Healthcare Financial Services IG Edition 1
1.0.0 - STU Saudi Arabia flag

Healthcare Financial Services IG Edition 1 - Local Development build (v1.0.0) 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 Conformance
.... 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 Submission
.... 4.9 Information Request
.... 4.10 Cancellation
.... 4.11 Error Notice
.... 4.12 Polling
.... 4.13 Status
... 5 Artifact Overview
... 6 Artifacts
.... 6.1 CapabilityStatement - Insurer
.... 6.2 CapabilityStatement - nphies
.... 6.3 CapabilityStatement - Provider
.... 6.4 MessageDefinition-CancelRequest
.... 6.5 MessageDefinition-CancelResponse
.... 6.6 Nphies Authorization (base)
.... 6.7 Nphies Claim (base)
.... 6.8 Nphies Encounter
.... 6.9 Nphies MessageHeader (base)
.... 6.10 Nphies Task (base)
.... 6.11 Nphies Advanced Authorization
.... 6.12 Nphies Authorization Institutional
.... 6.13 Nphies Authorization Oral
.... 6.14 Nphies Authorization Pharmacy
.... 6.15 Nphies Authorization Professional
.... 6.16 Nphies Authorization Response
.... 6.17 Nphies Authorization Vision
.... 6.18 Nphies Bundle
.... 6.19 Nphies Cancel Request
.... 6.20 Nphies Cancel Response
.... 6.21 Nphies Claim Institutional
.... 6.22 Nphies Claim Oral
.... 6.23 Nphies Claim Pharmacy
.... 6.24 Nphies Claim Professional
.... 6.25 Nphies Claim Response
.... 6.26 Nphies Claim Vision
.... 6.27 Nphies Communication
.... 6.28 Nphies CommunicationRequest
.... 6.29 Nphies Coverage
.... 6.30 Nphies CoverageEligibilityRequest
.... 6.31 Nphies CoverageEligibilityResponse
.... 6.32 Nphies Encounter AMB (Auth)
.... 6.33 Nphies Encounter AMB (Claim)
.... 6.34 Nphies Encounter EMER (Auth)
.... 6.35 Nphies Encounter EMER (Claim)
.... 6.36 Nphies Encounter HH (Auth)
.... 6.37 Nphies Encounter HH (Claim)
.... 6.38 Nphies Encounter IMP (Auth)
.... 6.39 Nphies Encounter IMP (Claim)
.... 6.40 Nphies Encounter SS (Auth)
.... 6.41 Nphies Encounter SS (Claim)
.... 6.42 Nphies Encounter VR (Auth)
.... 6.43 Nphies Encounter VR (Claim)
.... 6.44 Nphies Insurer Organization
.... 6.45 Nphies Location
.... 6.46 Nphies MedicationRequest
.... 6.47 Nphies MessageHeader
.... 6.48 Nphies MessageHeader (Error Notice)
.... 6.49 Nphies OperationOutcome
.... 6.50 Nphies Organization
.... 6.51 Nphies Patient
.... 6.52 Nphies Payment Notice
.... 6.53 Nphies Payment Reconciliation
.... 6.54 Nphies Policy Holder Organization
.... 6.55 Nphies Poll Request
.... 6.56 Nphies Poll Response
.... 6.57 Nphies Practitioner
.... 6.58 Nphies Provider Organization
.... 6.59 Nphies Status Request
.... 6.60 Nphies Status Response
.... 6.61 Nphies VisionPrescription
.... 6.62 DP_Address
.... 6.63 DP_Annotation
.... 6.64 DP_Attachment
.... 6.65 DP_base64Binary
.... 6.66 DP_canonical
.... 6.67 DP_code
.... 6.68 DP_CodeableConcept
.... 6.69 DP_CodeableConcept_1
.... 6.70 DP_CodeableConcept_2
.... 6.71 DP_Coding
.... 6.72 DP_date
.... 6.73 DP_dateTime
.... 6.74 DP_decimal
.... 6.75 DP_Dosage
.... 6.76 DP_HumanName
.... 6.77 DP_id
.... 6.78 DP_Identifier_A
.... 6.79 DP_Identifier_B
.... 6.80 DP_Identifier_C
.... 6.81 DP_iduuid
.... 6.82 DP_instant
.... 6.83 DP_integer
.... 6.84 DP_markdown
.... 6.85 DP_Money
.... 6.86 DP_Money_SAR
.... 6.87 DP_oid
.... 6.88 DP_Period_1
.... 6.89 DP_Period_2
.... 6.90 DP_Period_3
.... 6.91 DP_Period_4
.... 6.92 DP_positiveInt
.... 6.93 DP_Quantity_1
.... 6.94 DP_Quantity_2
.... 6.95 DP_Range
.... 6.96 DP_Ratio
.... 6.97 DP_Reference_1
.... 6.98 DP_Reference_1or2a
.... 6.99 DP_Reference_1or2aor4
.... 6.100 DP_Reference_1or2b
.... 6.101 DP_Reference_1or3a
.... 6.102 DP_Reference_1or3b
.... 6.103 DP_Reference_1or4
.... 6.104 DP_Reference_2a
.... 6.105 DP_Reference_2b
.... 6.106 DP_Reference_3a
.... 6.107 DP_Reference_3aor4
.... 6.108 DP_Reference_3b
.... 6.109 DP_Reference_4
.... 6.110 DP_SimpleQuantity_1
.... 6.111 DP_SimpleQuantity_2
.... 6.112 DP_string
.... 6.113 DP_time
.... 6.114 DP_Timing
.... 6.115 DP_unsignedInt
.... 6.116 DP_uri
.... 6.117 DP_url
.... 6.118 DP_uuid
.... 6.119 Adjudication Outcome
.... 6.120 Adjudication Reissue Reason
.... 6.121 Administrative Gender
.... 6.122 Admission Specialty
.... 6.123 Advanced Auth Reason
.... 6.124 Authorization Offline Date
.... 6.125 Cause Of Death
.... 6.126 Claim Batch Identifier
.... 6.127 Claim Batch Number
.... 6.128 Claim Batch Period
.... 6.129 Component - Early Fee
.... 6.130 Component - nphies Fee
.... 6.131 Component - Payment
.... 6.132 Condition Onset
.... 6.133 Diagnosis Extension
.... 6.134 Diagnosis Sequence Extension
.... 6.135 Diagnosis Type Extension
.... 6.136 DiagnosisDiagnosisCodeableConcept
.... 6.137 Discharge Specialty
.... 6.138 Eligibility Offline Date
.... 6.139 Eligibility Offline Reference
.... 6.140 Eligibility Response
.... 6.141 Emergency Arrival Code
.... 6.142 Emergency Department Disposition
.... 6.143 Emergency Service Start
.... 6.144 Encounter
.... 6.145 Episode
.... 6.146 Error Expression
.... 6.147 Information Sequence Extension
.... 6.148 Intended Length Of Stay
.... 6.149 Maternity
.... 6.150 Newborn
.... 6.151 Nphies SupportingInfo - Admission Weight
.... 6.152 Nphies SupportingInfo - Attachment
.... 6.153 Nphies SupportingInfo - Birth Weight
.... 6.154 Nphies SupportingInfo - Chief Complaint
.... 6.155 Nphies SupportingInfo - Days Supply
.... 6.156 Nphies SupportingInfo - Diastolic BP
.... 6.157 Nphies SupportingInfo - Employment impacted
.... 6.158 Nphies SupportingInfo - Estimated length of stay
.... 6.159 Nphies SupportingInfo - History of Present Illness
.... 6.160 Nphies SupportingInfo - ICU Hours
.... 6.161 Nphies SupportingInfo - Information
.... 6.162 Nphies SupportingInfo - Investigation Result
.... 6.163 Nphies SupportingInfo - Lab Test
.... 6.164 Nphies SupportingInfo - Last Menstrual Period
.... 6.165 Nphies SupportingInfo - Missing Tooth
.... 6.166 Nphies SupportingInfo - Morphology
.... 6.167 Nphies SupportingInfo - Onset of symptoms
.... 6.168 Nphies SupportingInfo - Oxygen Saturation
.... 6.169 Nphies SupportingInfo - Patient height
.... 6.170 Nphies SupportingInfo - Patient History
.... 6.171 Nphies SupportingInfo - Patient weight
.... 6.172 Nphies SupportingInfo - Physical Examination
.... 6.173 Nphies SupportingInfo - Pulse
.... 6.174 Nphies SupportingInfo - Reason for visit of symptoms
.... 6.175 Nphies SupportingInfo - Respiratory Rate
.... 6.176 Nphies SupportingInfo - Systolic BP
.... 6.177 Nphies SupportingInfo - Temperature
.... 6.178 Nphies SupportingInfo - Treatment Plan
.... 6.179 Nphies SupportingInfo - Ventilation Hours
.... 6.180 Original Request
.... 6.181 Original Response
.... 6.182 Package Code
.... 6.183 Patient Identifier Country
.... 6.184 Patient Invoice
.... 6.185 Patient Occupation
.... 6.186 Patient Religion
.... 6.187 Patient Share
.... 6.188 Payer Share
.... 6.189 Pharmacist Selection Reason
.... 6.190 Pharmacist Substitute
.... 6.191 Prescribed Medication
.... 6.192 Prescription Extension
.... 6.193 Prior Authorization Response
.... 6.194 Provider Type
.... 6.195 Referring Provider Extension
.... 6.196 Sequence Extension
.... 6.197 Service Event Type
.... 6.198 Service Provider Extension
.... 6.199 Site Eligibility
.... 6.200 Supporting Info Category Extension
.... 6.201 Supporting Info Code Extension
.... 6.202 Supporting Info Extension
.... 6.203 Supporting Info Extension 2
.... 6.204 Supporting Info Extension 3
.... 6.205 Supporting Info Reason Extension
.... 6.206 Supporting Info Sequence Extension
.... 6.207 Supporting Info Timing Date Extension
.... 6.208 Supporting Info Timing Period Extension
.... 6.209 Supporting Info Value Attachment Extension
.... 6.210 Supporting Info Value Quantity Extension
.... 6.211 Supporting Info Value String Extension
.... 6.212 Tax
.... 6.213 Transfer
.... 6.214 Transfer Authorization Number
.... 6.215 Transfer Authorization Period
.... 6.216 Transfer Authorization Provider
.... 6.217 Triage Category
.... 6.218 Triage Date
.... 6.219 Adjudication
.... 6.220 Adjudication Error Codes
.... 6.221 Adjudication Outcome
.... 6.222 Adjudication Reason
.... 6.223 Admit Source
.... 6.224 Advanced Auth Reason
.... 6.225 Benefit Category
.... 6.226 Benefit Type
.... 6.227 Blood Pressure Absence Reason
.... 6.228 Body Site
.... 6.229 Cause of death
.... 6.230 Claim Information Category
.... 6.231 Claim response outcome
.... 6.232 Claim SubType
.... 6.233 Claim Type Codes
.... 6.234 Communication Reason
.... 6.235 Condition Onset
.... 6.236 Coverage Copay Type
.... 6.237 Coverage Financial Exception Codes
.... 6.238 Coverage Type
.... 6.239 Dental Billing
.... 6.240 Diagnosis on Admission
.... 6.241 Diagnosis Type
.... 6.242 Discharge Disposition
.... 6.243 Emergency Arrival Code
.... 6.244 Emergency Department Dispostion
.... 6.245 Encounter Class
.... 6.246 FDI Surface Codes
.... 6.247 FDI Tooth and Regions
.... 6.248 Height Absence Reason
.... 6.249 ICD-10-AM
.... 6.250 Info Reason
.... 6.251 Institutional Billing
.... 6.252 Institutional Body Site
.... 6.253 Intended Length Of Stay
.... 6.254 Investigation Result
.... 6.255 KSA Administrative Gender
.... 6.256 KSA Languages
.... 6.257 KSA Marital Status
.... 6.258 KSA Message Events
.... 6.259 Lens Type
.... 6.260 MetaTags
.... 6.261 Missing Tooth ReasonCodes
.... 6.262 Morphology Code
.... 6.263 Occupation
.... 6.264 Organization Identifier
.... 6.265 Organization type
.... 6.266 Oxygen Saturation Absence Reason
.... 6.267 Patient Identifier Type
.... 6.268 Payment Method
.... 6.269 Pharmacist Selection Reason
.... 6.270 Pharmacist Substitute
.... 6.271 Pharmacy Billing
.... 6.272 Practice Codes
.... 6.273 Practitioner Identifier
.... 6.274 Prescribed Medication
.... 6.275 Prescriber Billing
.... 6.276 Professional Billing
.... 6.277 Provider Type
.... 6.278 Pulse Absence Reason
.... 6.279 Reissue Reason
.... 6.280 Related Claim Relationship
.... 6.281 Religion
.... 6.282 Respiratory Rate Absence Reason
.... 6.283 Route of Admin
.... 6.284 Rta Diagnosis
.... 6.285 Service Event Type
.... 6.286 Service Type
.... 6.287 Site Eligibility
.... 6.288 Sub Site
.... 6.289 Task Codes
.... 6.290 Task Input Type
.... 6.291 Task Output Type
.... 6.292 Task Reason
.... 6.293 Task Status Reason
.... 6.294 Temperature Absence Reason
.... 6.295 Triage Category
.... 6.296 V3 ActPriority
.... 6.297 Vision Billing
.... 6.298 Visit Reason
.... 6.299 Weight Absence Reason
.... 6.300 Work Related Diagnosis
.... 6.301 Adjudication Error
.... 6.302 Adjudication Outcome
.... 6.303 Adjudication Reason
.... 6.304 Admit Source
.... 6.305 Advanced Auth Reason
.... 6.306 Benefit Category
.... 6.307 Benefit Type
.... 6.308 Blood Pressure Absence Reason
.... 6.309 Body Site
.... 6.310 Cause of death
.... 6.311 Claim Information Category
.... 6.312 Claim response outcome
.... 6.313 Claim SubType
.... 6.314 Communication Reason
.... 6.315 Concept Properties
.... 6.316 Condition Onset
.... 6.317 Coverage Copay Type
.... 6.318 Coverage Financial Exception
.... 6.319 Coverage Type
.... 6.320 Diagnosis on Admission
.... 6.321 Diagnosis Type
.... 6.322 Discharge disposition
.... 6.323 Emergency Arrival Code
.... 6.324 Emergency Department Disposition
.... 6.325 FDI Oral Region
.... 6.326 Height Absence Reason
.... 6.327 Imaging
.... 6.328 InfoReason
.... 6.329 Intended Length Of Stay
.... 6.330 Investigation Result
.... 6.331 KSA Adjudication Codes
.... 6.332 KSA Administrative Gender
.... 6.333 KSA Message Events
.... 6.334 Laboratory
.... 6.335 Lens Type
.... 6.336 Medical Devices
.... 6.337 Medication Codes
.... 6.338 MetaTags
.... 6.339 Missing Tooth Reason Codes
.... 6.340 MOH Category
.... 6.341 Morphology Code
.... 6.342 Occupation
.... 6.343 Oral Health - In-patient
.... 6.344 Oral Health - Out-patient
.... 6.345 Organization Type
.... 6.346 Oxygen Saturation Absence Reason
.... 6.347 Patient Identifier Type
.... 6.348 Payment Method
.... 6.349 Pharmacist Selection Reason
.... 6.350 Pharmacist Substitute
.... 6.351 Practice Codes
.... 6.352 Procedures
.... 6.353 Provider Type
.... 6.354 Pulse Absence Reason
.... 6.355 Reissue Reason
.... 6.356 Related Claim Relationship
.... 6.357 Religion
.... 6.358 Respiratory Rate Absence Reason
.... 6.359 Route of Administration
.... 6.360 RTA Diagnosis
.... 6.361 Scientific Codes
.... 6.362 Service Event Type
.... 6.363 Service Type
.... 6.364 Services
.... 6.365 Site Eligibility
.... 6.366 Sub Site
.... 6.367 Surface Codes
.... 6.368 Task Code
.... 6.369 Task Input Type
.... 6.370 Task Output Type
.... 6.371 Task Reason Code
.... 6.372 Task Status Reason
.... 6.373 Temperature Absence Reason
.... 6.374 Transportation - SRCA
.... 6.375 Triage Category
.... 6.376 Visit Reason
.... 6.377 Weight Absence Reason
.... 6.378 Work Related Diagnosis
.... 6.379 Advanced Authorization example #1
.... 6.380 Advanced Authorization example #2
.... 6.381 Advanced Authorization example #3
.... 6.382 Authorization Communication Request #1
.... 6.383 Authorization Institutional Request #1
.... 6.384 Authorization Institutional Response #1
.... 6.385 Authorization Oral Request #1
.... 6.386 Authorization Oral Request #2
.... 6.387 Authorization Oral Response #1
.... 6.388 Authorization Pharmacy Request #1
.... 6.389 Authorization Professional Request #1
.... 6.390 Authorization Vision Request #1
.... 6.391 Claim Institutional Request #1
.... 6.392 Claim Institutional Response #1
.... 6.393 Claim Oral Request #1
.... 6.394 Claim Oral Request #2
.... 6.395 Claim Oral Response #1
.... 6.396 Claim Pharmacy Request #1
.... 6.397 Claim Professional Request #1
.... 6.398 Claim Vision Request #1
.... 6.399 Coverage Eligibility Request #1
.... 6.400 Coverage Eligibility Request #2
.... 6.401 Coverage Eligibility Request #3
.... 6.402 Coverage Eligibility Response #1
.... 6.403 Coverage Eligibility Response #2
.... 6.404 Coverage Eligibility Response #3
.... 6.405 Coverage for Patient #1
.... 6.406 Coverage for Patient #2
.... 6.407 Coverage for Patient #3
.... 6.408 Coverage for Patient #5
.... 6.409 Encounter #1
.... 6.410 Encounter #10
.... 6.411 Encounter #11
.... 6.412 Encounter #12
.... 6.413 Encounter #13
.... 6.414 Encounter #14
.... 6.415 Encounter #15
.... 6.416 Encounter #2
.... 6.417 Encounter #3
.... 6.418 Encounter #4
.... 6.419 Encounter #5
.... 6.420 Encounter #6
.... 6.421 Encounter #7
.... 6.422 Encounter #8
.... 6.423 Encounter #9
.... 6.424 Health Card Example - Coverage
.... 6.425 Health Card Example - Employer
.... 6.426 Health Card Example - Insurer
.... 6.427 Health Card Example - Patient
.... 6.428 Location #1
.... 6.429 Medication Request #1
.... 6.430 Message Header
.... 6.431 Message Header - Communication Request
.... 6.432 Message Header - Payment Notice
.... 6.433 Message Header - Payment Reconciliation
.... 6.434 Message Header Error Notice #1
.... 6.435 Message Header Request - Cancel #1
.... 6.436 Message Header Request - Communication
.... 6.437 Message Header Request - Cov Elig
.... 6.438 Message Header Request - Inst Auth
.... 6.439 Message Header Request - Inst Claim
.... 6.440 Message Header Request - Polling #1
.... 6.441 Message Header Request - Polling #2
.... 6.442 Message Header Request - Polling #3
.... 6.443 Message Header Request - Status #1
.... 6.444 Message Header Response - Acknowledgement #1
.... 6.445 Message Header Response - Cancel #1
.... 6.446 Message Header Response - Cov Elig
.... 6.447 Message Header Response - Inst Auth
.... 6.448 Message Header Response - Inst Claim
.... 6.449 Message Header Response - Poll #1
.... 6.450 Message Header Response - Status #1
.... 6.451 Message: Acknowledgement #1
.... 6.452 Message: Authorization Advanced Response #1
.... 6.453 Message: Authorization Institutional Request #1
.... 6.454 Message: Authorization Institutional Response #1
.... 6.455 Message: Cancel Request #1
.... 6.456 Message: Cancel Response #1
.... 6.457 Message: Claim Institutional Request #1
.... 6.458 Message: Claim Institutional Response #1
.... 6.459 Message: Coverage Eligibility #1 Request
.... 6.460 Message: Coverage Eligibility #1 Response
.... 6.461 Message: Error Notice #1
.... 6.462 Message: Payment Notice #1
.... 6.463 Message: Payment Reconciliation #1
.... 6.464 Message: Polling Request #1
.... 6.465 Message: Polling Request #2
.... 6.466 Message: Polling Request #3
.... 6.467 Message: Polling Response #1
.... 6.468 Message: Status Request #1
.... 6.469 Message: Status Response #1
.... 6.470 Message:Communication #1
.... 6.471 Message:Communication Request #1
.... 6.472 Nphies Cancel Request #1
.... 6.473 Nphies Cancel Response #1
.... 6.474 Nphies Communication #1
.... 6.475 Nphies Status Request
.... 6.476 Nphies Status Response
.... 6.477 Operation Outcome #1
.... 6.478 Organization NPHIES
.... 6.479 Patient #1
.... 6.480 Patient #2
.... 6.481 Patient #3
.... 6.482 Patient #4
.... 6.483 Patient #5
.... 6.484 Payer Organization #1
.... 6.485 Payment Notice Example
.... 6.486 Payment Reconciliation Example
.... 6.487 Policy Holder Organization #1
.... 6.488 Poll Request #1
.... 6.489 Poll Request #2
.... 6.490 Poll Request #3
.... 6.491 Poll Response #1
.... 6.492 Practitioner #1
.... 6.493 Practitioner #2
.... 6.494 Practitioner #3
.... 6.495 Practitioner #4
.... 6.496 Professional Authorization Response #1
.... 6.497 Provider Organization #1
.... 6.498 Provider Organization #2
.... 6.499 Provider Organization #3
.... 6.500 Provider Organization #4
.... 6.501 Provider Organization #5
.... 6.502 Provider Organization #6
.... 6.503 VisionPrescription #1
... 7 Roadmap
... 8 Support