>FAIS Claims Manager rovides capability to receive claim submissions and respond to queries for claim responses.</p>\n</div><div class=\"lead\"><em>Security</em></div><blockquote><div><p>Recommend <a href=\"https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html\">ATNA</a>, encouraged <a href=\"https://profiles.ihe.net/ITI/IUA/index.html\">IHE-IUA</a> or <a href=\"http://www.hl7.org/fhir/smart-app-launch/\">SMART-app-launch</a></p>\n</div></blockquote><div class=\"lead\"><em>Summary of System-wide Interactions</em></div><ul><li><strong>SHALL </strong>support the <code>search-system</code>interaction.</li></ul></div></div><h3 id=\"resourcesCap1\">Capabilities by Resource/Profile</h3><h4 id=\"resourcesSummary1\">Summary</h4><p>The summary table lists the resources that are part of this configuration, and for each resource it lists:</p><ul><li>The relevant profiles (if any)</li><li>The interactions supported by each resource (<b><span class=\"bg-info\">R</span></b>ead, <b><span class=\"bg-info\">S</span></b>earch, <b><span class=\"bg-info\">U</span></b>pdate, and <b><span class=\"bg-info\">C</span></b>reate, are always shown, while <b><span class=\"bg-info\">VR</span></b>ead, <b><span class=\"bg-info\">P</span></b>atch, <b><span class=\"bg-info\">D</span></b>elete, <b><span class=\"bg-info\">H</span></b>istory on <b><span class=\"bg-info\">I</span></b>nstance, or <b><span class=\"bg-info\">H</span></b>istory on <b><span class=\"bg-info\">T</span></b>ype are only present if at least one of the resources has support for them.</li><li><span>The required, recommended, and some optional search parameters (if any). </span></li><li>The linked resources enabled for <code>_include</code></li><li>The other resources enabled for <code>_revinclude</code></li><li>The operations on the resource (if any)</li></ul><div class=\"table-responsive\"><table class=\"table table-condensed table-hover\"><thead><tr><th><b>Resource Type</b></th><th><b>Profile</b></th><th class=\"text-center\"><b title=\"GET a resource (read interaction)\">R</b></th><th class=\"text-center\"><b title=\"GET all set of resources of the type (search interaction)\">S</b></th><th class=\"text-center\"><b title=\"PUT a new resource version (update interaction)\">U</b></th><th class=\"text-center\"><b title=\"POST a new resource (create interaction)\">C</b></th><th><b title=\"Required and recommended search parameters\">Searches</b></th><th><code><b>_include</b></code></th><th><code><b>_revinclude</b></code></th><th><b>Operations</b></th></tr></thead><tbody><tr><td><a href=\"#CoverageEligibilityRequest1-1\">CoverageEligibilityRequest</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.CoverageEligibilityRequest.html\">FAIS CoverageEligibilityRequest Profile</a></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td></td><td/><td/><td><code>$submit</code></td></tr><tr><td><a href=\"#CoverageEligibilityResponse1-2\">CoverageEligibilityResponse</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.CoverageEligibilityResponse.html\">FAIS CoverageEligibilityResponse Profile</a></td><td class=\"text-center\">y</td><td class=\"text-center\">y</td><td class=\"text-center\"></td><td class=\"text-center\"></td><td>_lastUpdated, _id, status, request, patient, requestor</td><td/><td/><td/></tr><tr><td><a href=\"#Claim1-3\">Claim</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.Claim.html\">FAIS Claim Profile</a></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td></td><td/><td/><td><code>$submit</code>, <code>$cancel</code>, <code>$reprocess</code></td></tr><tr><td><a href=\"#ClaimResponse1-4\">ClaimResponse</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.ClaimResponse.html\">FAIS ClaimResponse Profile</a></td><td class=\"text-center\">y</td><td class=\"text-center\">y</td><td class=\"text-center\"></td><td class=\"text-center\"></td><td>_lastUpdated, _id, status, request, patient, requestor</td><td/><td/><td/></tr></tbody></table></div><hr/><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"CoverageEligibilityRequest1-1\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: supported </span>CoverageEligibilityRequest</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/coverageeligibilityrequest.html\">CoverageEligibilityRequest</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul/></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.CoverageEligibilityRequest.html\">FAIS CoverageEligibilityRequest Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>FAIS Check Coverage Eligibility transaction <a href=\"ITI-124.html\">[ITI-124]</a></p>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Extended Operations</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Operation</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-IHE.FAIS.CoverageEligibilityRequest.Submit.html\">$submit</a></td><td><div><p>Submits a coverage eligibility request to check the coverage of a beneficiary. FAIS Check Coverage Eligibility transaction <a href=\"ITI-124.html\">[ITI-124]</a>.</p>\n</div></td></tr></tbody></table></div></div></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"CoverageEligibilityResponse1-2\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHALL </span>CoverageEligibilityResponse</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/coverageeligibilityresponse.html\">CoverageEligibilityResponse</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>read</code>, <code>search-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.CoverageEligibilityResponse.html\">FAIS CoverageEligibilityResponse Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>FAIS Check Coverage Eligibility Status transaction <a href=\"ITI-125.html\">[ITI-125]</a></p>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-lg-7\"><span class=\"lead\">Search Parameters</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td>_lastUpdated</td><td><code>date</code></td><td><div><p>When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>_id</td><td><code>token</code></td><td><div><p>Logical id of this artifact</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>status</td><td><code>token</code></td><td><div><p>The status of the response</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>request</td><td><code>reference</code></td><td><div><p>The coverage eligiblity request</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>patient</td><td><code>reference</code></td><td><div><p>The beneficiary</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>requestor</td><td><code>reference</code></td><td><div><p>The provider making the request</p>\n</div></td></tr></tbody></table></div><div class=\"col-lg-5\">\u00a0</div></div></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"Claim1-3\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: supported </span>Claim</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/claim.html\">Claim</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul/></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.Claim.html\">FAIS Claim Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>Supports these transactions:</p>\n<ul>\n<li><a href=\"ITI-126.html\">Submit Claim [ITI-126]</a></li>\n<li><a href=\"ITI-127.html\">Cancel Claim [ITI-127]</a></li>\n<li><a href=\"ITI-128.html\">Re-process Claim [ITI-128]</a></li>\n</ul>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Extended Operations</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Operation</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-IHE.FAIS.Claim.Submit.html\">$submit</a></td><td><div><p>Submits a claim. FAIS Submit Claim transaction <a href=\"ITI-126.html\">[ITI-126]</a>.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-IHE.FAIS.Claim.Cancel.html\">$cancel</a></td><td><div><p>Cancels a claim. FAIS Cancel Claim transaction <a href=\"ITI-127.html\">[ITI-127]</a>.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-IHE.FAIS.Claim.Reprocess.html\">$reprocess</a></td><td><div><p>Re-processes a claim. FAIS Re-process Claim transaction <a href=\"ITI-128.html\">[ITI-128]</a>.</p>\n</div></td></tr></tbody></table></div></div></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"ClaimResponse1-4\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHALL </span>ClaimResponse</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/claimresponse.html\">ClaimResponse</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>read</code>, <code>search-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.ClaimResponse.html\">FAIS ClaimResponse Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>FAIS Track Claim transaction <a href=\"ITI-129.html\">[ITI-129]</a></p>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-lg-7\"><span class=\"lead\">Search Parameters</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td>_lastUpdated</td><td><code>date</code></td><td><div><p>When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>_id</td><td><code>token</code></td><td><div><p>Logical id of this artifact</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>status</td><td><code>token</code></td><td><div><p>The status of the response</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>request</td><td><code>reference</code></td><td><div><p>The coverage eligiblity request</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>patient</td><td><code>reference</code></td><td><div><p>The beneficiary</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>requestor</td><td><code>reference</code></td><td><div><p>The provider making the request</p>\n</div></td></tr></tbody></table></div><div class=\"col-lg-5\">\u00a0</div></div></div></div></div></div>"
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"version" : "1.0.1-current",
"name" : "IHE_FAIS_ClaimsManager",
"title" : "IHE FAIS Claims Manager",
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"date" : "2024-07-17",
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"description" : "CapabilityStatement for [Claims Requestor Actor](volume-1.html#claims-manager).\n\nThe Claims Manager processes claims requests from the Claims Requestor. It follows internal business processes to create the claim that are beyond the scope of this profile. It also responds to claim tracking requests to return the status of the requested claim.",
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"description" : "Recommend [ATNA](https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html), encouraged [IHE-IUA](https://profiles.ihe.net/ITI/IUA/index.html) or [SMART-app-launch](http://www.hl7.org/fhir/smart-app-launch/)"
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🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityRequest"
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]
}
IG © 2024+ IHE IT Infrastructure Technical Committee. Package ihe.iti.fais#1.0.1-current based on FHIR 4.0.1. Generated 2024-11-22
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