OpenHIE Finance and Insurance Service (FIS)
Finance and Insurance Service stores, categorizes, and facilitates the administration of centralised claims and finance related data to care provision to patients within the HIE. The service receives claims/financial data from Point of Service applications (including financing applications acting as a point of service interface outside of other PoS systems) and curates the management of them.
See also Non-Functional Requirements.
Major Process Group: Beneficiary Management
FISF-01
BP required;
FISF-02
BP recommended
FISF-03
BP required;
FISF-04
BP recommended
FISF-05
BP required;
Major Process Group: Provider Management
FISF-06
BP required;
WF recommended
FISF-07
Recommended
Major Process Group: Premium Management
FISF-08
BP Required; WF required
Major Process Group: Claims Management
FISF-09
BP required;
FISF-10
BP required;
FISF-11
BP recommended
FISF-12
BP recommended
Major Process Group: Accounting
FISF-13
FISF-14
BP Required;
WF recommended
FISF-15
BP Required;
WF recommended
Major Process Group: Care Management
FISF-16
BP optional
FISF-17
BP optional
FISF-18
BP optional
FISF-19
BP optional
Major Process Group: Utilization Management
FISF-20
BP recommended
FISF-21
BP recommended
Major Process Group: Provider Quality Management
FISF-22
BP recommended (align with FR)
Major Process Group: Financial / Audit Management
FISF-23
BP recommended,
WF recommended
FISF-24
BP recommended
FISF-25
BP recommended
FISF-26
BP recommended
Major Process Group: Medical Loss
FISF-27
Correct and balance any inequities or variances across regional boundaries and across service provision types
BP recommended
Major Process Group: Audit and Fraud
FISF-28
BP recommended
WF recommended
FISF-29
BP recommended
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