Healthcare Financial Services IG Edition 1
0.3.0 - ci-build Saudi Arabia flag

Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Artifacts

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Structures: Abstract Profiles

These are profiles on resources or data types that describe patterns used by other profiles, but cannot be instantiated directly. I.e. instances can conform to profiles based on these abstract profiles, but do not declare conformance to the abstract profiles themselves.

Nphies Authorization (base)

Nphies Authorization (base) Profile

Nphies Claim (base)

Nphies Claim (base) Profile

Nphies Encounter

Encounter Profile

Nphies MessageHeader (base)

MessageHeader (base) Profile

Nphies Task (base)

Nphies Task (base) Profile

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

Nphies Advanced Authorization

Nphies Advanced Authorization Profile

Nphies Authorization Institutional

Nphies Institutional Authorization Profile

Nphies Authorization Oral

Nphies Oral Authorization Profile

Nphies Authorization Pharmacy

Nphies Pharmacy Authorization Profile

Nphies Authorization Professional

Nphies Professional Authorization Profile

Nphies Authorization Response

Nphies Authorization Response Profile

Nphies Authorization Vision

Nphies Vision Authorization Profile

Nphies Bundle

Bundle Profile

Nphies Cancel Request

Nphies Cancel Request Profile

Nphies Cancel Response

Nphies Cancel Response Profile

Nphies Claim Institutional

Nphies Institutional Claim Profile

Nphies Claim Oral

Nphies Oral Claim Profile

Nphies Claim Pharmacy

Nphies Pharmacy Claim Profile

Nphies Claim Professional

Nphies Professional Claim Profile

Nphies Claim Response

Nphies Claim Response Profile

Nphies Claim Vision

Nphies Vision Claim Profile

Nphies Communication

Nphies Communication Profile

Nphies CommunicationRequest

Nphies CommunicationRequest Profile

Nphies Coverage

Coverage Profile

Nphies CoverageEligibilityRequest

Coverage Eligibility Request Profile

Nphies CoverageEligibilityResponse

Coverage Eligibility Response Profile

Nphies Encounter AMB (Auth)

Encounter Ambulatory Profile for Authorization

Nphies Encounter AMB (Claim)

Encounter Ambulatory Profile for Claim

Nphies Encounter EMER (Auth)

Encounter Emergency Profile for Authorization

Nphies Encounter EMER (Claim)

Encounter Emergency Profile for Claim

Nphies Encounter HH (Auth)

Encounter Home Care Profile for Authorization

Nphies Encounter HH (Claim)

Encounter Home Care Profile for Claim

Nphies Encounter IMP (Auth)

Encounter In-Patient Profile for Authorization

Nphies Encounter IMP (Claim)

Encounter In-Patient Profile for Claim

Nphies Encounter SS (Auth)

Encounter Day Case Profile for Authorization

Nphies Encounter SS (Claim)

Encounter Day Case Profile for Claim

Nphies Encounter VR (Auth)

Encounter Telemedicine Profile for Authorization

Nphies Encounter VR (Claim)

Encounter Telemedicine Profile for Claim

Nphies Insurer Organization

Insurer Organization Profile

Nphies Location

Location - Department Profile

Nphies MedicationRequest

MedicationRequest Profile

Nphies MessageHeader

MessageHeader Profile

Nphies MessageHeader (Error Notice)

MessageHeader (MessageError Notice) Profile

Nphies OperationOutcome

Operation Outcome Profile

Nphies Organization

Organization Profile for referring to general organizations.

Nphies Patient

Patient Profile

Nphies Payment Notice

Nphies Payment Notice Profile

Nphies Payment Reconciliation

Nphies Payment Reconciliation Profile

Nphies Policy Holder Organization

Policy Holder Profile

Nphies Poll Request

Nphies Poll Request Profile

Nphies Poll Response

Nphies Poll Response Profile

Nphies Practitioner

Nphies Practitioner Profile

Nphies Provider Organization

Provider Organization Profile

Nphies Status Request

Nphies Status Request Profile

Nphies Status Response

Nphies Status Response Profile

Nphies VisionPrescription

Nphies VisionPrescription Profile

Structures: Data Type Profiles

These define constraints on FHIR data types for systems conforming to this implementation guide.

DP_Address

Address datatype, only text required, sets lengths for text and key elements.

DP_Annotation

Text note with attribution.

DP_Attachment

Attachment datatype, requires either .data or .url, .size and .hash supplied plus other required elements.

DP_CodeableConcept

A CodeableConcept which requires at least one coding specifying the system and code.

DP_CodeableConcept_1

A CodeableConcept which requires either one coding specifying the system and code or text.

DP_CodeableConcept_2

A CodeableConcept which requires at least one and up to two codings specifying the system and code.

DP_Coding

A Coding datatype which requires the system and code.

DP_Dosage

Dosage datatype with timing, route and doseAndRate required.

DP_HumanName

A HumanName datatype, only text required, sets the lengths for text and key elements.

DP_Identifier_A

Business Identifier for Resources: system and value required.

DP_Identifier_B

Business Identifier to identify a well-known entity based on the identification standards adopted by NPHIES: type, system and value required.

DP_Identifier_C

Business Identifier to identify an item such as an EFT or cheque: type and value required.

DP_Money

Money datatype requiring both currency and the value.

DP_Money_SAR

Money datatype requiring currency=SAR and the value.

DP_Period_1

Period datatype which constrains the start and end to complete dates. Both optional.

DP_Period_2

Period datatype which constrains the start and end to complete dates. Both required.

DP_Period_3

Period datatype which constrains the start and end to complete dates. Only start is required.

DP_Period_4

Period datatype which constrains the start and end to complete dates. Only end is required.

DP_Quantity_1

Quantity datatype which only requires a value.

DP_Quantity_2

Quantity data which requires a value, system and code.

DP_Range

Range datatype requiring both low and high values’

DP_Ratio

A ratio requiring both numberator and demoninator.

DP_Reference_1

Reference using the full URL. Example: where the referenced resource will be included within the bundle.

DP_Reference_1or2a

Reference where either pattern is permitted.

DP_Reference_1or2aor4

Reference where either pattern is permitted or when providing either name.

DP_Reference_1or2b

used refrence or when providing well known identifiers rather than including a resource when there is a choice of resource types, e.g. Reference(Organization or Practitioner).

DP_Reference_1or3a

Reference where either pattern is permitted.

DP_Reference_1or3b

Reference where either a full URL or an Identifier with system, value and optional type.

DP_Reference_1or4

Reference or identifier or display, used when providing either name example(practitioner name) when the full resource information is unknown or well known identifiers Example: VisionPrescription.prescriber

DP_Reference_2a

Used when providing well known identifiers rather than including a resource when there is only one valid resource type, e.g. Reference(Organization)

DP_Reference_2b

used when providing well known identifiers rather than including a resource when there is a choice of resource types, e.g. Reference(Organization or Practitioner)

DP_Reference_3a

Used when providing the business identifier for a resource when there is only one valid resource type, e.g. Reference(Claim)

DP_Reference_3aor4

Used when providing the business identifier for a resource when there is only one valid resource type or when providing either name.

DP_Reference_3b

Used when providing the business identifier for a resource when there is a choice of valid resource types, e.g. Reference(Claim or EligibilityRequest)

DP_Reference_4

Reference used when providing either name example(practitioner name) when the full resource information is unknown or well known identifiers Example: VisionPrescription.prescriber

DP_SimpleQuantity_1

SimpleQuantity datatype which only requires a value.

DP_SimpleQuantity_2

SimpleQuantity data which requires a value, system and codee, for example for medication quantity.

DP_Timing

Timing datatype requiring boundsPeriod, duration, durationUnit and periodUnit.

DP_base64Binary

String field where contents are a base64 string.

DP_canonical

Url datatype for specifying canonical urls

DP_code

A code from a predefined code system.

DP_date

A date which must be a complete date (YYYY-MM-DD).

DP_dateTime

DateTime datatype length limited to 29 characters.

DP_decimal

Decimal datatype length limited to 30 characters.

DP_id

An id datatype limited to 64 characters.

DP_iduuid

Id datatype where the content is required to be a GUID (UUID) without the ‘urn:uuid:’ prefix.

DP_instant

A time datatype requireming a full timestamp.

DP_integer

Integer with a maximum length of 12 characters.

DP_markdown

A string datatype containing text marked-up in markdown with a maximum length of 10MB.

DP_oid

Oid datatype with a maximum length of 60 characters.

DP_positiveInt

Positive integer datatype with length limited to 11 characters.

DP_string

String datatype.

DP_time

Tiem datatype requiring complete time (HH:MM:SS).

DP_unsignedInt

Unsigned integer with a length limit of 11 characters.

DP_uri

Uri datatype with a length limit of 255 characters.

DP_url

Url datatype limited to 255 characters.

DP_uuid

A uuid (GUID) datatype which requires the ‘urn:uuid:’ prefix.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

Adjudication Outcome

A code indicating the outcome of the adjudication such as rejected, partially approved/paid or approved/paid as submitted.

Adjudication Reissue Reason

The reason the adjudicator has reissued an authroization or claim response.

Administrative Gender

Gender of the patient as per the nphies adopted list of codes.

Admission Specialty

The speciality of the doctor who admitted the patient.

Advanced Auth Reason Extension

The reason the adjudicator has reissued an authroization or claim response.

Authorization Number

Transfer approval authorization number.

Authorization Offline Date

Date when the offline authorization was obtained.

Authorization Period

Transfer approval authorization period.

Authorization Provider

Transferred to provider.

Cause Of Death

The cause of death of the patient.

Claim Batch Identifier

A provider supplied id for the Batch. Each Batch must have a unique Batch Id for the issuing provider.

Claim Batch Number

A provider supplied unique number for each claim within a batch.

Claim Batch Period

The creation period associated with the claims in the batch.

Component - Early Fee

The charge for early settlemnt of the payment.

Component - Payment

The charge for nphies services.

Component - Payment

The amount of the payment.

Condition Onset

The first time that this diagnosis has been identified in regards to the patient episode.

Diagnosis Extension

Information about diagnoses relevant to the advanced preauthorized items

Diagnosis Related Group

The Diagnosis Related Group code assigned to the suite of treatment, proposed or performed, value-based care.

Diagnosis Sequence Extension

A number to uniquely identify diagnosis entries.

Diagnosis Type Extension

When the condition was observed or the relative ranking

DiagnosisDiagnosisCodeableConcept

The diagnosis code

Discharge Specialty

The speciality of the doctor who discharged the patient.

Eligibility Offline Date

The date when the insurer provided the eligibility string to reference supplied by the insurer when the online services were not available.

Eligibility Offline Reference

An eligibility string to reference supplied by the insurer when the online services were not available.

Eligibility Response

A reference to the CoverageEligibilityResponse previously returned by the insurer.

Emergency Arrival Code

The method how the patient came to the emergency department.

Emergency Department Disposition

Category or kind of location after discharge from emergency department.

Emergency Service Start

The exact date and time when patient start availing the service at the emergency department.

Encounter

The Encouter during which the services were performed.

Episode

Provider issued episode identifier.

Error Expression

Expression for error location as part of error reporting to indicate the location of error.

Information Sequence Extension

Exceptions, special conditions and supporting information applicable for this service or product.

Intended Length Of Stay

The intended Length Of Stay at the time of the admission.

Maternity

To confirm if this item will be counted under the maternity benefit.

Newborn

Flag to identify that this request is for a newborn.

Nphies SupportingInfo - Admission Weight

Nphies SupportingInfo - Admission Weight Extension Profile: The patient’s weight on admission.

Nphies SupportingInfo - Attachment

Nphies SupportingInfo - Attachment Extension Profile: A file of additional information.

Nphies SupportingInfo - Birth Weight

Nphies SupportingInfo - Birth Weight Extension Profile: The patient’s Birth Weight.

Nphies SupportingInfo - Chief Complaint

Nphies SupportingInfo - Chief Complaint Extension Profile: The patient’s chief complaint.

Nphies SupportingInfo - Days Supply

Nphies SupportingInfo - Days Supply Extension Profile: The number of days worth of medication or durable medical equipment.

Nphies SupportingInfo - Diastolic BP

Nphies SupportingInfo - Diastolic Extension Profile: Diastolic Blood Pressure.

Nphies SupportingInfo - Employment impacted

Nphies SupportingInfo - Employment impacted Extension Profile: The period during which the patient was unable to work due to the complaint.

Nphies SupportingInfo - Estimated length of stay

Nphies SupportingInfo - Estimated length of stay Extension Profile: The patient’s estimated length of stay.

Nphies SupportingInfo - History of Present Illness

Nphies SupportingInfo - History of Present Illness Extension Profile: The patient’s history of the present illness.

Nphies SupportingInfo - ICU Hours

Nphies SupportingInfo - ICU Hours Extension Profile: The number of hours spent in ICU.

Nphies SupportingInfo - Information

Nphies SupportingInfo - Information Extension Profile: A brief text message providing some information.

Nphies SupportingInfo - Investigation Result

Nphies SupportingInfo - Investigation Result Extension Profile: The documented result of an investigation.

Nphies SupportingInfo - Lab Test

Nphies SupportingInfo - Lab Test Extension Profile: The results of a lab test.

Nphies SupportingInfo - Last Menstrual Period

Nphies SupportingInfo - Last Menstrual Period Extension Profile: The patient’s Last Menstrual Period.

Nphies SupportingInfo - Missing Tooth

Nphies SupportingInfo - Missing Tooth Extension Profile: Identifies teeth which are missing, either pulled or never erupted.

Nphies SupportingInfo - Morphology

Nphies SupportingInfo - Morphology Extension Profile: Anatomical form, structure and specific features.

Nphies SupportingInfo - Onset of symptoms

Nphies SupportingInfo - Onset Extension Profile: The date when the patient first noticed the symptoms of the complaint.

Nphies SupportingInfo - Oxygen Saturation

Nphies SupportingInfo - Oxygen Saturation Extension Profile: The patient’s Oxygen Saturation.

Nphies SupportingInfo - Patient History

Nphies SupportingInfo - Patient History Extension Profile: The patient’s past surgical and medical history.

Nphies SupportingInfo - Patient height

Nphies SupportingInfo - Patient height Extension Profile: The patient’s height

Nphies SupportingInfo - Patient weight

Nphies SupportingInfo - Patient weight Extension Profile: The patient’s weight.

Nphies SupportingInfo - Physical Examination

Nphies SupportingInfo - Physical Examination Extension Profile: The patient’s physical-examination notes.

Nphies SupportingInfo - Pulse

Nphies SupportingInfo - Pulse Extension Profile: The patient’s pulse.

Nphies SupportingInfo - Reason for visit of symptoms

Nphies SupportingInfo - Reason for visit Extension Profile: The reason or purpose for the visit.

Nphies SupportingInfo - Respiratory Rate

Nphies SupportingInfo - Respiratory Rate Extension Profile: The patient’s Respiratory Rate.

Nphies SupportingInfo - Systolic BP

Nphies SupportingInfo - Systolic Extension Profile: Systolic Blood Pressure.

Nphies SupportingInfo - Temperature

Nphies SupportingInfo - Temperature Extension Profile: The patient’s terperature.

Nphies SupportingInfo - Treatment Plan

Nphies SupportingInfo - Treatment Plan Extension Profile: The proposed course of treatment.

Nphies SupportingInfo - Ventilation Hours

Nphies SupportingInfo - Ventilation Hours Extension Profile: The number of hours spent on a ventilator.

Original Request

The id of the message header or operation outcome of the original request.

Original Response

The id of the message header or operation outcome of the original response.

Package Code

A package billing code or bundle code used to group products and services to a particular health condition.

Patient Identifier Country

Patient identifier country as per the nphies adopted list of countries.

Patient Invoice

The number of the patient invoice on which the service was billed.

Patient Occupation

Patient occupation as per the nphies adopted list of occupations.

Patient Religion

Patient religion as per the nphies adopted list of religions.

Patient Share

The amount due from the Patient.

Payer Share

The amount due from the Payer.

Pharmacist Selection Reason

Reason for selecting the trade or brand name.

Pharmacist Substitute

Reason for providing a substitute to the prescribed drug.

Prescribed Medication

The medication code received in the prescription.

Prescription Extension

Prescription to support the dispensing of pharmacy, device or vision products.

Prior Authorization Response

Reference to priorauthorization response ID.

Provider Type

The provider type indicates establishment type of the healthcare provider such as: Hospital, clinic..etc.

Referring Provider Extension

The referring provider

Sequence Extension

A number to uniquely identify Sequence entries.

Service Event Type

To classify the visit for new or established patient.

Service Provider Extension

The party who will provide the services

Site Eligibility

Code to indicate whether the patient is eligible or not eligible and why.

Supporting Info Category Extension

The general class of the information supplied: information; exception; accident, employment; onset, etc.

Supporting Info Code Extension

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought

Supporting Info Extension

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues

Supporting Info Extension 2

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues

Supporting Info Extension 3

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues

Supporting Info Reason Extension

Provides the reason in the situation where a reason code is required in addition to the content

Supporting Info Sequence Extension

A number to uniquely identify supporting information entries

Supporting Info Timing Date Extension

The date when or period to which this information refers

Supporting Info Timing Period Extension

The date when or period to which this information refers

Supporting Info Value Attachment Extension

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data

Supporting Info Value Boolean Extension

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data

Supporting Info Value Quantity Extension

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data

Supporting Info Value Reference Extension

A reference, either FHIR resource reference or the busuness identifier of an information object, for example a document in an external repository

Supporting Info Value String Extension

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data

Tax

The amount of Tax (VAT) levied on the full cost of this line item.

Transfer

Flag to indicate a request to transfer services to another provider.

Triage Category

The appropriate level of care for a patient based on their medical case severity.

Triage Date

The exact date & time when the triage category for patient was determined at the emergency department.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Adjudication

Adjudication Value codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.

Adjudication Error Codes

Codes for errors encountered during the processing of the adjudication.

Adjudication Outcome

The processing status of the claim or authorization.

Adjudication Reason

Codes supporting the understanding of the adjudication result and explaining variance from the expected amount.

Admit Source

This value set defines a set of codes that can be used to indicate the origin of a patient admission.

Advanced Auth Reason

This code set includes codes for different advancedAuthorization reasons.

Benefit Category

Codes for the categories of benefits.

Benefit Type

Codes identfying the type of benefit components such as: deductible, copay, visit.

Blood Pressure Absence Reason

This value set includes blood-pressure-Absence-Reason codes.

Body Site

This code set includes Specific and identified anatomical location of the service provided to the patient (limb, tooth, etc.).

Cause of death

This valueset includes Encounter Cause of Death codes.

Claim Information Category

The general class of the information supplied: information, exception, accident, employment, onset, etc.

Claim SubType

Claim SubType codes which are used to identify different types of claims within broader claim type for example: within type ‘institutional’ there may be subtypes for ‘emergency’ services, ‘ inpatient’ and ‘outpatient’.

Claim Type Codes

Claim Type codes used to indicate the style of claim to support the requirements of different discipline such as: ‘institutional’, ‘pharmacy’, ‘oral’.

Claim response outcome

Claim processing outcome codes.

Communication Reason

Code indicating the reason or justification for the communication.

Condition Onset

This valueset provides codes to describe whether a condition was observed to have begun during patient care..

Coverage Copay Type

Codes indicating the type of service for which a copay is specified and copayment maximum limit or rate.

Coverage Financial Exception Codes

This valueset includes Coverage Financial Exception Codes.

Coverage Type

The coverage type codes which are applicable in Saudi Arabia.

Dental Billing

Dental billing codes.

Diagnosis Related Group

Diagnosis related group codes.

Diagnosis Type

Diagnosis type codes.

Diagnosis on Admission

Diagnosis on Admission codes.

Discharge Disposition

This valueset defines a set of codes that can be used identify where the patient went when the patient left the hospital.

Emergency Arrival Code

This valueset includes encounter emergency arrival code.

Emergency Department Dispostion

This valueset includes encounter emergency department disposition codes.

Encounter Class

Codes to describe the nature of an encounter.

FDI Surface Codes

FDI Surface Codes

FDI Tooth and Regions

FDI Tooth codes and oral regions codes.

Height Absence Reason

This value set includes Height Absence Reason codes.

ICD-10-AM

ICD-10-AM diagonsis and healthcare related codes.

Info Reason

Reason code to convey why supporting information was supplied..

Institutional Billing

Institutional billing codes.

Institutional Body Site

Institutional body site codes.

Intended Length Of Stay

This valueset includes codes to convey the patient’s intended length of stay in a facility.

Investigation Result

This valueset includes Investigation Results Supporting info codes.

KSA Administrative Gender

A set of administrative gender codes applicable for healthcare administration in Saudi Arabia.

KSA Languages

List of languages supported by the specifications.

KSA Marital Status

The list of codes indicating a person’s marital status within Saudi Arabia.

KSA Message Events

List of message event codes used in Saudi Arabia healthcare message exchanges.

Lens Type

Type of lens to be supplied for glasses or contacts.

MetaTags

This value set includes codes for meta tags.

Missing Tooth ReasonCodes

This value set provides codes for reasons why a tooth is missing.

Morphology Code

This valueset includes Morphology Supporting info Codes.

Occupation

List of occupation codes used in Saudi Arabia.

Organization Identifier

Codes to indicate the type of organization identifier.

Organization type

List of codes to typify organizations within the Saudi Arabia healthcare system.

Oxygen Saturation Absence Reason

This value set includes Oxygen-Saturation Absence Reason codes.

Patient Identifier Type

Codes for the supported patient identifiers for the healthcare system in Saudi Arabia.

Payment Method

This code set includes codes for different payment methods such as Electronic Fund Transfer (EFT), check, debit, credit and charge codes.

Pharmacist Selection Reason

Pharmacist medication selection reason codes.

Pharmacist Substitute

Pharmacist substitution reason codes.

Pharmacy Billing

Pharmacy billing codes.

Practice Codes

Practice codes to describe the nature of the clinical practice.

Practitioner Identifier

Practitioner Identifier

Prescribed Medication

Prescribed Medication

Prescriber Billing

Prescriber billing codes.

Professional Billing

Professional billing codes.

Provider Type

Codes typifying healthcare provider organizations in Saudi Arabia.

Pulse Absence Reason

This value set includes Pulse Absence Reason codes.

Reissue Reason

Reason codes conveying why the adjudicator has reissued an authorization or claim response.

Related Claim Relationship

Related-Claim relationship codes.

Religion

Codes for recognized religions.

Respiratory Rate Absence Reason

This value set includes Respiratory Rate Absence reason codes.

Route of Admin

This code set provides codes for routes to administer medicine.

Service Event Type

This valueset includes Claim service event type codes.

Service Type

This value set defines a set of codes for clinical service-types.

Site Eligibility

The codes used to convey Eligibility for services rendered at a specified service site.

Sub Site

Body subsites such as surfaces, directions and substructures.

Task Codes

Type of action that is expected to be performed.

Task Input Type

Codes indicating the type of data provided in a task input element.

Task Output Type

Codes indicating the type of data provided in a task output element.

Task Reason

A set of codes used to specify the reason for the task.

Task Status Reason

This value set includes codes for the Task status reason including cancellation rejection reasons.

Temperature Absence Reason

This value set includes Temperature Absence Reason codes.

Triage Category

This valueset includes Encounter triage category codes.

V3 ActPriority

A set of codes (e.g., for routine, emergency), specifying the urgency under which an encounter occurred.

Vision Billing

Vision billing codes.

Visit Reason

The resaon for the visit to the healthcare provider.

Weight Absence Reason

This value set includes Weight Absence Reason codes.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Adjudication Error

This code set includes a set of adjudication error codes which may be issued during the validation of a message.

Adjudication Outcome

A code indicating the outcome of the adjudication such as rejected, partially approved/paid or approved/paid as submitted.

Adjudication Reason

This code set includes a list of the adjudication denial codes.

Admit Source

This code set defines a set of codes that can be used to indicate from where the patient was admitted.

Advanced Auth Reason

Code to indicate the reason for sending an advanced-preAuthorization.

Benefit Category

A code to identify the general type of benefits under which products and services are provided.

Benefit Type

A code to indicate the benefit classification.

Blood Pressure Absence Reason

This code set includes the permissible values when the blood pressure is not provided.

Body Site

This code set includes Specific and identified anatomical location of the service provided to the patient (limb, tooth, etc.)

Cause of death

This codeset provides Encounter Cause of Death codes.

Claim Information Category

This code set includes Information Category codes to distinguish the type of supporting Information being provided.

Claim SubType

This code set includes Claim SubType codes which are used to distinguish the claim types for example within type institutional there may be subtypes for emergency services, bed stay and transportation.

Claim response outcome

Claim processing outcome codes.

Communication Reason

Set of code indicating the reason or justification for the communication.

Concept Properties

The concept property codes used in nphies Code Systems.

Condition Onset

This code system provides codes to describe whether a condition was observed to have begun during patient care.

Coverage Copay Type

Cost category. This value set includes sample Coverage Copayment Type codes.

Coverage Financial Exception

This value set includes Coverage Financial Exception Codes.

Coverage Type

This set of codes includes Coverage Type codes.

Diagnosis Related Group

This code set contains codes to indicate the Diagnosis Related Goup code for value-based care

Diagnosis Type

This code set includes Diagnosis Type codes.

Diagnosis on Admission

This code set includes Diagnosis on Admission codes.

Discharge disposition

A set of codes that can be used to distinguish where or how the patient left the hospital.

Emergency Arrival Code

This Code Set provides the encounter emergency arrival code to typify how the patient arrived at emergency care.

Emergency Department Disposition

The encounter emergency department disposition typifying how the patient left emergency care.

FDI Oral Region

This code set contains the FDI tooth and oral region codes.

Height Absence Reason

This code set includes Height-Absence-Reason codes.

Imaging

This code set includes Imaging Procedures.

InfoReason

A code to indicate the reason for submitting the supporting information.

Intended Length Of Stay

This codeset includes the intended length of stay codes.

Investigation Result

This codeset includes Investigation Results Supporting info codes

KSA Adjudication Codes

KSA adjudication codes used in addition to the HL7 adjudication codesystem codes.

KSA Administrative Gender

The Saudi codes for administrative genders

KSA Message Events

The Saudi codes for FHIR message events.

Laboratory

This code set includes Laboratory tests, observations and Blood Bank products

Lens Type

A code to indicate the product to be supplied (e.g. lens, contact)

MOH Category

These are MOH-specific billing codes.

Medical Devices

This code system includes codes for Medical devices.

Medication Codes

This system includes codes for packaged Medications.

MetaTags

This code system includes codes for the meta tags.

Missing Tooth Reason Codes

This set includes Missing Tooth Reason codes.

Morphology Code

This code system includes Morphology codes.

Occupation

Patient occupation codes as per the nphies adopted list of occupations

Oral Health - In-patient

This code set includes Oral Health - In-patient billing codes.

Oral Health - Out-patient

This code set includes Oral Health - Out-patient billing codes.

Organization Type

This code set defines a set of codes that can be used to indicate a type of organization.

Oxygen Saturation Absence Reason

This code set includes Oxygen-Saturation-Absence-Reason codes.

Patient Identifier Type

Codes to indicate the type of patient identifier.

Payment Method

Code to indicate the payment method used for claim settlement

Pharmacist Selection Reason

This Code set includes reason for selecting a specific drug by the pharmacist.

Pharmacist Substitute

This Code set include reason for providing a substitution to the prescribed drug

PracticeCodes

A code specifying the practitioner specialty.

Procedures

This code set includes medical Procedures.

Provider Type

This code system includes Provider Type codes.

Pulse Absence Reason

This code set includes Pulse-Absence-Reason codes.

Reissue Reason

The set of codes indicating the reason why adjudicator has reissued an authorization response or claim response.

Related Claim Relationship

This code set includes Related Claim Relationship codes.

Religion

Codes for recognized religions.

Respiratory Rate Absence Reason

This code set includes the permissible values when the respiratory rate value is absent.

Route of Administration

This code set provides route to administer medicine codes.

Scientific Codes

This code set includes codes for scientific codes for medications.

Service Event Type

This codeset includes Claim service event type codes.

Service Type

This code set defines a set of service-types codes.

Services

This code set includes Room and Board, In-patient Rounding, Consultations, and Service codes.

Site Eligibility

This code set includes codes indicating the eligibility of the coverage at the identified site.

Sub Site

This code set contains codes to indicate the sublocation region or surface of the bodySite, e.g. limb region or tooth surface(s).

Surface Codes

This value set includes a list of the FDI tooth surface codes.

Task Code

Codes indicating the type of the action that is expected to be performed.

Task Input Type

Codes defining the type of content in Task.input.

Task Output Type

Codes defining the type of content in Task.input.

Task Status Reason

This code set includes codes for the the Task status reason including cancellation rejection reasons.

TaskReasonCode

A set of codes used to specify the reason for the task.

Temperature Absence Reason

This code set includes Temperature-Absence-Reason codes.

Transportation - SRCA

This code set includes Ambulance and transportation services codes (SRCA)

Triage Category

This codeset includes enocunter triage category codes.

Visit Reason

Codes indicating the reason for the visit to the healthcare provider.

Weight Absence Reason

This code set includes Weight-Absence-Reason codes.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Advanced Authorization example #1

Advanced Authorization with multiple extensions.

Advanced Authorization example #2

Advanced Authorization with chief complain reported as text.

Authorization Communication Request #1

Communication Request.

Authorization Institutional Request #1

Institutional Authorization - DayCase Request.

Authorization Institutional Response #1

Authorization Institutional - DayCase Response.

Authorization Oral Request #1

Oral Authorization Request - exam, antibiotic sensitivity test and crown.

Authorization Pharmacy Request #1

Pharmacy Authorization - Headache Request.

Authorization Professional Request #1

Professional Authorization - Emergency Request Request.

Authorization Vision Request #1

Vision Authorization Request - glasses.

Claim Institutional Request #1

Claim Institutional Request with DischargeDisposition - Died.

Claim Institutional Response #1

Claim Institutional with DischargeDisposition - Died Response.

Claim Oral Request #1

Oral Claim Request with multiple items.

Claim Oral Request #2

Oral Claim Request.

Claim Oral Response #1

Oral Claim Response.

Claim Pharmacy Request #1

Pharmacy Claim - Bstch Request.

Claim Professional Request #1

Professional Claim - Emergency Request Request.

Claim Vision Request #1

Vision Claim Request - glasses.

Coverage Eligibility Request #1

Eligibilty Request Benefits and Validation

Coverage Eligibility Request #2

Eligibilty Request Newborn

Coverage Eligibility Response #1

Eligibility Response Benefits and Validation

Coverage Eligibility Response #2

Coverage Eligibility Response Issue

Coverage for Patient #1

Male Patient’s Extended Healthcare Coverage

Coverage for Patient #2

Newborn (Mom’s) Extended Healthcare Coverage

Coverage for Patient #3

Child Patient Extended Healthcare Coverage

Coverage for Patient #5

House Wife Patient’s Extended Healthcare Coverage.

Encounter #1

Hospital Emergency Encounter

Encounter #10

Inpatient Claim Encounter

Encounter #11

Professional Emergency Encounter

Encounter #12

Dental Clinic Encounter

Encounter #13

Home Health Encounter

Encounter #14

Virtual Encounter

Encounter #2

Professional Emergency Encounter

Encounter #3

Dental Clinic Encounter

Encounter #4

Institutional Short Stay Encounter

Encounter #5

Home Health Encounter

Encounter #6

Inpatient Encounter

Encounter #7

Virtual Encounter

Encounter #8

Hospital Emergency Encounter

Encounter #9

Hospital Emergency Encounter

Health Card Example - Coverage

Example resources supporting the sample Health Insurance card: Ahmad Khaled Abbas -Male Adult Patient

Health Card Example - Employer

A sample Employer: Elal Construction

Health Card Example - Insurer

A sample insurer: Health Insurance Inc.

Health Card Example - Patient

A sample patient: Ahmed Patient

Location #1

Saudi General Hospital Clinic

Message Header

Message Header for Advanced Authorization.

Message Header - Payment Notice

Message Header for Payment Notice.

Message Header - Payment Reconciliation

Message Header for Payment Reconciliation.

Message Header Error Notice #1

Message Header Error Notice for invalid response

Message Header Request - Cancel #1

Message Header for cancelling a Professional Authorization.

Message Header Request - Cov Elig

Message Header Request for Coverage Eligibility Request

Message Header Request - Inst Auth

Message Header Request for Institutional Authorization Request.

Message Header Request - Inst Claim

Message Header Request for Institutional Claim Request.

Message Header Request - Polling #1

Message Header Request for Polling Request #1.

Message Header Request - Polling #2

Message Header Request for Polling Request #2.

Message Header Request - Polling #3

Message Header Request for Polling Request #3.

Message Header Request - Status #1

Message Header Request for Status Request #1.

Message Header Response - Acknowledgement #1

Message Header for Acknowledgement #1.

Message Header Response - Cancel #1

Message Header for Cancel Response #1.

Message Header Response - Cov Elig

Message Header Response for Coverage Eligibility Response

Message Header Response - Inst Auth

Message Header Response for Institutional Authorization Response.

Message Header Response - Inst Claim

Message Header Response for Institutional Claim Response.

Message Header Response - Poll #1

Message Header Response for Poll Response #1.

Message Header Response - Status #1

Message Header for Status Response #1.

Message: Acknowledgement #1

Full message for Acknowledgement #1 - insurer received valid Error Notice.

Message: Authorization Advanced Response #1

Full message for Advanced Authorization with multiple extensions.

Message: Authorization Institutional Request #1

Full message for Institutional Authorization Request- DayCase Request.

Message: Authorization Institutional Response #1

Full message for Institutional Authorization Response - DayCase Response.

Message: Cancel Request #1

Full message for Cancel Request #1 - cancel a Professional Authorization.

Message: Cancel Response #1

Full message for Cancel Response #1 - returns processing status.

Message: Claim Institutional Request #1

Full message for Claim Institutional with DischargeDisposition - Died Request.

Message: Claim Institutional Response #1

Full message for Institutional Claim with DischargeDisposition - Died Response.

Message: Coverage Eligibility #1 Request

Full message for Coverage Eligibility Request- benefits and validation

Message: Coverage Eligibility #1 Response

Full message for Coverage Eligibility Response - benefits and validation

Message: Error Notice #1

Full message for Error Notice #1 - notifying an insurer of an invalid response message.

Message: Payment Notice #1

Full message for Payment Notice.

Message: Payment Reconciliation #1

Full message for Payment Reconciliation.

Message: Polling Request #1

Full message for Polling Request #1 - simple request for next message from the queue, if any.

Message: Polling Request #2

Full message for Polling Request #2 - request up to 25 queued messages excluding PaymentReconciliations.

Message: Polling Request #3

Full message for Polling Request #3 - request a response to a specific request message.

Message: Polling Response #1

Full message for Polling Response #1 - returns a single message from the queue.

Message: Status Request #1

Full message for Status Request #1 - request processing status of an institutional authorization request.

Message: Status Response #1

Full message for Status Response #1 - returns processing status.

Nphies Cancel Request #1

Nphies Cancel Request for Professional Authorization

Nphies Cancel Response #1

Cancel response for Professional Authorization

Nphies Communication #1

Provision of missing lab report.

Nphies Status Request

Nphies Status Request for Institutional Authorization

Nphies Status Response

Nphies Status Response for Institutional Authorization

Operation Outcome #1

Operation Outcome for Resource Id Missing

Organization NPHIES

nphies clearinghouse system

Patient #1

Ahmad Khaled Abbas - Male Adult Patient

Patient #2

Maria Khaled Rizwan - Female Adult Patient

Patient #3

Baby of Maria Rizwan - Male Child Patient

Patient #4

Muhammad Khaled Abbas - Male Child Patient

Patient #5

Sara Abbas - Female Housewife Patient.

Payer Organization #1

Saudi National Insurance

Payment Notice Example

Payment Notice.

Payment Reconciliation Example

Payment Reconciliation.

Policy Holder Organization #1

Policy Holder Organization

Poll Request #1

Poll Request #1 - simple request for next message from the queue, if any.

Poll Request #2

Poll Request #2 - request up to 25 queued messages excluding PaymentReconciliations.

Poll Request #3

Poll Request #3 - request a response to a specific request message.

Poll Response #1

Poll Response to Request #1 - returns a single message from the queue.

Practitioner #1

Dr. Ameera Hassan Practitioner.

Practitioner #2

Dr. Amar Moustafa Practitioner.

Practitioner #3

Dr. Yasser Mahfooz Practitioner.

Practitioner #4

Dr. Ashraf Naeem Practitioner.

Professional Authorization Response #1

Professional Authorization-Emergency Response.

Provider Organization #1

Saudi General Hospital

Provider Organization #2

Saudi Dental Clinic

Provider Organization #3

Saudi Vision Care

Provider Organization #4

Saudi Professional Clinic

Provider Organization #5

Saudi Pharmacy

VisionPrescription #1

Prescribed lenses for both eyes - Sara Abbas Vision Prescription.