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