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
​http://hl7.org/fhir/patient.html​
4
Process query
internal
​
​
5
Return Beneficiary Details response
IOL
FHIR Patient
​http://hl7.org/fhir/patient.html​
6
Forward Beneficiary Details response
POS
​
​

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	http://hl7.org/fhir/patient.html
4	Process query	internal
5	Return Beneficiary Details response	IOL	FHIR Patient	http://hl7.org/fhir/patient.html
6	Forward Beneficiary Details response	POS

HFW-001: Enroll Beneficiary

HFW-003: Check Coverage Eligibility

Last modified 1yr ago

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.