HFW-002: Query Beneficiary
Last updated
Last updated
The PoS system is searching for beneficiary master data in the FIS based on a specific query (e.g. by name, ID, age etc …). The FIS returns all master data from the CR and adds FIS specific master data .
Example use case: An insurance agent is looking for information about a beneficiary to respond to a service desk call.
Workflow Maturity
Workflow is defined and ARB approved
Initial implementations are underway
Standards
HL7 FHIR Financial Module: http://hl7.org/fhir/financial-module.html
Assumptions & Prerequisites
None
Actors
PoS - The point of service system that captures a patient clinical encounter, it is responsible for sending this encounter on to the HIE.
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.
(link to permanent text in https://www.websequencediagrams.com/)
1
Fetch / Register patient
CR
(CRWF-1,3,4)
2
Submit Patient/Beneficiary Query
IOL
4
Process query
internal
6
Forward Beneficiary Details response
POS
Newly Defined