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

Table of Contents

.. 0 Table of Contents
... 1 Home
... 2 Background
.... 2.1 Introduction
.... 2.2 Credits
... 3 Specification
.... 3.1 Message Structure
.... 3.2 Message Exchange
.... 3.3 Error Handling
... 4 Use Cases
.... 4.1 Eligibility
.... 4.2 Prior-Authorization
.... 4.3 Advanced Authorization
.... 4.4 Claim Submission
.... 4.5 Batch Claims
.... 4.6 Payment Reconciliation
.... 4.7 Payment Notification
.... 4.8 Information Request
.... 4.9 Information Submission
.... 4.10 Cancellation
.... 4.11 Error Notice
.... 4.12 Polling
.... 4.13 Status
.... 4.14 Artifact Overview
... 5 Roadmap
... 6 Downloads
... 7 Artifacts
.... 7.1 Nphies Authorization (base)
.... 7.2 Nphies Claim (base)
.... 7.3 Nphies Encounter
.... 7.4 Nphies MessageHeader (base)
.... 7.5 Nphies Task (base)
.... 7.6 Nphies Advanced Authorization
.... 7.7 Nphies Authorization Institutional
.... 7.8 Nphies Authorization Oral
.... 7.9 Nphies Authorization Pharmacy
.... 7.10 Nphies Authorization Professional
.... 7.11 Nphies Authorization Response
.... 7.12 Nphies Authorization Vision
.... 7.13 Nphies Bundle
.... 7.14 Nphies Cancel Request
.... 7.15 Nphies Cancel Response
.... 7.16 Nphies Claim Institutional
.... 7.17 Nphies Claim Oral
.... 7.18 Nphies Claim Pharmacy
.... 7.19 Nphies Claim Professional
.... 7.20 Nphies Claim Response
.... 7.21 Nphies Claim Vision
.... 7.22 Nphies Communication
.... 7.23 Nphies CommunicationRequest
.... 7.24 Nphies Coverage
.... 7.25 Nphies CoverageEligibilityRequest
.... 7.26 Nphies CoverageEligibilityResponse
.... 7.27 Nphies Encounter AMB (Auth)
.... 7.28 Nphies Encounter AMB (Claim)
.... 7.29 Nphies Encounter EMER (Auth)
.... 7.30 Nphies Encounter EMER (Claim)
.... 7.31 Nphies Encounter HH (Auth)
.... 7.32 Nphies Encounter HH (Claim)
.... 7.33 Nphies Encounter IMP (Auth)
.... 7.34 Nphies Encounter IMP (Claim)
.... 7.35 Nphies Encounter SS (Auth)
.... 7.36 Nphies Encounter SS (Claim)
.... 7.37 Nphies Encounter VR (Auth)
.... 7.38 Nphies Encounter VR (Claim)
.... 7.39 Nphies Insurer Organization
.... 7.40 Nphies Location
.... 7.41 Nphies MedicationRequest
.... 7.42 Nphies MessageHeader
.... 7.43 Nphies MessageHeader (Error Notice)
.... 7.44 Nphies OperationOutcome
.... 7.45 Nphies Organization
.... 7.46 Nphies Patient
.... 7.47 Nphies Payment Notice
.... 7.48 Nphies Payment Reconciliation
.... 7.49 Nphies Policy Holder Organization
.... 7.50 Nphies Poll Request
.... 7.51 Nphies Poll Response
.... 7.52 Nphies Practitioner
.... 7.53 Nphies Provider Organization
.... 7.54 Nphies Status Request
.... 7.55 Nphies Status Response
.... 7.56 Nphies VisionPrescription
.... 7.57 DP_Address
.... 7.58 DP_Annotation
.... 7.59 DP_Attachment
.... 7.60 DP_base64Binary
.... 7.61 DP_canonical
.... 7.62 DP_code
.... 7.63 DP_CodeableConcept
.... 7.64 DP_CodeableConcept_1
.... 7.65 DP_CodeableConcept_2
.... 7.66 DP_Coding
.... 7.67 DP_date
.... 7.68 DP_dateTime
.... 7.69 DP_decimal
.... 7.70 DP_Dosage
.... 7.71 DP_HumanName
.... 7.72 DP_id
.... 7.73 DP_Identifier_A
.... 7.74 DP_Identifier_B
.... 7.75 DP_Identifier_C
.... 7.76 DP_iduuid
.... 7.77 DP_instant
.... 7.78 DP_integer
.... 7.79 DP_markdown
.... 7.80 DP_Money
.... 7.81 DP_Money_SAR
.... 7.82 DP_oid
.... 7.83 DP_Period_1
.... 7.84 DP_Period_2
.... 7.85 DP_Period_3
.... 7.86 DP_Period_4
.... 7.87 DP_positiveInt
.... 7.88 DP_Quantity_1
.... 7.89 DP_Quantity_2
.... 7.90 DP_Range
.... 7.91 DP_Ratio
.... 7.92 DP_Reference_1
.... 7.93 DP_Reference_1or2a
.... 7.94 DP_Reference_1or2aor4
.... 7.95 DP_Reference_1or2b
.... 7.96 DP_Reference_1or3a
.... 7.97 DP_Reference_1or3b
.... 7.98 DP_Reference_1or4
.... 7.99 DP_Reference_2a
.... 7.100 DP_Reference_2b
.... 7.101 DP_Reference_3a
.... 7.102 DP_Reference_3aor4
.... 7.103 DP_Reference_3b
.... 7.104 DP_Reference_4
.... 7.105 DP_SimpleQuantity_1
.... 7.106 DP_SimpleQuantity_2
.... 7.107 DP_string
.... 7.108 DP_time
.... 7.109 DP_Timing
.... 7.110 DP_unsignedInt
.... 7.111 DP_uri
.... 7.112 DP_url
.... 7.113 DP_uuid
.... 7.114 Adjudication Outcome
.... 7.115 Adjudication Reissue Reason
.... 7.116 Administrative Gender
.... 7.117 Admission Specialty
.... 7.118 Advanced Auth Reason Extension
.... 7.119 Authorization Number
.... 7.120 Authorization Offline Date
.... 7.121 Authorization Period
.... 7.122 Authorization Provider
.... 7.123 Cause Of Death
.... 7.124 Claim Batch Identifier
.... 7.125 Claim Batch Number
.... 7.126 Claim Batch Period
.... 7.127 Component - Early Fee
.... 7.128 Component - Payment
.... 7.129 Component - Payment
.... 7.130 Condition Onset
.... 7.131 Diagnosis Extension
.... 7.132 Diagnosis Related Group
.... 7.133 Diagnosis Sequence Extension
.... 7.134 Diagnosis Type Extension
.... 7.135 DiagnosisDiagnosisCodeableConcept
.... 7.136 Discharge Specialty
.... 7.137 Eligibility Offline Date
.... 7.138 Eligibility Offline Reference
.... 7.139 Eligibility Response
.... 7.140 Emergency Arrival Code
.... 7.141 Emergency Department Disposition
.... 7.142 Emergency Service Start
.... 7.143 Encounter
.... 7.144 Episode
.... 7.145 Error Expression
.... 7.146 Information Sequence Extension
.... 7.147 Intended Length Of Stay
.... 7.148 Maternity
.... 7.149 Newborn
.... 7.150 Nphies SupportingInfo - Admission Weight
.... 7.151 Nphies SupportingInfo - Attachment
.... 7.152 Nphies SupportingInfo - Birth Weight
.... 7.153 Nphies SupportingInfo - Chief Complaint
.... 7.154 Nphies SupportingInfo - Days Supply
.... 7.155 Nphies SupportingInfo - Diastolic BP
.... 7.156 Nphies SupportingInfo - Employment impacted
.... 7.157 Nphies SupportingInfo - Estimated length of stay
.... 7.158 Nphies SupportingInfo - History of Present Illness
.... 7.159 Nphies SupportingInfo - ICU Hours
.... 7.160 Nphies SupportingInfo - Information
.... 7.161 Nphies SupportingInfo - Investigation Result
.... 7.162 Nphies SupportingInfo - Lab Test
.... 7.163 Nphies SupportingInfo - Last Menstrual Period
.... 7.164 Nphies SupportingInfo - Missing Tooth
.... 7.165 Nphies SupportingInfo - Morphology
.... 7.166 Nphies SupportingInfo - Onset of symptoms
.... 7.167 Nphies SupportingInfo - Oxygen Saturation
.... 7.168 Nphies SupportingInfo - Patient height
.... 7.169 Nphies SupportingInfo - Patient History
.... 7.170 Nphies SupportingInfo - Patient weight
.... 7.171 Nphies SupportingInfo - Physical Examination
.... 7.172 Nphies SupportingInfo - Pulse
.... 7.173 Nphies SupportingInfo - Reason for visit of symptoms
.... 7.174 Nphies SupportingInfo - Respiratory Rate
.... 7.175 Nphies SupportingInfo - Systolic BP
.... 7.176 Nphies SupportingInfo - Temperature
.... 7.177 Nphies SupportingInfo - Treatment Plan
.... 7.178 Nphies SupportingInfo - Ventilation Hours
.... 7.179 Original Request
.... 7.180 Original Response
.... 7.181 Package Code
.... 7.182 Patient Identifier Country
.... 7.183 Patient Invoice
.... 7.184 Patient Occupation
.... 7.185 Patient Religion
.... 7.186 Patient Share
.... 7.187 Payer Share
.... 7.188 Pharmacist Selection Reason
.... 7.189 Pharmacist Substitute
.... 7.190 Prescribed Medication
.... 7.191 Prescription Extension
.... 7.192 Prior Authorization Response
.... 7.193 Provider Type
.... 7.194 Referring Provider Extension
.... 7.195 Sequence Extension
.... 7.196 Service Event Type
.... 7.197 Service Provider Extension
.... 7.198 Site Eligibility
.... 7.199 Supporting Info Category Extension
.... 7.200 Supporting Info Code Extension
.... 7.201 Supporting Info Extension
.... 7.202 Supporting Info Extension 2
.... 7.203 Supporting Info Extension 3
.... 7.204 Supporting Info Reason Extension
.... 7.205 Supporting Info Sequence Extension
.... 7.206 Supporting Info Timing Date Extension
.... 7.207 Supporting Info Timing Period Extension
.... 7.208 Supporting Info Value Attachment Extension
.... 7.209 Supporting Info Value Boolean Extension
.... 7.210 Supporting Info Value Quantity Extension
.... 7.211 Supporting Info Value Reference Extension
.... 7.212 Supporting Info Value String Extension
.... 7.213 Tax
.... 7.214 Transfer
.... 7.215 Triage Category
.... 7.216 Triage Date
.... 7.217 Adjudication
.... 7.218 Adjudication Error Codes
.... 7.219 Adjudication Outcome
.... 7.220 Adjudication Reason
.... 7.221 Admit Source
.... 7.222 Advanced Auth Reason
.... 7.223 Benefit Category
.... 7.224 Benefit Type
.... 7.225 Blood Pressure Absence Reason
.... 7.226 Body Site
.... 7.227 Cause of death
.... 7.228 Claim Information Category
.... 7.229 Claim response outcome
.... 7.230 Claim SubType
.... 7.231 Claim Type Codes
.... 7.232 Communication Reason
.... 7.233 Condition Onset
.... 7.234 Coverage Copay Type
.... 7.235 Coverage Financial Exception Codes
.... 7.236 Coverage Type
.... 7.237 Dental Billing
.... 7.238 Diagnosis on Admission
.... 7.239 Diagnosis Related Group
.... 7.240 Diagnosis Type
.... 7.241 Discharge Disposition
.... 7.242 Emergency Arrival Code
.... 7.243 Emergency Department Dispostion
.... 7.244 Encounter Class
.... 7.245 FDI Surface Codes
.... 7.246 FDI Tooth and Regions
.... 7.247 Height Absence Reason
.... 7.248 ICD-10-AM
.... 7.249 Info Reason
.... 7.250 Institutional Billing
.... 7.251 Institutional Body Site
.... 7.252 Intended Length Of Stay
.... 7.253 Investigation Result
.... 7.254 KSA Administrative Gender
.... 7.255 KSA Languages
.... 7.256 KSA Marital Status
.... 7.257 KSA Message Events
.... 7.258 Lens Type
.... 7.259 MetaTags
.... 7.260 Missing Tooth ReasonCodes
.... 7.261 Morphology Code
.... 7.262 Occupation
.... 7.263 Organization Identifier
.... 7.264 Organization type
.... 7.265 Oxygen Saturation Absence Reason
.... 7.266 Patient Identifier Type
.... 7.267 Payment Method
.... 7.268 Pharmacist Selection Reason
.... 7.269 Pharmacist Substitute
.... 7.270 Pharmacy Billing
.... 7.271 Practice Codes
.... 7.272 Practitioner Identifier
.... 7.273 Prescribed Medication
.... 7.274 Prescriber Billing
.... 7.275 Professional Billing
.... 7.276 Provider Type
.... 7.277 Pulse Absence Reason
.... 7.278 Reissue Reason
.... 7.279 Related Claim Relationship
.... 7.280 Religion
.... 7.281 Respiratory Rate Absence Reason
.... 7.282 Route of Admin
.... 7.283 Service Event Type
.... 7.284 Service Type
.... 7.285 Site Eligibility
.... 7.286 Sub Site
.... 7.287 Task Codes
.... 7.288 Task Input Type
.... 7.289 Task Output Type
.... 7.290 Task Reason
.... 7.291 Task Status Reason
.... 7.292 Temperature Absence Reason
.... 7.293 Triage Category
.... 7.294 V3 ActPriority
.... 7.295 Vision Billing
.... 7.296 Visit Reason
.... 7.297 Weight Absence Reason
.... 7.298 Adjudication Error
.... 7.299 Adjudication Outcome
.... 7.300 Adjudication Reason
.... 7.301 Admit Source
.... 7.302 Advanced Auth Reason
.... 7.303 Benefit Category
.... 7.304 Benefit Type
.... 7.305 Blood Pressure Absence Reason
.... 7.306 Body Site
.... 7.307 Cause of death
.... 7.308 Claim Information Category
.... 7.309 Claim response outcome
.... 7.310 Claim SubType
.... 7.311 Communication Reason
.... 7.312 Concept Properties
.... 7.313 Condition Onset
.... 7.314 Coverage Copay Type
.... 7.315 Coverage Financial Exception
.... 7.316 Coverage Type
.... 7.317 Diagnosis on Admission
.... 7.318 Diagnosis Related Group
.... 7.319 Diagnosis Type
.... 7.320 Discharge disposition
.... 7.321 Emergency Arrival Code
.... 7.322 Emergency Department Disposition
.... 7.323 FDI Oral Region
.... 7.324 Height Absence Reason
.... 7.325 Imaging
.... 7.326 InfoReason
.... 7.327 Intended Length Of Stay
.... 7.328 Investigation Result
.... 7.329 KSA Adjudication Codes
.... 7.330 KSA Administrative Gender
.... 7.331 KSA Message Events
.... 7.332 Laboratory
.... 7.333 Lens Type
.... 7.334 Medical Devices
.... 7.335 Medication Codes
.... 7.336 MetaTags
.... 7.337 Missing Tooth Reason Codes
.... 7.338 MOH Category
.... 7.339 Morphology Code
.... 7.340 Occupation
.... 7.341 Oral Health - In-patient
.... 7.342 Oral Health - Out-patient
.... 7.343 Organization Type
.... 7.344 Oxygen Saturation Absence Reason
.... 7.345 Patient Identifier Type
.... 7.346 Payment Method
.... 7.347 Pharmacist Selection Reason
.... 7.348 Pharmacist Substitute
.... 7.349 PracticeCodes
.... 7.350 Procedures
.... 7.351 Provider Type
.... 7.352 Pulse Absence Reason
.... 7.353 Reissue Reason
.... 7.354 Related Claim Relationship
.... 7.355 Religion
.... 7.356 Respiratory Rate Absence Reason
.... 7.357 Route of Administration
.... 7.358 Scientific Codes
.... 7.359 Service Event Type
.... 7.360 Service Type
.... 7.361 Services
.... 7.362 Site Eligibility
.... 7.363 Sub Site
.... 7.364 Surface Codes
.... 7.365 Task Code
.... 7.366 Task Input Type
.... 7.367 Task Output Type
.... 7.368 Task Status Reason
.... 7.369 TaskReasonCode
.... 7.370 Temperature Absence Reason
.... 7.371 Transportation - SRCA
.... 7.372 Triage Category
.... 7.373 Visit Reason
.... 7.374 Weight Absence Reason
.... 7.375 Advanced Authorization example #1
.... 7.376 Advanced Authorization example #2
.... 7.377 Authorization Communication Request #1
.... 7.378 Authorization Institutional Request #1
.... 7.379 Authorization Institutional Response #1
.... 7.380 Authorization Oral Request #1
.... 7.381 Authorization Pharmacy Request #1
.... 7.382 Authorization Professional Request #1
.... 7.383 Authorization Vision Request #1
.... 7.384 Claim Institutional Request #1
.... 7.385 Claim Institutional Response #1
.... 7.386 Claim Oral Request #1
.... 7.387 Claim Oral Request #2
.... 7.388 Claim Oral Response #1
.... 7.389 Claim Pharmacy Request #1
.... 7.390 Claim Professional Request #1
.... 7.391 Claim Vision Request #1
.... 7.392 Coverage Eligibility Request #1
.... 7.393 Coverage Eligibility Request #2
.... 7.394 Coverage Eligibility Response #1
.... 7.395 Coverage Eligibility Response #2
.... 7.396 Coverage for Patient #1
.... 7.397 Coverage for Patient #2
.... 7.398 Coverage for Patient #3
.... 7.399 Coverage for Patient #5
.... 7.400 Encounter #1
.... 7.401 Encounter #10
.... 7.402 Encounter #11
.... 7.403 Encounter #12
.... 7.404 Encounter #13
.... 7.405 Encounter #14
.... 7.406 Encounter #2
.... 7.407 Encounter #3
.... 7.408 Encounter #4
.... 7.409 Encounter #5
.... 7.410 Encounter #6
.... 7.411 Encounter #7
.... 7.412 Encounter #8
.... 7.413 Encounter #9
.... 7.414 Health Card Example - Coverage
.... 7.415 Health Card Example - Employer
.... 7.416 Health Card Example - Insurer
.... 7.417 Health Card Example - Patient
.... 7.418 Location #1
.... 7.419 Message Header
.... 7.420 Message Header - Payment Notice
.... 7.421 Message Header - Payment Reconciliation
.... 7.422 Message Header Error Notice #1
.... 7.423 Message Header Request - Cancel #1
.... 7.424 Message Header Request - Cov Elig
.... 7.425 Message Header Request - Inst Auth
.... 7.426 Message Header Request - Inst Claim
.... 7.427 Message Header Request - Polling #1
.... 7.428 Message Header Request - Polling #2
.... 7.429 Message Header Request - Polling #3
.... 7.430 Message Header Request - Status #1
.... 7.431 Message Header Response - Acknowledgement #1
.... 7.432 Message Header Response - Cancel #1
.... 7.433 Message Header Response - Cov Elig
.... 7.434 Message Header Response - Inst Auth
.... 7.435 Message Header Response - Inst Claim
.... 7.436 Message Header Response - Poll #1
.... 7.437 Message Header Response - Status #1
.... 7.438 Message: Acknowledgement #1
.... 7.439 Message: Authorization Advanced Response #1
.... 7.440 Message: Authorization Institutional Request #1
.... 7.441 Message: Authorization Institutional Response #1
.... 7.442 Message: Cancel Request #1
.... 7.443 Message: Cancel Response #1
.... 7.444 Message: Claim Institutional Request #1
.... 7.445 Message: Claim Institutional Response #1
.... 7.446 Message: Coverage Eligibility #1 Request
.... 7.447 Message: Coverage Eligibility #1 Response
.... 7.448 Message: Error Notice #1
.... 7.449 Message: Payment Notice #1
.... 7.450 Message: Payment Reconciliation #1
.... 7.451 Message: Polling Request #1
.... 7.452 Message: Polling Request #2
.... 7.453 Message: Polling Request #3
.... 7.454 Message: Polling Response #1
.... 7.455 Message: Status Request #1
.... 7.456 Message: Status Response #1
.... 7.457 Nphies Cancel Request #1
.... 7.458 Nphies Cancel Response #1
.... 7.459 Nphies Communication #1
.... 7.460 Nphies Status Request
.... 7.461 Nphies Status Response
.... 7.462 Operation Outcome #1
.... 7.463 Organization NPHIES
.... 7.464 Patient #1
.... 7.465 Patient #2
.... 7.466 Patient #3
.... 7.467 Patient #4
.... 7.468 Patient #5
.... 7.469 Payer Organization #1
.... 7.470 Payment Notice Example
.... 7.471 Payment Reconciliation Example
.... 7.472 Policy Holder Organization #1
.... 7.473 Poll Request #1
.... 7.474 Poll Request #2
.... 7.475 Poll Request #3
.... 7.476 Poll Response #1
.... 7.477 Practitioner #1
.... 7.478 Practitioner #2
.... 7.479 Practitioner #3
.... 7.480 Practitioner #4
.... 7.481 Professional Authorization Response #1
.... 7.482 Provider Organization #1
.... 7.483 Provider Organization #2
.... 7.484 Provider Organization #3
.... 7.485 Provider Organization #4
.... 7.486 Provider Organization #5
.... 7.487 VisionPrescription #1