OpenHIE Architecture Specification
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  • Specification Overview
  • How to use the Specification
  • Architecture Specification
    • Architecture
    • Architectural Principles
    • Standards and Profiles
  • OpenHIE Component Specifications
    • Non-Functional Requirements
    • Client Registry (CR)
    • OpenHIE Facility Registry (FR)
    • OpenHIE Finance and Insurance Service (FIS)
    • OpenHIE Health Management Information System (HMIS)
    • OpenHIE Health Worker Registry (HWR)
    • OpenHIE Interoperability Layer (IOL)
    • OpenHIE Logistics Management Information System (LMIS)
    • OpenHIE Product Catalogue (PC)
    • OpenHIE Shared Health Record (SHR)
    • OpenHIE Terminology Service (TS)
    • Point-Of-Care Systems
  • Workflow (Exchange) Specification
    • Aggregate Reporting Workflows
      • Export Aggregate Data
      • Validate and Save Aggregate Data
    • Alerting / Sending Reminders or Information
      • Send Client Alert Workflow
      • Send Health Worker Alert Workflow
    • Care Services Discovery
      • Query Health Worker and/or Facility Records Workflow
      • Query Care Services Records Workflow
      • Search Care Services Workflow
      • Request Care Services Updates Workflow
    • Community Health Workflows
      • Request Community Based Follow-Up
    • Laboratory Work Flows
      • Order Laboratory Test
      • Report Lab Results
    • Patient Identity Management Workflows
      • Create Patient Demographic Record Workflow
      • Update Patient Demographic Record Workflow
      • Query Patient Demographic Records by Identifier Workflow
      • Query Patient Demographic Records by Demographics Workflow (something missing)
    • Shared Health Record
      • Save Patient-level Clinical Data Workflow
      • Query Patient-level Clinical Data Workflow
      • Register / Store Document
      • Retrieve Document
    • Terminology Service Workflows
      • Expand Value Set
      • Translate Code
      • Verify Code Existence
      • Verify Code Membership
      • Query Value Set
      • Query Code Systems
      • Query Concept Maps
      • Lookup Code
    • Vaccine Workflows
      • Retrieve Health Certificate
    • OpenHIE Finance and Insurance Services Workflows
      • HFW-001: Enroll Beneficiary
      • HFW-002: Query Beneficiary
      • HFW-003: Check Coverage Eligibility
      • HFW-004: Claiming
      • HFW-005: Claim Tracking
  • Make the Specification Better
  • Change Log and Versioning
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  1. Workflow (Exchange) Specification

OpenHIE Finance and Insurance Services Workflows

This collection of workflows allows an external system with access to the HIE to save and retrieve Finance and Insurance Information.

The workflows are designed to support the following types of data exchanges with systems that have access to the HIE.

  1. A point-of-care system can enroll a beneficiary

  2. A point-of-care system can search for a beneficiary in the Finance and Insurance Services system

  3. A point-of-care system can check a beneficiary's eligibility

  4. A point-of-care system can run a pre-determination, pre-authorization and claim

  5. A point-of-care system can track a claim's status

PreviousRetrieve Health CertificateNextHFW-001: Enroll Beneficiary

Last updated 3 years ago