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

Changes to Other IHE Specifications

IHE Technical Frameworks General Introduction Appendix A: Actors

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.

IHE Technical Frameworks General Introduction Appendix B: Transactions

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.

IHE Technical Frameworks General Introduction Appendix D: Glossary

Editor, add the following new or modified terms to the IHE Technical Frameworks General Introduction Appendix D:

Term	Definition	Acronyms/Abbreviations	Synonyms
none