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 1.0.0-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

: Claims Requestor Actor - TTL Representation

Active as of 2024-07-17

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CapabilityStatement ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "IHE.FAIS.ClaimsRequestor"] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CapabilityStatement IHE.FAIS.ClaimsRequestor</b></p><a name=\"IHE.FAIS.ClaimsRequestor\"> </a><a name=\"hcIHE.FAIS.ClaimsRequestor\"> </a><a name=\"IHE.FAIS.ClaimsRequestor-en-US\"> </a><h2 id=\"title\">IHE FAIS Claims Requestor</h2><ul><li>Implementation Guide Version: 1.0.0-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>client</code></h3></div><div class=\"panel-body\"><div><p>FAIS Claims Requestor provides capability to submit claim requests and query 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>MAY </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=\"#Claim1-1\">Claim</a></td><td>Supported Profiles<br/>  <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>$reprocess</code></td></tr><tr><td><a href=\"#ClaimResponse1-2\">ClaimResponse</a></td><td>Supported Profiles<br/>  <a href=\"StructureDefinition-IHE.FAIS.ClaimResponse.html\">FAIS ClaimResponse Profile</a></td><td class=\"text-center\">y</td><td class=\"text-center\">y</td><td class=\"text-center\"></td><td class=\"text-center\"></td><td>_lastUpdated, _id, status, request, patient, requestor</td><td/><td/><td/></tr></tbody></table></div><hr/><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"Claim1-1\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: supported </span>Claim</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/claim.html\">Claim</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul/></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.Claim.html\">FAIS Claim Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>Supports these transactions:</p>\n<ul>\n<li><a href=\"ITI-126.html\">Submit Claim [ITI-126]</a></li>\n<li><a href=\"ITI-127.html\">Cancel Claim [ITI-127]</a></li>\n<li><a href=\"ITI-128.html\">Re-process Claim [ITI-128]</a></li>\n</ul>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Extended Operations</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Operation</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-IHE.FAIS.Claim.Submit.html\">$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=\"ClaimResponse1-2\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: MAY </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>MAY</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>MAY</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>MAY</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>MAY</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>MAY</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>MAY</b></td><td>patient</td><td><code>reference</code></td><td><div><p>The beneficiary</p>\n</div></td></tr><tr><td><b>MAY</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\"> </div></div></div></div></div></div>"
  ] ; # 
  fhir:url [ fhir:v "https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.ClaimsRequestor"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "1.0.0-current"] ; # 
  fhir:name [ fhir:v "IHE_FAIS_ClaimsRequestor"] ; # 
  fhir:title [ fhir:v "IHE FAIS Claims Requestor"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v "false"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2024-07-17"^^xsd:date] ; # 
  fhir:publisher [ fhir:v "IHE IT Infrastructure Technical Committee"] ; # 
  fhir:contact ( [
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "https://www.ihe.net/ihe_domains/it_infrastructure/" ]     ] )
  ] [
    ( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "iti@ihe.net" ]     ] )
  ] [
fhir:name [ fhir:v "IHE IT Infrastructure Technical Committee" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "iti@ihe.net" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "CapabilityStatement for [Claims Requestor Actor](volume-1.html#claims-requestor).\n\nThe Claims Requestor files a pre-determination, pre-authorization, or claim for a patient, as well as cancel and re-process claims, and can query for responses when the result is queued."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ]     ] )
  ] ) ; # 
  fhir:kind [ fhir:v "requirements"] ; # 
  fhir:fhirVersion [ fhir:v "4.0.1"] ; # 
  fhir:format ( [ fhir:v "application/fhir+xml"] [ fhir:v "application/fhir+json"] ) ; # 
  fhir:rest ( [
fhir:mode [ fhir:v "client" ] ;
fhir:documentation [ fhir:v "FAIS Claims Requestor provides capability to submit claim requests and query for claim responses." ] ;
fhir:security [
fhir:description [ fhir:v "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/)" ]     ] ;
    ( fhir:resource [
fhir:type [ fhir:v "Claim" ] ;
      ( fhir:supportedProfile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim>       ] ) ;
fhir:documentation [ fhir:v "Supports these transactions:\n* [Submit Claim [ITI-126]](ITI-126.html)\n* [Cancel Claim [ITI-127]](ITI-127.html)\n* [Re-process Claim [ITI-128]](ITI-128.html)" ] ;
      ( fhir:operation [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "SHALL" ]         ] ) ;
fhir:name [ fhir:v "submit" ] ;
fhir:definition [
fhir:v "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Submit"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Submit>         ] ;
fhir:documentation [ fhir:v "Submits a claim.  FAIS Submit Claim transaction [[ITI-126]](ITI-126.html)." ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "SHALL" ]         ] ) ;
fhir:name [ fhir:v "cancel" ] ;
fhir:definition [
fhir:v "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Cancel"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Cancel>         ] ;
fhir:documentation [ fhir:v "Cancels a claim.  FAIS Cancel Claim transaction [[ITI-127]](ITI-127.html)." ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "SHALL" ]         ] ) ;
fhir:name [ fhir:v "reprocess" ] ;
fhir:definition [
fhir:v "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Reprocess"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Reprocess>         ] ;
fhir:documentation [ fhir:v "Re-processes a claim.  FAIS Re-process Claim transaction [[ITI-128]](ITI-128.html)." ]       ] )     ] [
fhir:type [ fhir:v "ClaimResponse" ] ;
      ( fhir:supportedProfile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse>       ] ) ;
fhir:documentation [ fhir:v "FAIS Track Claim transaction [[ITI-129]](ITI-129.html)" ] ;
      ( fhir:interaction [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:code [ fhir:v "read" ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:code [ fhir:v "search-type" ]       ] ) ;
      ( fhir:searchParam [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:name [ fhir:v "_lastUpdated" ] ;
fhir:type [ fhir:v "date" ] ;
fhir:documentation [ fhir:v "When the resource version last changed.  The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb." ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:name [ fhir:v "_id" ] ;
fhir:type [ fhir:v "token" ] ;
fhir:documentation [ fhir:v "Logical id of this artifact" ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:name [ fhir:v "status" ] ;
fhir:type [ fhir:v "token" ] ;
fhir:documentation [ fhir:v "The status of the response" ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:name [ fhir:v "request" ] ;
fhir:type [ fhir:v "reference" ] ;
fhir:documentation [ fhir:v "The coverage eligiblity request" ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:name [ fhir:v "patient" ] ;
fhir:type [ fhir:v "reference" ] ;
fhir:documentation [ fhir:v "The beneficiary" ]       ] [
        ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]         ] ) ;
fhir:name [ fhir:v "requestor" ] ;
fhir:type [ fhir:v "reference" ] ;
fhir:documentation [ fhir:v "The provider making the request" ]       ] )     ] ) ;
    ( fhir:interaction [
      ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation"^^xsd:anyURI ] ;
fhir:value [ fhir:v "MAY" ]       ] ) ;
fhir:code [ fhir:v "search-system" ]     ] )
  ] ) . #