Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
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
Roadmap
There are a number of places where this version of the implementation guide varies from FHIR or industry ‘best practise’ to accommodate the current business practises in Saudi Arabia. Consideration will be given in future versions of the implementation guide to better align Saudi practices with other practise guidelines and then to reflect those changes within this guide.
ValueSet Changes
| ValueSet | Description of Change |
|---|---|
| practitioner-identifier-type | Added 'PRN' to the list of codes to be used with the Practitioner resource as the identifier.type. For now both 'PRN' and 'MD' type codes will be accepted but in future versions of the IG the support for 'MD' is likely to be removed. |
| body-site | Changed to SNOMED body-site codes (https://hl7.org/fhir/valueset-body-site.html). |
Field Length Changes
Changed the length of Coding.code.display from 100 to 500 to accomodate longer display strings in code systems.
Missing Data Reasons
Missing data indicators in Claim.supportingInfo is handled by using proprietary sets of codes, which are not themselves harmonized, within the .reason element rather than using a standard FHIR data-absent extension placed within the element where the data would have been expected. This means that implementers must look for a choice of two optional elements rather than one required element and must program separate logic for the same missing data concept from multiple ‘missing-value’ code systems.
This issue is found in uses of Claim.supportingInfo for the concepts:
| Category.code | SupportingInfo Element | ValueSet |
|---|---|---|
| vital-sign-weight | valueQuantity | http://nphies.sa/terminology/ValueSet/weight-absence-reason |
| vital-sign-systolic | valueQuantity | http://nphies.sa/terminology/ValueSet/blood-pressure-absence-reason |
| vital-sign-diastolic | valueQuantity | http://nphies.sa/terminology/ValueSet/blood-pressure-absence-reason |
| vital-sign-height | valueQuantity | http://nphies.sa/terminology/ValueSet/height-absence-reason |
| temperature | valueQuantity | http://nphies.sa/terminology/ValueSet/temperature-absence-reason |
| pulse | valueQuantity | http://nphies.sa/terminology/ValueSet/pulse-absence-reason |
| oxygen-saturation | valueQuantity | http://nphies.sa/terminology/ValueSet/oxygen-saturation-absence-reason |
| respiratory-rate | valueQuantity | http://nphies.sa/terminology/ValueSet/respiratory-rate-absence-reason |
Redundant and Experimental Code Systems
Several nphies CodeSystems mimic or duplicate HL7 CodeSystems, or CodeSystems used are valid HL7 CodeSystems and are flagged as experimental, or have example-styled names such as ex-some-codes. These should be replaced with the HL7 CodeSystem once they have been marked non-experimental, or renamed, and formalized into the HL7 Terminology (THO) environment.
These issues are found in the following CodeSystems:
| CodeSystem | HL7 URL | nphies URL |
|---|---|---|
| Benefit Type | http://terminology.hl7.org/CodeSystem/benefit-type | http://nphies.sa/terminology/CodeSystem/benefit-type |
| Diagnosis Type | http://terminology.hl7.org/CodeSystem/ex-diagnosistype | http://nphies.sa/terminology/CodeSystem/diagnosis-type |
| Claim Information Category | http://terminology.hl7.org/CodeSystem/claiminformationcategory | http://nphies.sa/terminology/CodeSystem/claim-information-category |
| Coverage Financial Exception | http://terminology.hl7.org/CodeSystem/ex-coverage-financial-exception | http://nphies.sa/terminology/CodeSystem/coverage-financial-exception |
| Diagnosis on Admission | http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission | http://nphies.sa/terminology/CodeSystem/diagnosis-on-admission |
| Vision Prescription Product | http://terminology.hl7.org/CodeSystem/ex-visionprescriptionproduct | http://nphies.sa/terminology/CodeSystem/lens-type |
| Related Claim Relationship | http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship | http://nphies.sa/terminology/CodeSystem/related-claim-relationship |
| Claim FundsReserve | http://hl7.org/fhir/ValueSet/fundsreserve | n/a |
| Claim Payee.type | http://hl7.org/fhir/ValueSet/payeetype | n/a |
Messaging
In FHIR R5 and later use Bundle.identifier and rather than Bundle.id to establish message identity. FHIR R5 contains the note:
Previous releases used a combination of Bundle.id and MessageHeader.id in an attempt to establish the message identity. This posed problems when crossing the boundaries between messaging and RESTful exchange. The current release uses Bundle.identifier exclusively to establish and maintain the message identity.
Future versions of this specification which are based on FHIR R5 and later will need to adjust the message content requirements, duplicate checking and other message handling to align with those changes.
SupportingInfo Extension
The SupportingInfo Extension is used with the Advanced Authorization to provide relevant clinical and supporting information to the target provider in the same manner as the Claim.supportingInfo data structure (See also Overview - SupportingInfo). This extension has been defined as standalone extension containing several other standalone, full path, extensions. While this is technically valid it is not the FHIR best-practise for complex extensions. Two new extension have been provided in this IG for future consideration to replace the current SupportingInfo Extension:
- SupportingInfo Extension #2 provides the same data elements as the SupportingInfo Extension using the shorter absolute URLs; and,
- SupportingInfo Extension #3 provides a complex extension with the same data elements as the Claim.supportingInfo data structure using absolute URLs.