Finance and Insurance Service (FAIS)
1.0.0 - trial-use
Finance and Insurance Service (FAIS)
1.0.0 - trial-use
This page is part of the IHE ITI Finance and Insurance Services (v1.0.0: Publication) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
| Active as of 2024-07-17 |
{
"resourceType" : "CapabilityStatement",
"id" : "IHE.FAIS.BeneficiaryManager",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CapabilityStatement IHE.FAIS.BeneficiaryManager</b></p><a name=\"IHE.FAIS.BeneficiaryManager\"> </a><a name=\"hcIHE.FAIS.BeneficiaryManager\"> </a><a name=\"IHE.FAIS.BeneficiaryManager-en-US\"> </a><h2 id=\"title\">IHE FAIS Beneficiary Manager</h2><ul><li>Implementation Guide Version: 1.0.0 </li><li>FHIR Version: 4.0.1 </li><li>Supported Formats: <code>application/fhir+xml</code>, <code>application/fhir+json</code></li><li>Supported Patch Formats: </li><li>Published on: 2024-07-17 </li><li>Published by: IHE IT Infrastructure Technical Committee </li></ul><blockquote class=\"impl-note\"><p><strong>Note to Implementers: FHIR Capabilities</strong></p><p>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.</p></blockquote><h2 id=\"rest\">FHIR RESTful Capabilities</h2><div class=\"panel panel-default\"><div class=\"panel-heading\"><h3 id=\"mode1\" class=\"panel-title\">Mode: <code>server</code></h3></div><div class=\"panel-body\"><div><p>FAIS Beneficiary Manager processes requests from the Beneficiary Requestor on Insurance Plans and Enrollment Responses and receives the Enrollment Request submission.</p>\n</div><div class=\"lead\"><em>Security</em></div><blockquote><div><p>Recommend <a href=\"https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html\">ATNA</a>, encouraged <a href=\"https://profiles.ihe.net/ITI/IUA/index.html\">IHE-IUA</a> or <a href=\"http://www.hl7.org/fhir/smart-app-launch/\">SMART-app-launch</a></p>\n</div></blockquote><div class=\"lead\"><em>Summary of System-wide Interactions</em></div><ul><li><strong>SHALL </strong>support the <code>search-system</code>interaction.</li></ul></div></div><h3 id=\"resourcesCap1\">Capabilities by Resource/Profile</h3><h4 id=\"resourcesSummary1\">Summary</h4><p>The summary table lists the resources that are part of this configuration, and for each resource it lists:</p><ul><li>The relevant profiles (if any)</li><li>The interactions supported by each resource (<b><span class=\"bg-info\">R</span></b>ead, <b><span class=\"bg-info\">S</span></b>earch, <b><span class=\"bg-info\">U</span></b>pdate, and <b><span class=\"bg-info\">C</span></b>reate, are always shown, while <b><span class=\"bg-info\">VR</span></b>ead, <b><span class=\"bg-info\">P</span></b>atch, <b><span class=\"bg-info\">D</span></b>elete, <b><span class=\"bg-info\">H</span></b>istory on <b><span class=\"bg-info\">I</span></b>nstance, or <b><span class=\"bg-info\">H</span></b>istory on <b><span class=\"bg-info\">T</span></b>ype are only present if at least one of the resources has support for them.</li><li><span>The required, recommended, and some optional search parameters (if any). </span></li><li>The linked resources enabled for <code>_include</code></li><li>The other resources enabled for <code>_revinclude</code></li><li>The operations on the resource (if any)</li></ul><div class=\"table-responsive\"><table class=\"table table-condensed table-hover\"><thead><tr><th><b>Resource Type</b></th><th><b>Profile</b></th><th class=\"text-center\"><b title=\"GET a resource (read interaction)\">R</b></th><th class=\"text-center\"><b title=\"GET all set of resources of the type (search interaction)\">S</b></th><th class=\"text-center\"><b title=\"PUT a new resource version (update interaction)\">U</b></th><th class=\"text-center\"><b title=\"POST a new resource (create interaction)\">C</b></th><th><b title=\"Required and recommended search parameters\">Searches</b></th><th><code><b>_include</b></code></th><th><code><b>_revinclude</b></code></th><th><b>Operations</b></th></tr></thead><tbody><tr><td><a href=\"#InsurancePlan1-1\">InsurancePlan</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.InsurancePlan.html\">FAIS InsurancePlan Profile</a></td><td class=\"text-center\">y</td><td class=\"text-center\">y</td><td class=\"text-center\"></td><td class=\"text-center\"></td><td>_lastUpdated, _id, status, type, name, identifier, administered-by, owned-by, network, coverage-area, benefit-type</td><td/><td/><td/></tr><tr><td><a href=\"#EnrollmentRequest1-2\">EnrollmentRequest</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.EnrollmentRequest.html\">FAIS EnrollmentRequest Profile</a></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td class=\"text-center\"></td><td></td><td/><td/><td><code>$submit</code></td></tr><tr><td><a href=\"#EnrollmentResponse1-3\">EnrollmentResponse</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-IHE.FAIS.EnrollmentResponse.html\">FAIS EnrollmentResponse Profile</a></td><td class=\"text-center\">y</td><td class=\"text-center\">y</td><td class=\"text-center\"></td><td class=\"text-center\"></td><td>_lastUpdated, _id, status, request</td><td/><td/><td/></tr></tbody></table></div><hr/><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"InsurancePlan1-1\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHALL </span>InsurancePlan</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/insuranceplan.html\">InsurancePlan</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>read</code>, <code>search-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.InsurancePlan.html\">FAIS InsurancePlan Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>FAIS Query Insurance Plan transaction <a href=\"ITI-121.html\">[ITI-121]</a></p>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-lg-7\"><span class=\"lead\">Search Parameters</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td>_lastUpdated</td><td><code>date</code></td><td><div><p>When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>_id</td><td><code>token</code></td><td><div><p>Logical id of this artifact</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>status</td><td><code>token</code></td><td><div><p>The status of the Insurance Plan</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>type</td><td><code>token</code></td><td><div><p>The type of the Insurance Plan</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>name</td><td><code>string</code></td><td><div><p>The name of the Insurance Plan</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>identifier</td><td><code>token</code></td><td><div><p>The business identifiers of the Insurance Plan</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>administered-by</td><td><code>reference</code></td><td><div><p>Who administers the Insurance Plan</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>owned-by</td><td><code>reference</code></td><td><div><p>Who owns the Insurance Plan</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-InsurancePlan-network.html\">network</a></td><td><code>reference</code></td><td><div><p>The Insurance Plan network</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-InsurancePlan-coverageArea.html\">coverage-area</a></td><td><code>reference</code></td><td><div><p>The Insurance Plan coverage area</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-InsurancePlan-benefitType.html\">benefit-type</a></td><td><code>token</code></td><td><div><p>The Insurance Plan type of benefit</p>\n</div></td></tr></tbody></table></div><div class=\"col-lg-5\">\u00a0</div></div></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"EnrollmentRequest1-2\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: supported </span>EnrollmentRequest</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/enrollmentrequest.html\">EnrollmentRequest</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul/></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.EnrollmentRequest.html\">FAIS EnrollmentRequest Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>FAIS Enroll Beneficiary transaction <a href=\"ITI-122.html\">[ITI-122]</a></p>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Extended Operations</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Operation</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-IHE.FAIS.EnrollmentRequest.Submit.html\">$submit</a></td><td><div><p>Submits an enrollment request to enroll a new beneficiary with the request coverage. FAIS Enroll Beneficiary transaction <a href=\"ITI-122.html\">[ITI-122]</a></p>\n</div></td></tr></tbody></table></div></div></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"EnrollmentResponse1-3\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHALL </span>EnrollmentResponse</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/enrollmentresponse.html\">EnrollmentResponse</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>read</code>, <code>search-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-IHE.FAIS.EnrollmentResponse.html\">FAIS EnrollmentResponse Profile</a></p></div></div><p/><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Documentation</span><blockquote><div><p>FAIS Check Enrollment Status transaction <a href=\"ITI-123.html\">[ITI-123]</a></p>\n</div></blockquote></div></div><div class=\"row\"><div class=\"col-lg-7\"><span class=\"lead\">Search Parameters</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td>_lastUpdated</td><td><code>date</code></td><td><div><p>When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>_id</td><td><code>token</code></td><td><div><p>Logical id of this artifact</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>status</td><td><code>token</code></td><td><div><p>The status of the response</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td>request</td><td><code>reference</code></td><td><div><p>The enrollment request</p>\n</div></td></tr></tbody></table></div><div class=\"col-lg-5\">\u00a0</div></div></div></div></div></div>"
},
"url" : "https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.BeneficiaryManager",
"version" : "1.0.0",
"name" : "IHE_FAIS_BeneficiaryManager",
"title" : "IHE FAIS Beneficiary Manager",
"status" : "active",
"experimental" : false,
"date" : "2024-07-17",
"publisher" : "IHE IT Infrastructure Technical Committee",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.ihe.net/ihe_domains/it_infrastructure/"
}
]
},
{
"telecom" : [
{
"system" : "email",
"value" : "iti@ihe.net"
}
]
},
{
"name" : "IHE IT Infrastructure Technical Committee",
"telecom" : [
{
"system" : "email",
"value" : "iti@ihe.net"
}
]
}
],
"description" : "CapabilityStatement for [Beneficiary Manager Actor](volume-1.html#beneficiary-manager).\n\nThe Beneficiary Manager processes requests from the Beneficiary Requestor actor. It follows internal business processes to enroll beneficiaries from the Beneficiary Requestor that are beyond the scope of this profile and will return the result of the enrollment. It also responds to queries about insurance plans.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001"
}
]
}
],
"kind" : "requirements",
"fhirVersion" : "4.0.1",
"format" : [
"application/fhir+xml",
"application/fhir+json"
],
"rest" : [
{
"mode" : "server",
"documentation" : "FAIS Beneficiary Manager processes requests from the Beneficiary Requestor on Insurance Plans and Enrollment Responses and receives the Enrollment Request submission.",
"security" : {
"description" : "Recommend [ATNA](https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html), encouraged [IHE-IUA](https://profiles.ihe.net/ITI/IUA/index.html) or [SMART-app-launch](http://www.hl7.org/fhir/smart-app-launch/)"
},
"resource" : [
{
"type" : "InsurancePlan",
"supportedProfile" : [
🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.InsurancePlan"
],
"documentation" : "FAIS Query Insurance Plan transaction [[ITI-121]](ITI-121.html)",
"interaction" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"code" : "read"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"code" : "search-type"
}
],
"searchParam" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "_lastUpdated",
"type" : "date",
"documentation" : "When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb."
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "_id",
"type" : "token",
"documentation" : "Logical id of this artifact"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "status",
"type" : "token",
"documentation" : "The status of the Insurance Plan"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "type",
"type" : "token",
"documentation" : "The type of the Insurance Plan"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "name",
"type" : "string",
"documentation" : "The name of the Insurance Plan"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "identifier",
"type" : "token",
"documentation" : "The business identifiers of the Insurance Plan"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "administered-by",
"type" : "reference",
"documentation" : "Who administers the Insurance Plan"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "owned-by",
"type" : "reference",
"documentation" : "Who owns the Insurance Plan"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHOULD"
}
],
"name" : "network",
"definition" : "https://profiles.ihe.net/ITI/FAIS/SearchParameter/InsurancePlan-network",
"type" : "reference",
"documentation" : "The Insurance Plan network"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHOULD"
}
],
"name" : "coverage-area",
"definition" : "https://profiles.ihe.net/ITI/FAIS/SearchParameter/InsurancePlan-coverageArea",
"type" : "reference",
"documentation" : "The Insurance Plan coverage area"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHOULD"
}
],
"name" : "benefit-type",
"definition" : "https://profiles.ihe.net/ITI/FAIS/SearchParameter/InsurancePlan-benefitType",
"type" : "token",
"documentation" : "The Insurance Plan type of benefit"
}
]
},
{
"type" : "EnrollmentRequest",
"supportedProfile" : [
🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.EnrollmentRequest"
],
"documentation" : "FAIS Enroll Beneficiary transaction [[ITI-122]](ITI-122.html)",
"operation" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "submit",
"definition" : "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.EnrollmentRequest.Submit",
"documentation" : "Submits an enrollment request to enroll a new beneficiary with the request coverage. FAIS Enroll Beneficiary transaction [[ITI-122]](ITI-122.html)"
}
]
},
{
"type" : "EnrollmentResponse",
"supportedProfile" : [
🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.EnrollmentResponse"
],
"documentation" : "FAIS Check Enrollment Status transaction [[ITI-123]](ITI-123.html)",
"interaction" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"code" : "read"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"code" : "search-type"
}
],
"searchParam" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "_lastUpdated",
"type" : "date",
"documentation" : "When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb."
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "_id",
"type" : "token",
"documentation" : "Logical id of this artifact"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "status",
"type" : "token",
"documentation" : "The status of the response"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"name" : "request",
"type" : "reference",
"documentation" : "The enrollment request"
}
]
}
],
"interaction" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
"valueCode" : "SHALL"
}
],
"code" : "search-system"
}
]
}
]
}
IG © 2024+ IHE IT Infrastructure Technical Committee. Package ihe.iti.fais#1.0.0 based on FHIR 4.0.1. Generated 2024-11-13
Links: Table of Contents |
QA Report
| New Issue | Issues
Version History |
|
Propose a change