Stream: implementers
Topic: Mode of transmission for FHIR "claim" implementation
raj (May 05 2020 at 14:37):
We are planning to use the FHIR "Claim" resource model for one of our projects and have a query regarding the mode of transmission.
Ours is an insurance company and the FHIR data would be sent to us from Health care facilities and providers.
Would like to know what mode of transmission is generally used in industry:
-
Bulk Export from Provider to our company via API. There would be a batch process at provider end which would transmit this data once per day and we will receive it via API
2.Provider would send every case via API in real time. We will have a service that listens to this API and pull the data. -
Provider would send the data via API to a shared/FTP path. We will have a service that pulls the data from this folder for further processing.
Also, would like to confirm that we will be receiving data from multiple facilities and therefore, wondering if anyone has implemented with any specific architecture .
Any inputs are helpful. Thanks!
Lloyd McKenzie (May 05 2020 at 15:26):
I'm not sure that FHIR claim submission is a standard mode anywhere right now, though the answer would definitely vary by country. Where are you based?
raj (May 05 2020 at 17:44):
@Lloyd McKenzie
I am using the below latest resource
https://www.hl7.org/fhir/claim.html
This has the data model which is closest to Health care facility and provider's Invoices that we currently receive in non-standard format. We are trying to digitize the receipt of Invoices by using this model . It seems this Claim resource model is also being used for UB04 template which I found from https://confluence.hl7.org/display/FM/Documentation
Am I missing anything when you say Claim resource is not being used anymore since I can access the latest version from FHIR?
This is for US based company.
Lloyd McKenzie (May 05 2020 at 17:47):
It's not that it's not being used "anymore", it's that it's not necessarily being used very much yet - and in the U.S. it's unlikely to get used at all due to regulatory issues which mandate that the vast bulk of claims in the U.S. are submitted using X12 and NCPDP. Even if implementers might prefer to move to FHIR for claims submission, they can't. There's some work to allow the use of FHIR Claim for prior authorization in the U.S., though even then there's an expectation that X12 would be in the middle somewhere. (Do a search for Da Vinci Prior Authorization Support.)
Last updated: Apr 12 2022 at 19:14 UTC
