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

CapabilityStatement: Coverage Requestor Actor

Official URL: https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.CoverageRequestor Version: 1.0.0-current
Active as of 2024-07-17 Computable Name: IHE_FAIS_CoverageRequestor

CapabilityStatement for Coverage Requestor Actor.

The Coverage Requestor checks for what coverage a patient has and can query for responses when the result is queued.

Raw OpenAPI-Swagger Definition file | Download

Generated Narrative: CapabilityStatement IHE.FAIS.CoverageRequestor

IHE FAIS Coverage Requestor

  • Implementation Guide Version: 1.0.0-current
  • FHIR Version: 4.0.1
  • Supported Formats: application/fhir+xml, application/fhir+json
  • Supported Patch Formats:
  • Published on: 2024-07-17
  • Published by: IHE IT Infrastructure Technical Committee

Note to Implementers: FHIR Capabilities

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.

FHIR RESTful Capabilities

Mode: client

FAIS Coverage Requestor provides capability to submit coverage eligibility requests and query for coverage eligibility responses.

Security

Recommend ATNA, encouraged IHE-IUA or SMART-app-launch

Summary of System-wide Interactions
  • MAY support the search-systeminteraction.

Capabilities by Resource/Profile

Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

  • The relevant profiles (if any)
  • The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
  • The required, recommended, and some optional search parameters (if any).
  • The linked resources enabled for _include
  • The other resources enabled for _revinclude
  • The operations on the resource (if any)
Resource TypeProfileRSUCSearches_include_revincludeOperations
CoverageEligibilityRequestSupported Profiles
  FAIS CoverageEligibilityRequest Profile		$submit
CoverageEligibilityResponseSupported Profiles
  FAIS CoverageEligibilityResponse Profile		yy_lastUpdated, _id, status, request, patient, requestor
Core FHIR Resource
CoverageEligibilityRequest
Reference Policy
Interaction summary

    Supported Profiles

    FAIS CoverageEligibilityRequest Profile

    Documentation

    FAIS Check Coverage Eligibility transaction [ITI-124]

    Extended Operations
    ConformanceOperationDocumentation
    SHALL$submit

    Submits a coverage eligibility request to check the coverage of a beneficiary. FAIS Check Coverage Eligibility transaction [ITI-124].

    Core FHIR Resource
    CoverageEligibilityResponse
    Reference Policy
    Interaction summary
    • MAY support read, search-type.

    Supported Profiles

    FAIS CoverageEligibilityResponse Profile

    Documentation

    FAIS Check Coverage Eligibility Status transaction [ITI-125]

    Search Parameters
    ConformanceParameterTypeDocumentation
    MAY_lastUpdateddate

    When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.

    MAY_idtoken

    Logical id of this artifact

    MAYstatustoken

    The status of the response

    MAYrequestreference

    The coverage eligiblity request

    MAYpatientreference

    The beneficiary

    MAYrequestorreference

    The provider making the request