HFW-005: Claim Tracking
Workflow Maturity |
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Description | This workflow allows a PoS to request the current processing status of a claim in the FIS. |
Example | A hospital has sent an electronic reimbursement claim to the insurance company. After a waiting period the hospital wants to verify if the claim was processed. |
Status | OHIE LEVEL 0 |
Referenced Standards | |
Assumptions & Prerequisites |
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Actors |
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Validations | The PoS or IOL should validate the FHIR resources being submitted. |
title HFW-005: Claim Tracking
participant PoS
participant IOL
participant FIS
note over PoS, FIS
Assumes that claiming was done already (HFW-004: Claiming)
end note
PoS -> IOL: [1] Submit claim response query (Claim ID)
IOL -> FIS: [2] Forward query
FIS -> FIS: [3] Process query
alt accepted
FIS -> IOL: [4] Return positive claim result
IOL -> PoS: [5] Forward positive claim result
else rejected
FIS -> IOL: [6] Return negative claim result
IOL -> PoS: [7] Forward negative claim result
else queued
FIS -> IOL: [8] Return queued status notification
IOL -> PoS: [9] Forward queued status notification
else not found
FIS -> IOL: [10] Return not found notification
IOL -> PoS: [11] Forward not found notification
end
Ref | Interaction | Endpoint | Data | Transaction Spec |
---|---|---|---|---|
1 | Submit claim response query (Claim ID) | IOL | FHIR ClaimResponse | |
2 | Forward query | FIS | | |
3 | Process query | internal | | |
4 | Return positive claim result | IOL | FHIR ClaimResponse | |
5 | Forward positive claim result | PoS | | |
6 | Return negative claim result | IOL | FHIR ClaimResponse | |
7 | Forward negative claim result | PoS | | |
8 | Return queued status notification | IOL | FHIR ClaimResponse | |
9 | Forward queued status notification | PoS | | |
10 | Return not found notification | IOL | HTTP 404 | |
11 | Forward not found notification | PoS | | |
Last modified 1yr ago