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

Table of Contents

.. 0 Table of Contents
... 1 Finance and Insurance Service (FAIS) Home
... 2 1:57 Finance and Insurance Service (FAIS)
... 3 2:3.121 Query Insurance Plan [ITI-121]
... 4 2:3.122 Enroll Beneficiary [ITI-122]
... 5 2:3.123 Check Enrollment Status [ITI-123]
... 6 2:3.124 Check Coverage Eligibility [ITI-124]
... 7 2:3.125 Check Coverage Eligibility Status [ITI-125]
... 8 2:3.126 Submit Claim [ITI-126]
... 9 2:3.127 Cancel Claim [ITI-127]
... 10 2:3.128 Re-process Claim [ITI-128]
... 11 2:3.129 Track Claim [ITI-129]
... 12 Test Plan
... 13 Changes to Other IHE Specifications
... 14 Download and Analysis
... 15 Significant Changes and Issues
... 16 Artifacts Summary
.... 16.1 Beneficiary Manager Actor
.... 16.2 Beneficiary Requestor Actor
.... 16.3 Claims Manager Actor
.... 16.4 Claims Requestor Actor
.... 16.5 Coverage Requestor Actor
.... 16.6 FAIS Claim $cancel
.... 16.7 FAIS Claim $reprocess
.... 16.8 FAIS Claim $submit
.... 16.9 FAIS Coverage Eligibility Request $submit
.... 16.10 FAIS Enrollment Request $submit
.... 16.11 SearchParameter for InsurancePlan on the coverage.benefit.type element
.... 16.12 SearchParameter for InsurancePlan on the coverageArea element
.... 16.13 SearchParameter for InsurancePlan on the network element
.... 16.14 Audit Event for Cancel Claim Transaction by the Claims Requestor and Claims Manager for Update
.... 16.15 Audit Event for Check Coverage Eligibility Status Transaction by the Coverage Requestor and Claims Manager for Query
.... 16.16 Audit Event for Check Coverage Eligibility Status Transaction by the Coverage Requestor and Claims Manager for Read
.... 16.17 Audit Event for Check Coverage Eligibility Transaction by the Coverage Requestor and Claims Manager for Create
.... 16.18 Audit Event for Check Enrollment Status Transaction by the Beneficiary Requestor and Beneficiary Manager for Query
.... 16.19 Audit Event for Check Enrollment Status Transaction by the Beneficiary Requestor and Beneficiary Manager for Read
.... 16.20 Audit Event for Enroll Beneficiary Transaction by the Beneficiary Requestor and Beneficiary Manager for Create
.... 16.21 Audit Event for Query Insurance Plan Transaction by the Beneficiary Requestor and Beneficiary Manager for Query
.... 16.22 Audit Event for Query Insurance Plan Transaction by the Beneficiary Requestor and Beneficiary Manager for Read
.... 16.23 Audit Event for Re-process Claim Transaction by the Claims Requestor and Claims Manager for Update
.... 16.24 Audit Event for Submit Claim Transaction by the Claims Requestor and Claims Manager for Create
.... 16.25 Audit Event for Track Claim Transaction by the Claims Requestor and Claims Manager for Read
.... 16.26 Audit Event for Track Claim Transaction by the Coverage Requestor and Claims Manager for Query
.... 16.27 FAIS Claim Bundle Profile
.... 16.28 FAIS Claim Profile
.... 16.29 FAIS ClaimResponse Bundle Profile
.... 16.30 FAIS ClaimResponse Profile
.... 16.31 FAIS CoverageEligibilityRequest Bundle Profile
.... 16.32 FAIS CoverageEligibilityRequest Profile
.... 16.33 FAIS CoverageEligibilityResponse Bundle Profile
.... 16.34 FAIS CoverageEligibilityResponse Profile
.... 16.35 FAIS EnrollmentRequest Bundle Profile
.... 16.36 FAIS EnrollmentRequest Profile
.... 16.37 FAIS EnrollmentResponse Bundle Profile
.... 16.38 FAIS EnrollmentResponse Profile
.... 16.39 FAIS InsurancePlan Profile
.... 16.40 Request Status Reason
.... 16.41 Audit example for ITI-121 for Beneficiary Manager for query.
.... 16.42 Audit example for ITI-121 for Beneficiary Requestor for read.
.... 16.43 Audit example for ITI-122 for Beneficiary Requestor for submit.
.... 16.44 Audit example for ITI-123 for Beneficiary Manager for query.
.... 16.45 Audit example for ITI-123 for Beneficiary Requestor for read.
.... 16.46 Audit example for ITI-124 for Coverage Requestor for submit.
.... 16.47 Audit example for ITI-125 for Beneficiary Manager for query.
.... 16.48 Audit example for ITI-125 for Claims Manager for read.
.... 16.49 Audit example for ITI-126 for Claims Requestor for submit.
.... 16.50 Audit example for ITI-127 for Claims Requestor for cancel.
.... 16.51 Audit example for ITI-128 for Claims Requestor for re-process.
.... 16.52 Audit example for ITI-129 for Claims Manager for query.
.... 16.53 Audit example for ITI-129 for Claims Requestor for read.
.... 16.54 Device Example - FAIS Beneficiary Manager
.... 16.55 Device Example - FAIS Beneficiary Requestor
.... 16.56 Device Example - FAIS Claims Manager
.... 16.57 Device Example - FAIS Claims Requestor
.... 16.58 Device Example - FAIS Coverage Requestor
.... 16.59 Example Coverage
.... 16.60 Example Coverage Eligibility Request
.... 16.61 Example Coverage Eligibility Request Bundle
.... 16.62 Example Coverage Eligibility Response
.... 16.63 Example Enrollment Request
.... 16.64 Example Enrollment Request Bundle
.... 16.65 Example Enrollment Response
.... 16.66 Example Insurer
.... 16.67 Example Patient Beneficiary
.... 16.68 Use Case 1 - Example Coverage
.... 16.69 Use Case 1 - Example Enrollment Request
.... 16.70 Use Case 1 - Example Enrollment Request Bundle
.... 16.71 Use Case 1 - Example Enrollment Response
.... 16.72 Use Case 1 - Example Enrollment Response Bundle
.... 16.73 Use Case 1 - Example Insurance Plan
.... 16.74 Use Case 1 - Example Insurer: National Health Insurance Scheme
.... 16.75 Use Case 1 - Example Network: National Health Hospital System
.... 16.76 Use Case 1 - Example Patient Beneficiary
.... 16.77 Use Case 2 - Example Coverage Eligibility Request
.... 16.78 Use Case 2 - Example Coverage Eligibility Request Bundle
.... 16.79 Use Case 2 - Example Coverage Eligibility Response
.... 16.80 Use Case 2 - Example Coverage Eligibility Response Bundle
.... 16.81 Use Case 2 - Example Doctor
.... 16.82 Use Case 2 - Local Hospital
.... 16.83 Use Case 3 - Example accepted claim response
.... 16.84 Use Case 3 - Example accepted claim response bundle
.... 16.85 Use Case 3 - Example cancelled claim
.... 16.86 Use Case 3 - Example claim
.... 16.87 Use Case 3 - Example claim bundle
.... 16.88 Use Case 3 - Example denied claim response
.... 16.89 Use Case 3 - Example queued claim response
.... 16.90 Use Case 4 - Example accepted pre-determination response
.... 16.91 Use Case 4 - Example pre-determination claim
.... 16.92 Use Case 5 - Example accepted pre-determination response
.... 16.93 Use Case 5 - Example pre-authorization claim
.... 16.94 Testing Feature File for ITI 121
.... 16.95 Testing Feature File for ITI 122
.... 16.96 Testing Feature File for ITI 123
.... 16.97 Testing Feature File for ITI 124
.... 16.98 Testing Feature File for ITI 125
.... 16.99 Testing Feature File for ITI 126
.... 16.100 Testing Feature File for ITI 127
.... 16.101 Testing Feature File for ITI 128
.... 16.102 Testing Feature File for ITI 129