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

Information Submission

Overview

This use case enables Healthcare Providers (HCPs) to both respond to a previously received Communication Request from the Health Insurance Company (HIC) by providing the necessary supporting information or to proactively share additional informations with provider. This may include documents such as radiology reports, laboratory results, prescriptions, or any other relevant attachments or comments.

Workflow

1. Provider sends an Information Submission Message to the nphies system.
2. nphies validates the message and if valid proceeds to Step 3 otherwise proceeds to Step 6.
3. nphies forwards the Information Submission Message to the designated insurer or Third Pary Administrator (TPA).
4. In real time the insurer or TPA validates the message and returns an Acknowledgement Message.
5. nphies validates the message and if valid proceeds to Step 6 otherwise a separate Error Notice Message is queued for the HIC or TPA.
6. nphies returns an Acknowledgement Message with business content or errors to the provider.

This is a REAL TIME and DEFERRED use case. In the event that nphies is not able to successfully deliver the Information Submission Message to the HIC within less than one minute then nphies will generate a response message, with a bundle.meta.tag to identify that the message has been stored for forwarding to the HIC issued by nphies, see Meta Tag: nphies-generated.

Message Structures

Information Submission Message

The key resources for the message are provided below and all require nphies-profiled resources as provided in the Artifacts. Note: the MessageHeader resource must be the first .entry in the bundle and any other resources may follow in any order.

Nphies Bundle (.type = message )
  Nphies MessageHeader (.eventCoding = communication)
  Nphies Communication
  Nphies Patient
  Nphies Organization (Provider)
  Nphies Organization (Insurer)
  [Nphies Location]
  [any additional resources]

Acknowledgement Message

See Acknowledgement Message.

Guidance

• Solicited attachements: When submitting additional information in response to an Information Request, a CommunicationRequest, the identifier of the Information Request SHALL be provided in the Communication.about.

• Unsolicited attachements: When submitting additional information proactively to support a financial transaction such as a claim or authorization request, the identifier of the request SHALL be provided in the Communication.about.

Full Message Examples

See also: Information Guides.

Key Extensions

None to report.

Error Handling

If nphies detects errors in the request message such that the request cannot be processed then the response message will contain an OperationOutcome resource rather than a business-level Status Response resource. Otherwise if nphies detects errors within the request it will return a Status Response with errors (Task.output.type = 'error') and an extension indicating where the error occurred.

Like all other response messages the provider receives from nphies, if there are other messages queued at nphies which have not been delivered to the provider then this will be reflected in the presence of a MessageHeader.meta.tag.