OpenMRS insurance claims module

Owned by Arkadiusz Lalo
Last updated: Feb 05, 2020 by Kamil Madej
2 min read

Initial Statement:

Module used to dealing with insurance claim aspects.

Team Members:

Kamil Madej - Technical Leader

Arkadiusz Lalo - Developer

Damian Borowiecki - Developer

Bartlomiej Kaminski - Developer

Dawid Ruchniewicz - Developer

Tomasz Mueller - QA


GitHub repositories:

Showcase:

https://drive.google.com/drive/folders/1jZQkMWpBfeLFmTvZneocsD_3zRSEgLUK

Description:

The module will be responsible for checking patient insurance enrollment on registration (in external Insurance Management Information System) status and submitting claims (managing patient billing). The module additionally needs to extend the user interface using the extension points (fragments) in other modules such as:

  • the Registration App Module, responsible for the patient registration interface,
  • the interface responsible for recording patient visits (form entry) will also need to be extended to support billing details.

The module will also provide its own interface that will give a billing/claim overview.

This module will depend on the existing OpenMRS FHIR module - it will leverage it to act as an FHIR client that will communicate with external Insurance Management Information System. Any extension that will be required to the FHIR module will be contributed to the FHIR module codebase. The new module will allow configuring connection details through an admin interface.

Communication standard

FHIR STU3 will be the main standard of communication between OpenMRS and external Insurance Management Information System. The financial module of FHIR will be used to represent the claim/enrollment data being exchanged between systems.

Since FHIR will be used as the standard of data exchange it will be possible for OpenMRS to integrate with systems that implement the standard.

Short term goals:

There are several goals which can be identified (as short term goals) at the beginning of project:

  • Set up of code bases, development environment, automated tests and code quality tools
  • Set up of CI/CD process
  • Extend the OpenMRS FHIR module (the support of additional entities should be covered in the new module to avoid issues with modules dependencies) 
  • Creation of basic logic related to claims managing
  • Claim submission user interface
  • Extension of the patient registration screen with enrollment verification
  • Form entry user interface extension
  • Module admin screen in OpenMRS

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