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

Status

Overview

When a provider has not received a final business response for a business request for an unusually long time, the provider may send a Status Request to the insurer or TPA via nphies. The insurer or TPA will return the processing status of indicated target request in a Status Response.

Workflow

1. Provider sends a Status Request Message to the nphies system.
   • nphies validates the request and, if valid, proceeds to Step 2. Otherwise, it generates an error response.
2. nphies forwards the request to the designated insurer or TPA.
   • The insurer or TPA processes the request and returns a Status Response Message.
3. nphies validates the response and, if valid, proceeds to Step 4; otherwise, an Error Notice Message is generated.
4. nphies returns the Status Response Message with the procesing status code, or errors, to the provider.

This is a REAL TIME use case. In addition to returning the requested status or errors, nphies will provide the Meta Tag: queued-messages should any messages remain in the queue. Note that Status messages are not themselves queued, if nphies is unable to deliver the Status Request then an immediate error is return to the provider and if a Status Response cannot be delivered to the provider it is logged but not queued for latter return to the provider.

Message Structures

Status Request 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 = status-check)
  Nphies Task (.code.coding.code = status)
  Nphies Organization (Provider)
  Nphies Organization (Insurer)

Status Response 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 = status-response)
  Nphies Task (.code.coding.code = status)
  Nphies Organization (Provider)
  Nphies Organization (Insurer)

Guidance

A Status Request uses a Task resource to provide the parameter of the request message for which the processing status is requested in the Task.focus.identifier element. The response to such a request is a Status Response which is also a Task resource providing the processing status (Task.output.type = ‘status’) of the requested message in the Task.output.valueCodeableConcept element or errors (Task.output.type = ‘error’) in the response message.

Full Message Examples

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.