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

  • Workflow is defined and ARB approved

  • Initial implementations are underway

Standards

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

RefInteractionEndpointDataTransaction 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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