Finance and Insurance Service (FAIS)
1.0.0-comment - ballot
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. For a full list of available versions, see the Directory of published versions
This section modifies other IHE profiles or the General Introduction appendices and is not a part of the FAIS Profile. The content here will be incorporated into the target narrative at a future time, usually when FAIS Profile goes normative.
Editor, add the following new or modified actors to the IHE Technical Frameworks General Introduction Appendix A: |
Actor | Definition |
---|---|
Beneficiary Requestor | Enroll beneficiaries and search for insurance plans. |
Beneficiary Manager | Process beneficiary enrollment and respond to queries on insurance plans. |
Coverage Requestor | Check the coverage eligibility of beneficiaries. |
Claims Requestor | Send claims and check for claim response updates. |
Claims Manager | Process claims, manage updates to claim responses, and respond to coverage eligibility requests. |
Editor, add the following new or modified transactions to the IHE Technical Frameworks General Introduction Appendix B: |
Transaction | Definition |
---|---|
Enroll Beneficiary | Enroll a beneficiary under the requested coverage. |
Check Enrollment Status | Check the status of a pending enrollment response. |
Query Insurance Plan | Search for insurance plans. |
Check Coverage Eligibility | Check a beneficiary for the requested coverage. |
Check Coverage Eligibility Status | Check the status of a pending coverage eligiblity request. |
Submit Claim | Submit a new claim for a beneficiary. |
Cancel Claim | Cancel a previously submitted claim. |
Re-process Claim | Re-process a previously denied claim. |
Track Claim | Check the status of a pending claim. |
Editor, add the following new or modified terms to the IHE Technical Frameworks General Introduction Appendix D: |
Term | Definition | Acronyms/Abbreviations | Synonyms |
---|---|---|---|
none |