This page is part of the IHE ITI Finance and Insurance Services (v1.0.0-comment: Publication Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Finance and Insurance (FAIS) Service Home

Official URL: https://profiles.ihe.net/ITI/FAIS/ImplementationGuide/ihe.iti.fais				Version: 1.0.0-comment
Active as of 2024-08-09				Computable Name: IHE_ITI_FAIS

The Finance and Insurance Service (FAIS) stores, categorizes, and facilitates the administration of centralized claims and finance data for patient care. The service receives claims/financial data from Point of Service applications (including financing applications acting as a point of service interface outside of other PoS systems) and curates the management of them.

Organization of This Guide

This guide is organized into the following sections:

1. Volume 1:
   1. Introduction
   2. Actors, Transactions, and Content
   3. Actor Options
   4. Required Actor Groupings
   5. Overview
   6. Security Considerations
   7. Cross Profile Considerations
2. Volume 2: Transaction Detail
   1. 3.YY2 Query Insurance Plan [ITI-YY2]
   2. 3.YY1 Enroll Beneficiary [ITI-YY1]
   3. 3.YY3 Check Enrollment Status [ITI-YY3]
   4. 3.YY4 Check Coverage Eligibility [ITI-YY4]
   5. 3.YY7 Check Coverage Eligibility Status [ITI-YY7]
   6. 3.YY5 Submit Claim [ITI-YY5]
   7. 3.YY8 Cancel Claim [ITI-YY8]
   8. 3.YY9 Re-process Claim [ITI-YY9]
   9. 3.YY6 Track Claim [ITI-YY6]
3. Other
   1. Changes to Other IHE Specifications
   2. Download and Analysis
   3. Test Plan

See also the Table of Contents and the index of Artifacts defined as part of this implementation guide.

Conformance Expectations

IHE uses the normative words: SHALL, SHOULD, and MAY according to standards conventions.

Must Support

The use of mustSupport in StructureDefinition profiles equivalent to the IHE use of R2 as defined in Appendix Z.

mustSupport of true - only has a meaning on items that are minimal cardinality of zero (0), and applies only to the source actor populating the data. The source actor SHALL populate the elements marked with MustSupport, if the concept is supported by the actor, a value exists, and security and consent rules permit. The consuming actors SHOULD handle these elements being populated or being absent/empty. Note that sometimes mustSupport will appear on elements with a minimal cardinality greater than zero (0), this is due to inheritance from a less constrained profile.