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OpenMRS fieldFHIR fieldNote
claimCodeclaimclaimResponse.identifierClaim number

uuid


Unique uuid code
adjustmentclaimResponse.payment.adjustmentThe contents of the adjustment message (getting from response)
approvedTotalclaimResponse.totalBenefitTotal benefit payable for the Claim
dateProcessedclaimResponse.createdDate of processing claim
rejectionReasonclaimResponse.errorOptional rejection reason message
statusclaimResponse.processNoteInformation about current claim status

...

uuidclaimResponse.communicationRequest - Reference(Claim)Request for additional information


Code Block
titleSample ClaimResponse

InsuranceClaimDiagnosis → claim.diagnosis

FHIR resources:

The diagnosis is a part of the FHIR Claim resource.

...

InsuranceClaimItem → Claim.item / ClaimResponse.item

FHIR resources:

...

{
  "resourceType": "ClaimResponse",
  "id": "claim_uuid",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "https://hl7.org/fhir/

...

Code Block
titleSample ClaimResponse
{
  "resourceType": "ClaimResponse",
  "id": "claim_uuid",
  "identifier": [
    {
      "use": "usual",
      "type":valueset-identifier-type.html",
            "code": "ACSN"
          }
        ]
      },
      "value": "claim_uuid"
    },
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "https://hl7.org/fhir/valueset-identifier-type.html",
            "code": "MR"
          }
        ]
      },
      "value": "claim_code"
    }
  ],
  "created": "2019-11-05T17:00:29+01:00",
  "request": {
    "reference": "Claim/8a589dc9-435f-4453-957a-31106cf0d932"
  },
  "outcome": {
    "coding": [
      {
        "codingcode": ["2"
      }
   { ],
    "text": "ENTERED"
  },
  "systemerror": "https://hl7.org/fhir/valueset-identifier-type.html",[
    {
       "code": "ACSN"{
          }"coding": [
         ] {
     },       "valuecode": "claimerror_uuidcode"
        },  }
        ],
 {       "usetext": "usualerror_code",
      "type": {}
    }
  ],
  "codingtotalBenefit": [{
    "value": 1234567890.21
  },
  "payment": {
    "adjustmentReason": {
      "systemtext": "https://hl7.org/fhir/valueset-identifier-type.html",adjustment reason"
       },
    "codedate": "MR2019-11-05"

         },
  "communicationRequest": [
    ]
 {
    },       "valuereference": "CommunicationRequest/claim_codeuuid"
    }
  ],
  "created": "2019-11-05T17:00:29+01:00",
  "request": {
    "reference": "Claim/8a589dc9-435f-4453-957a-31106cf0d932"
  },
  "outcome": {
    "coding": [
      {
        "code": "2"
      }
    ],
    "text": "ENTERED"
  },
  "error": [
    {
      "code": {
        "coding": [
          {
            "code": "error_code"
          }
        ],
        "text": "error_code"
      }
    }
  ],
  "totalBenefit": {
    "value": 1234567890.21
  },
  "payment": {
    "adjustmentReason": {
      "text": "adjustment reason"
    },
    "date": "2019-11-05"
  },
  "communicationRequest": [
    {
      "reference": "CommunicationRequest/claim_uuid"
    }
  ]
}
}


InsuranceClaimDiagnosis → claim.diagnosis

FHIR resources:

The diagnosis is a part of the FHIR Claim resource.

OpenMRS fieldFHIR fieldRequest or responseNote
conceptclaim.diagnosisRequestThe value of concept which describe the diagnosis
claim

The claim which is connect with the diagnosis; not mapped because this is part of FHIR claim resource

InsuranceClaimItem → Claim.item / ClaimResponse.item

FHIR resources:

OpenMRS fieldFHIR fieldRequest or responseNote
quantityProvidedclaim.item.quantityRequestInformation about the amount of requested items
quantityApprovedclaimResponse.item.adjudication.valueResponseInformation about the amount of approved items
priceApprovedclaimResponse.item.adjudication.amountResponseThe approved price
priceAskedclaim.item.unitPriceRequestThe requested price. The value is determined based on value of price attribute from related ProvidedItem.
explanationclaim.informationRequestOptional additional information for claimed item
justificationclaimResponse.processNoteResponseOptional additional information for claimed item  (getting from response)
rejectionReasonclaimResponse.item.adjudication.reasonResponseOptional rejection reason message
itemclaim.item.serviceRequestThe related item. The related ProvidedItem provides the value of the product code which is entered into claim.item.service.
claimsee above
The related claim
statusclaimResponse.item.adjudication.reason / extensionResponseThe related status for claimed item



InsurancePolicy → Coverage

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