HFW-001: Enroll Beneficiary
This transaction allows a POS system to enroll a patient/beneficiary into a Health Financing and Insurance System, to save patient/beneficiary level demographic data to a Client Registry (optional) and to save the beneficiary insurance identifier to a Client Registry (optional). Coverage eligibility can be verified beforehand.
Example Use Cases
  • A field agent of the national insurance provider registers a household into a specific insurance scheme.
Workflow Maturity
Newly Defined
  • Workflow is defined and ARB approved
  • Initial implementations are underway
Referenced Standards
HL7 FHIR Financial Module: http://hl7.org/fhir/financial-module.html
Assumptions & Prerequisites
  • The registration process uses existing Patient Identity Management processes for registration and querying
  • Unique insuree identifier is managed by FIS
  • IOL implicitly verifies all messages for syntax
  • The PoS system has a curated list of FIS that interact with that system
Actors
  • PoS - The point of service system that captures an enrollment request.
  • IOL - Mediates the transactions between the PoS system and the infrastructure services to facilitate easier interoperability.
  • CR - The source of truth for patient demographic and identifier detail. It is able to be queried using an identifier to find the enterprise identifier for a particular person.
  • FIS - Financing and Insurance System that manages data on beneficiaries and their coverage.
Validations
The IOL should validate the FHIR resources being submitted.

Interaction Description

Source code

(link to permanent text in https://www.websequencediagrams.com/)
title HFW-001: Enroll beneficiary
participant PoS
participant IOL
participant FIS
participant CR
note over PoS, CR
Assumes that registration or querying of CR is done here
PoS->HIE: [1] Fetch / Register patient (CRWF-1,3,4)
end Note
PoS->IOL: [2] Submit enrollment request
IOL->FIS: [3] Forward enrollment request
FIS->FIS: [4] Verify enrollment eligibility
alt success
FIS->FIS: [5] Process enrollment
opt
FIS->CR: [6] * Register HF identifier with CR (CRWF-2)
end
FIS->IOL: [7] Return positive enrollment response
IOL->PoS: [8] Forward positive enrollment response
PoS->PoS: [9] Add details to patient record
else validation error
FIS->IOL: [10] Return negative enrollment response
IOL->PoS: [11] Forward negative enrollment response
end

Technical Details

#
Interaction
Endpoint
Data
Transaction Options
1
Fetch / Register patient
CR
2
Submit enrollment request
IOL
3
Forward enrollment request
FIS
FHIR Contract(Patient,Organization,InsurancePlan)
http://hl7.org/fhir/contract.html
4
Verify enrollment eligibility
internal
5
Process enrollment
internal
6
Register HF identifier with CR
CR
CRWF-2
7
Return positive enrollment response
IOL
FHIR Contract(Patient,Organization,InsurancePlan)
http://hl7.org/fhir/contract.html
8
Forward positive enrollment response
POS
9
Add details to patient record
internal
10
Return negative enrollment
IOL
FHIR Contract(Patient,Organization,InsurancePlan)
http://hl7.org/fhir/contract.html
11
Forward negative enrollment response
POS
Copy link
On this page
Interaction Description
Technical Details