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

Changes to Other IHE Specifications

This section modifies other IHE profiles or the General Introduction appendices and is not a part of the FAIS Profile. The content here will be incorporated into the target narrative at a future time, usually when FAIS Profile goes normative.

IHE Technical Frameworks General Introduction Appendix A: Actors

Editor, add the following new or modified actors to the IHE Technical Frameworks General Introduction Appendix A:
Actor Definition
Beneficiary Requestor Enroll beneficiaries and search for insurance plans.
Beneficiary Manager Process beneficiary enrollment and respond to queries on insurance plans.
Coverage Requestor Check the coverage eligibility of beneficiaries.
Claims Requestor Send claims and check for claim response updates.
Claims Manager Process claims, manage updates to claim responses, and respond to coverage eligibility requests.

IHE Technical Frameworks General Introduction Appendix B: Transactions

Editor, add the following new or modified transactions to the IHE Technical Frameworks General Introduction Appendix B:
Transaction Definition
Query Insurance Plan [ITI-121] Search for insurance plans.
Enroll Beneficiary [ITI-122] Enroll a beneficiary under the requested coverage.
Check Enrollment Status [ITI-123] Check the status of an enrollment response.
Check Coverage Eligibility [ITI-124] Check a beneficiary for the requested coverage.
Check Coverage Eligibility Status [ITI-125] Check the status of a coverage eligibility request.
Submit Claim [ITI-126] Submit a new claim for a beneficiary.
Cancel Claim [ITI-127] Cancel a previously submitted claim.
Re-process Claim [ITI-128] Re-process a previously denied claim.
Track Claim [ITI-129] Check the status of a claim.

IHE Technical Frameworks General Introduction Appendix D: Glossary

Editor, add the following new or modified terms to the IHE Technical Frameworks General Introduction Appendix D:
Term Definition Acronyms/Abbreviations Synonyms
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