> For the complete documentation index, see [llms.txt](https://guides.ohie.org/arch-spec/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://guides.ohie.org/arch-spec/introduction/openhie-finance-and-insurance-services-workflows/hfw-001-enroll-beneficiary.md).
# 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: |
| 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/](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 | | [CRWF-1](https://guides.ohie.org/arch-spec/introduction/patient-identity-management-workflows/create-patient-demographic-record-workflow-1), [CRWF-3](https://guides.ohie.org/arch-spec/introduction/patient-identity-management-workflows/query-patient-demographic-records-by-identifier-workflow), [CRWF-4](https://guides.ohie.org/arch-spec/introduction/patient-identity-management-workflows/create-patient-demographic-record-workflow) |
| 2 | Submit enrollment request | IOL | | |
| 3 | Forward enrollment request | FIS | FHIR Contract(Patient,Organization,InsurancePlan) | |
| 4 | Verify enrollment eligibility | internal | | |
| 5 | Process enrollment | internal | | |
| 6 | Register HF identifier with CR | CR | | [CRWF-2](https://guides.ohie.org/arch-spec/introduction/patient-identity-management-workflows/update-patient-demographic-record-workflow) |
| 7 | Return positive enrollment response | IOL | FHIR Contract(Patient,Organization,InsurancePlan) | |
| 8 | Forward positive enrollment response | POS | | |
| 9 | Add details to patient record | internal | | |
| 10 | Return negative enrollment | IOL | FHIR Contract(Patient,Organization,InsurancePlan) | |
| 11 | Forward negative enrollment response | POS | | |