Finance and Insurance Service (FAIS)
1.0.0-comment - ballot International flag

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

Table of Contents

.. 0 Table of Contents
... 1 Finance and Insurance (FAIS) Service Home
... 2 1:XX Finance and Insurance Service (FAIS)
... 3 2:3.YY2 Query Insurance Plan [ITI-YY2]
... 4 2:3.YY1 Enroll Beneficiary [ITI-YY1]
... 5 2:3.YY3 Check Enrollment Status [ITI-YY3]
... 6 2:3.YY4 Check Coverage Eligibility [ITI-YY4]
... 7 2:3.YY7 Check Coverage Eligibility Status [ITI-YY7]
... 8 2:3.YY5 Submit Claim [ITI-YY5]
... 9 2:3.YY8 Cancel Claim [ITI-YY8]
... 10 2:3.YY9 Re-process Claim [ITI-YY9]
... 11 2:3.YY6 Track Claim [ITI-YY6]
... 12 Test Plan
... 13 Changes to Other IHE Specifications
... 14 Download and Analysis
... 15 Significant Changes and Issues
... 16 Artifacts Summary
.... 16.1 Beneficiary Manager Actor
.... 16.2 Beneficiary Requestor Actor
.... 16.3 Claims Manager Actor
.... 16.4 Claims Requestor Actor
.... 16.5 Coverage Requestor Actor
.... 16.6 FAIS Claim $cancel
.... 16.7 FAIS Claim $reprocess
.... 16.8 FAIS Claim $submit
.... 16.9 FAIS Coverage Eligibility Request $submit
.... 16.10 FAIS Enrollment Request $submit
.... 16.11 Audit Event for Cancel Claim Transaction by the Claims Requestor and Claims Manager for Update
.... 16.12 Audit Event for Check Coverage Eligibility Status Transaction by the Coverage Requestor and Claims Manager for Query
.... 16.13 Audit Event for Check Coverage Eligibility Status Transaction by the Coverage Requestor and Claims Manager for Read
.... 16.14 Audit Event for Check Coverage Eligibility Transaction by the Coverage Requestor and Claims Manager for Create
.... 16.15 Audit Event for Check Enrollment Status Transaction by the Beneficiary Requestor and Beneficiary Manager for Query
.... 16.16 Audit Event for Check Enrollment Status Transaction by the Beneficiary Requestor and Beneficiary Manager for Read
.... 16.17 Audit Event for Enroll Beneficiary Transaction by the Beneficiary Requestor and Beneficiary Manager for Create
.... 16.18 Audit Event for Query Insurance Plan Transaction by the Beneficiary Requestor and Beneficiary Manager for Query
.... 16.19 Audit Event for Query Insurance Plan Transaction by the Beneficiary Requestor and Beneficiary Manager for Read
.... 16.20 Audit Event for Re-process Claim Transaction by the Claims Requestor and Claims Manager for Update
.... 16.21 Audit Event for Submit Claim Transaction by the Claims Requestor and Claims Manager for Create
.... 16.22 Audit Event for Track Claim Transaction by the Claims Requestor and Claims Manager for Read
.... 16.23 Audit Event for Track Claim Transaction by the Coverage Requestor and Claims Manager for Query
.... 16.24 FAIS Claim Bundle Profile
.... 16.25 FAIS Claim Profile
.... 16.26 FAIS ClaimResponse Bundle Profile
.... 16.27 FAIS ClaimResponse Profile
.... 16.28 FAIS CoverageEligibilityRequest Bundle Profile
.... 16.29 FAIS CoverageEligibilityRequest Profile
.... 16.30 FAIS CoverageEligibilityResponse Bundle Profile
.... 16.31 FAIS CoverageEligibilityResponse Profile
.... 16.32 FAIS EnrollmentRequest Bundle Profile
.... 16.33 FAIS EnrollmentRequest Profile
.... 16.34 FAIS EnrollmentResponse Bundle Profile
.... 16.35 FAIS EnrollmentResponse Profile
.... 16.36 FAIS InsurancePlan Profile
.... 16.37 Audit example for ITI-YY1 for Beneficiary Requestor for submit.
.... 16.38 Audit example for ITI-YY2 for Beneficiary Manager for query.
.... 16.39 Audit example for ITI-YY2 for Beneficiary Requestor for read.
.... 16.40 Audit example for ITI-YY3 for Beneficiary Manager for query.
.... 16.41 Audit example for ITI-YY3 for Beneficiary Requestor for read.
.... 16.42 Audit example for ITI-YY4 for Coverage Requestor for submit.
.... 16.43 Audit example for ITI-YY5 for Claims Requestor for submit.
.... 16.44 Audit example for ITI-YY6 for Claims Manager for query.
.... 16.45 Audit example for ITI-YY6 for Claims Requestor for read.
.... 16.46 Audit example for ITI-YY7 for Beneficiary Manager for query.
.... 16.47 Audit example for ITI-YY7 for Claims Manager for read.
.... 16.48 Audit example for ITI-YY8 for Claims Requestor for cancel.
.... 16.49 Audit example for ITI-YY9 for Claims Requestor for re-process.
.... 16.50 Device Example - FAIS Beneficiary Manager
.... 16.51 Device Example - FAIS Beneficiary Requestor
.... 16.52 Device Example - FAIS Claims Manager
.... 16.53 Device Example - FAIS Claims Requestor
.... 16.54 Device Example - FAIS Coverage Requestor
.... 16.55 Example Coverage
.... 16.56 Example Coverage Eligibility Request
.... 16.57 Example Coverage Eligibility Request Bundle
.... 16.58 Example Coverage Eligibility Response
.... 16.59 Example Enrollment Request
.... 16.60 Example Enrollment Request Bundle
.... 16.61 Example Enrollment Response
.... 16.62 Example Insurer
.... 16.63 Example Patient Beneficiary
.... 16.64 Use Case 1 - Example Coverage
.... 16.65 Use Case 1 - Example Enrollment Request
.... 16.66 Use Case 1 - Example Enrollment Request Bundle
.... 16.67 Use Case 1 - Example Enrollment Response
.... 16.68 Use Case 1 - Example Enrollment Response Bundle
.... 16.69 Use Case 1 - Example Insurance Plan
.... 16.70 Use Case 1 - Example Insurer: National Health Insurance Scheme
.... 16.71 Use Case 1 - Example Network: National Health Hospital System
.... 16.72 Use Case 1 - Example Patient Beneficiary
.... 16.73 Use Case 2 - Example Coverage Eligibility Request
.... 16.74 Use Case 2 - Example Coverage Eligibility Request Bundle
.... 16.75 Use Case 2 - Example Coverage Eligibility Response
.... 16.76 Use Case 2 - Example Coverage Eligibility Response Bundle
.... 16.77 Use Case 2 - Example Doctor
.... 16.78 Use Case 2 - Local Hospital
.... 16.79 Use Case 3 - Example accepted claim response
.... 16.80 Use Case 3 - Example accepted claim response bundle
.... 16.81 Use Case 3 - Example cancelled claim
.... 16.82 Use Case 3 - Example claim
.... 16.83 Use Case 3 - Example claim bundle
.... 16.84 Use Case 3 - Example denied claim response
.... 16.85 Use Case 3 - Example queued claim response
.... 16.86 Use Case 4 - Example accepted pre-determination response
.... 16.87 Use Case 4 - Example pre-determination claim
.... 16.88 Use Case 5 - Example accepted pre-determination response
.... 16.89 Use Case 5 - Example pre-authorization claim
.... 16.90 Testing Feature File for ITI YY1
.... 16.91 Testing Feature File for ITI YY2
.... 16.92 Testing Feature File for ITI YY3
.... 16.93 Testing Feature File for ITI YY4
.... 16.94 Testing Feature File for ITI YY5
.... 16.95 Testing Feature File for ITI YY6
.... 16.96 Testing Feature File for ITI YY7
.... 16.97 Testing Feature File for ITI YY8
.... 16.98 Testing Feature File for ITI YY9