Finance and Insurance Service (FAIS)
1.0.0 - trial-use International flag

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

CapabilityStatement: Beneficiary Requestor Actor

Official URL: https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.BeneficiaryRequestor Version: 1.0.0
Active as of 2024-07-17 Computable Name: IHE_FAIS_BeneficiaryRequestor

CapabilityStatement for Beneficiary Requestor Actor.

The Beneficiary Requestor can enroll beneficiaries and optionally query insurance plans from a Beneficiary Manager.

Raw OpenAPI-Swagger Definition file | Download

Generated Narrative: CapabilityStatement IHE.FAIS.BeneficiaryRequestor

IHE FAIS Beneficiary Requestor

  • Implementation Guide Version: 1.0.0
  • FHIR Version: 4.0.1
  • Supported Formats: application/fhir+xml, application/fhir+json
  • Supported Patch Formats:
  • Published on: 2024-07-17
  • Published by: IHE IT Infrastructure Technical Committee

Note to Implementers: FHIR Capabilities

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.

FHIR RESTful Capabilities

Mode: client

FAIS Beneficiary Requestor provides capability to query insurance plans, submit enrollment requests, and query for enrollment responses.

Security

Recommend ATNA, encouraged IHE-IUA or SMART-app-launch

Summary of System-wide Interactions
  • MAY support the search-systeminteraction.

Capabilities by Resource/Profile

Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

  • The relevant profiles (if any)
  • The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
  • The required, recommended, and some optional search parameters (if any).
  • The linked resources enabled for _include
  • The other resources enabled for _revinclude
  • The operations on the resource (if any)
Resource TypeProfileRSUCSearches_include_revincludeOperations
InsurancePlanSupported Profiles
  FAIS InsurancePlan Profile		yy_lastUpdated, _id, status, type, name, identifier, administered-by, owned-by, network, coverage-area, benefit-type
EnrollmentRequestSupported Profiles
  FAIS EnrollmentRequest Profile		$submit
EnrollmentResponseSupported Profiles
  FAIS EnrollmentResponse Profile		yy_lastUpdated, _id, status, request

Resource Conformance: MAY InsurancePlan

Core FHIR Resource
InsurancePlan
Reference Policy
Interaction summary
  • MAY support read, search-type.

Supported Profiles

FAIS InsurancePlan Profile

Documentation

FAIS Query Insurance Plan transaction [ITI-121]

Search Parameters
ConformanceParameterTypeDocumentation
MAY_lastUpdateddate

When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.

MAY_idtoken

Logical id of this artifact

MAYstatustoken

The status of the Insurance Plan

MAYtypetoken

The type of the Insurance Plan

MAYnamestring

The name of the Insurance Plan

MAYidentifiertoken

The business identifiers of the Insurance Plan

MAYadministered-byreference

Who administers the Insurance Plan

MAYowned-byreference

Who owns the Insurance Plan

MAYnetworkreference

The Insurance Plan network

MAYcoverage-areareference

The Insurance Plan coverage area

MAYbenefit-typetoken

The Insurance Plan type of benefit

 

Resource Conformance: supported EnrollmentRequest

Core FHIR Resource
EnrollmentRequest
Reference Policy
Interaction summary

    Supported Profiles

    FAIS EnrollmentRequest Profile

    Documentation

    FAIS Enroll Beneficiary transaction [ITI-122]

    Extended Operations
    ConformanceOperationDocumentation
    SHALL$submit

    Submits an enrollment request to enroll a new beneficiary with the request coverage. FAIS Enroll Beneficiary transaction [ITI-122]

    Resource Conformance: MAY EnrollmentResponse

    Core FHIR Resource
    EnrollmentResponse
    Reference Policy
    Interaction summary
    • MAY support read, search-type.

    Supported Profiles

    FAIS EnrollmentResponse Profile

    Documentation

    FAIS Check Enrollment Status transaction [ITI-123]

    Search Parameters
    ConformanceParameterTypeDocumentation
    MAY_lastUpdateddate

    When the resource version last changed. The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb.

    MAY_idtoken

    Logical id of this artifact

    MAYstatustoken

    The status of the response

    MAYrequestreference

    The enrollment request