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: Claims Requestor Actor

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

CapabilityStatement for Claims Requestor Actor.

The Claims Requestor files a pre-determination, pre-authorization, or claim for a patient, as well as cancel and re-process claims, and can query for responses when the result is queued.

Raw OpenAPI-Swagger Definition file | Download

Generated Narrative: CapabilityStatement IHE.FAIS.ClaimsRequestor

IHE FAIS Claims 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 Claims Requestor provides capability to submit claim requests and query for claim 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
ClaimSupported Profiles
  FAIS Claim Profile		$submit, $cancel, $reprocess
ClaimResponseSupported Profiles
  FAIS ClaimResponse Profile		yy_lastUpdated, _id, status, request, patient, requestor

Resource Conformance: supported Claim

Core FHIR Resource
Claim
Reference Policy
Interaction summary

    Supported Profiles

    FAIS Claim Profile

    Documentation
    Extended Operations
    ConformanceOperationDocumentation
    SHALL$submit

    Submits a claim. FAIS Submit Claim transaction [ITI-126].

    SHALL$cancel

    Cancels a claim. FAIS Cancel Claim transaction [ITI-127].

    SHALL$reprocess

    Re-processes a claim. FAIS Re-process Claim transaction [ITI-128].

    Resource Conformance: MAY ClaimResponse

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

    Supported Profiles

    FAIS ClaimResponse Profile

    Documentation

    FAIS Track Claim transaction [ITI-129]

    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 coverage eligiblity request

    MAYpatientreference

    The beneficiary

    MAYrequestorreference

    The provider making the request