HFW-002: Query Beneficiary
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
Newly Defined
  • 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.

Interaction Description

Source Code

(link to permanent text in https://www.websequencediagrams.com/)
title HFW-002: Query Beneficiary
participant PoS
participant IOL
participant FIS
participant CR
opt
note over PoS, CR
Assumes that querying of CR is done here
PoS->HIE: [1] Fetch patient (CRWF-3,4)
end Note
end opt
PoS->IOL: [2] Submit Patient/Beneficiary Query (Demographics / ID)
IOL->FIS: [3] Forward Query details
FIS->FIS: [4] Process query
FIS->IOL: [5] Return Beneficiary Details response
IOL->PoS: [6] Forward Beneficiary Details response

Technical Details

Ref
Interaction
Endpoint
Data
Transaction Spec
1
Fetch / Register patient
CR
(CRWF-1,3,4)
2
Submit Patient/Beneficiary Query
IOL
3
Forward Query details
FIS
FHIR Patient
4
Process query
internal
5
Return Beneficiary Details response
IOL
FHIR Patient
6
Forward Beneficiary Details response
POS
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Interaction Description
Technical Details