NHDR Implementation Guide Release 1.0
0.1.0 - ci-build

NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/nhdr-fhir-ig-review-project-2/ and changes regularly. See the Directory of published versions

## Mapping of Claims Form 1 to FHIR

View
Form

### Mapped Fields

Form Field | Use-Case Mapping / Target Element | Data Type | Cardinality | Notes
--- | --- | --- | --- | ---
Series # | Claim.identifier | Identifier | 0..* |
Part I - Member Information |  |  |  |
PhilHealth Identification Number (PIN) of Member | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.identifier | Identifier |  |
Name of Member (Last Name) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.name.family | string | 0..1 |
Name of Member (First Name) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.name.given[0] | string | 0..* | Use first instance of `name.given`
Name of Member (Name Extension) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.name.suffix | string | 0..* |
Name of Member (Middle Name) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.name.given[1] | string | 0..* | Use second instance of `name.given`
Date of Birth | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.birthDate | date | 0..1 |
Mailing Address (Unit/Room No./Floor) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.line | string | 0..* |
Mailing Address (Building Name) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.line | string | 0..* |
Mailing Address (Lot/Blk/House/Bldg. No.) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.line | string | 0..* |
Mailing Address (Street) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.line | string | 0..* |
Mailing Address (Subdivision/Village) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.line | string | 0..* |
Mailing Address (Barangay) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.extension:barangay | Coding | 0..1 | ValueSet: Barangay
Mailing Address (City/Municipality) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.extension:cityMunicipality | Coding | 0..1 | ValueSet: CityMunicipality
Mailing Address (Province) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.extension:province | Coding | 0..1 | ValueSet: Province
Mailing Address (Country) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.country | Coding | 0..1 | ValueSet: ​Country
Mailing Address (Zip Code) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.address.postalCode | string | 0..1 | ​ValueSet: PostalCodes
Sex | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.extension:sex | code | 0..1 | ValueSet: Sex
Contact Information Landline # (Area Code + Tel. No.) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.telecom | ContactPoint | 0..* | `telecom.system` = 'phone'
Contact Information (Mobile #) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.telecom | ContactPoint | 0..* | `telecom.system` = 'sms'
Contact Information (Email Address) | Claim.payee.party | Reference(PH RelatedPerson) | 0..1 |
► | RelatedPerson.telecom | ContactPoint | 0..* | `telecom.system` = 'email'
Patient is the member? [Yes, Proceed to Part III / No, Proceed to Part II] | Questionnaire.item.text | string | 0..1 |
Part II - Patient Information | (To be filled-out only if the patient is a dependent) |  |  |
PhilHealth Identification Number (PIN) of Dependent | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.identifier | Identifier |  |
Name of Patient (Last Name) | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.name.family | string | 0..1 |
Name of Patient (First Name) | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.name.given[0] | string | 0..* | Use first instance of `name.given`
Name of Patient (Name Extension) | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.name.suffix | string | 0..* |
Name of Patient (Middle Name) | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.name.given[1] | string | 0..* | Use second instance of `name.given`
Date of Birth | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.birthDate | date | 0..1 |
Relationship to Member | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.contact.relationship | CodeableConcept | 0..1 | ValueSet: Contact Relationship
Sex | Claim.patient | Reference(PH Patient) | 1..1 |
► | Patient.extension:sex | code | 0..1 | ValueSet: Sex
Part III - Member Certification |  |  |  |
Signature Type | Provenance.signature.type | Coding | 1..* |
Signature Over Printed Name of Member | Provenance.signature.data | base64Binary | 0..1 |
Signature Over Printed Name of Member | Provenance.signature.who | Reference(PH Patient or PH RelatedPerson) | 1..1 |
► | Patient.name RelatedPerson.name | HumanName | 0..* |
Date Signed (MM-DD-YYYY) | Provenance.signature.when | instant | 1..1 |
Signature Over Printed Name of Member's Representative | Provenance.signature.data | base64Binary | 0..1 |
Signature Over Printed Name of Member's Representative | Provenance.signature.who | Reference(PH RelatedPerson) | 1..1 |
► | RelatedPerson.name | HumanName | 0..1 |
Date Signed (MM-DD-YYYY) | Provenance.signature.when | instant | 1..1 |
Printed Thumbmark | Provenance.signature.data | base64Binary | 0..1 |
Relationship of the representative to the member | Provenance.signature.who | Reference(PH RelatedPerson) | 1..1 |
► | RelatedPerson.relationship | CodeableConcept | 0..* | ​ValueSet: Contact Relationship
Reason for signing on behalf of the member | Provenance.signature.extension:reason | string | 0..* |
Part IV - Employer's Certification | (for employed members only) |  |  |
PhilHealth Employer Number (PEN) | Claim.insurance.coverage | Reference(PH Coverage) | 1..1 |
► | Coverage.policyHolder | Reference(PH_Organization) | 0..1 |
► | Organization.identifier | Identifier | 0..* |
Contact No. | Claim.insurance.coverage | Reference(PH Coverage) | 1..1 |
► | Coverage.policyHolder | Reference(PH_Organization) | 0..1 |
► | Organization.telecom.value | string | 0..1 |
Business Name (Business Name of Employer) | Claim.insurance.coverage | Reference(PH Coverage) | 1..1 |
► | Coverage.policyHolder | Reference(PH_Organization) | 0..1 |
► | Organization.name | string | 0..1 |
Signature Type | Provenance.signature.type | Coding | 1..* |
Signature Over Printed Name of Employer/Authorized Representative | Provenance.signature.data | base64Binary | 0..1 |
Signature Over Printed Name of Employer/Authorized Representative | Provenance.signature.who | Reference(PH Organization) | 1..1 |
► | Organization.contact.name | HumanName | 0..1 |
Official Capacity / Designation | Provenance.signature.extension:position | CodeableConcept | 0..* |
CERTIFICATION OF EMPLOYER (Date Signed MM-DD-YYYY) | Provenance.signature.when | instant | 1..1 |
Part V - For PhilHealth Use Only |  |  |  |
Signature Type | Provenance.signature.type | Coding | 1..* |
Date Received | Provenance.recorded | instant | 1..1 |
LHIO / PRO Signature Over Printed Name | Provenance.signature.data | base64Binary | 0..1 |
LHIO / PRO Signature Over Printed Name | Provenance.signature.who | Reference(PH Organization) | 1..1 |
► | Organization.contact.name | HumanName | 0..1 |

### Mandatory Elements Not in the Form

Use-Case Mapping / Target Element | Data Type | Notes
--- | --- | ---
Provenance.target | ​Reference(PH_Claims) | Reference the intact Claim resource
Provenance.agent.who | Reference(PH_Organization) | Reference the intact Organization (Health Facility) resource
Organization.name | string | Derive from the referenced Organization resource
Claim.status | code | Use expected value 'submitted'
Claim.type | CodeableConcept | Use expected value '(custom ValueSet to be provided later)'
Claim.use | code | Use expected value 'claim'
Claim.created | dateTime | "Resource creation date", should be the `instant` that the resource was created.
Claim.provided | Reference(Practitioner/PractitionerRole/Organization) | "The provider which is responsible for the claim, predetermination or preauthorization."
Claim.priority | CodeableConcept | Use expected value 'normal'
Claim.payee.type | CodeableConcept | Use expected value 'subscriber/provider/other'
Claim.insurance.sequence | positiveInt | Expected incrementing value per object.
Claim.insurance.focal | boolean | Flag that determines the coverage to be used for the adjudication of this claim.
Questionnaire.status | code | Use expected value 'active'
Questionnaire.item.linkId | string | Expected incrementing value per questionnaire item.
Questionnaire.item.type | code | Indicates expected data type for the questionnaire item.