Finance and Insurance Service (FAIS)
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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

: Use Case 5 - Example pre-authorization claim - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="ex-preauthorization-5"/>
  <meta>
    <profile
             value="https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Claim ex-preauthorization-5</b></p><a name="ex-preauthorization-5"> </a><a name="hcex-preauthorization-5"> </a><a name="ex-preauthorization-5-en-US"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}">Institutional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-07-15 03:00:00+0000</p><p><b>enterer</b>: <a href="Practitioner-ex-doctor-2.html">Practitioner Kalu Kalu </a></p><p><b>insurer</b>: <a href="Organization-ex-insurer-1.html">Organization National Health Insurance Scheme</a></p><p><b>provider</b>: <a href="Practitioner-ex-doctor-2.html">Practitioner Kalu Kalu </a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>Payees</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}">Provider</span></td><td><a href="Organization-ex-network-1.html">Organization National Health Hospital System</a></td></tr></table><p><b>facility</b>: <a href="Location-ex-hospital-2.html">Location Local Hospital</a></p><h3>Diagnoses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://id.who.int/icd/release/11/mms XH1VB1}">Hybrid oncocytic chromophobe tumour</span></td></tr></table><h3>Procedures</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://loinc.org 21946-9}">Chemotherapy treatment Cancer</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage-ex-coverage-1.html">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --&gt; 2024-12-31</a></td></tr></table></div>
  </text>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="institutional"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>🔗 
    <reference value="Patient/ex-beneficiary-1"/>
  </patient>
  <created value="2024-07-15T03:00:00Z"/>
  <enterer>🔗 
    <reference value="Practitioner/ex-doctor-2"/>
  </enterer>
  <insurer>🔗 
    <reference value="Organization/ex-insurer-1"/>
  </insurer>
  <provider>🔗 
    <reference value="Practitioner/ex-doctor-2"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
        <code value="provider"/>
      </coding>
    </type>
    <party>🔗 
      <reference value="Organization/ex-network-1"/>
    </party>
  </payee>
  <facility>🔗 
    <reference value="Location/ex-hospital-2"/>
  </facility>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system value="http://id.who.int/icd/release/11/mms"/>
        <code value="XH1VB1"/>
        <display value="Hybrid oncocytic chromophobe tumour"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <procedure>
    <sequence value="1"/>
    <procedureCodeableConcept>
      <coding>
        <system value="http://loinc.org"/>
        <code value="21946-9"/>
        <display value="Chemotherapy treatment Cancer"/>
      </coding>
    </procedureCodeableConcept>
  </procedure>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/ex-coverage-1"/>
    </coverage>
  </insurance>
</Claim>