FHIR’s financial module encapsulates everything to do with paying for your healthcare.
If you work in this area, you need to understand how FHIR stores this data. You need to understand the 13 resources that make up FHIR’s module.
I’ve listed them out of order. Start with these:
– Claim
– Coverage
– CoverageEligibilityRequest
– ExplanationOfBenefit
– PaymentNotice
Then these:
– ClaimReponse
– CoverageEligibilityResponse
– Account
And finally these:
– Contract
– EnrollmentRequest
– EnrollmentResponse
– PaymentReconcilliation
– VisionPrescription
The financial module comes with a fantastic glossary of terms. Something I’d like to see more of in the FHIR documentation: https://hl7.org/fhir/R4/financial-module.html#fingloss
And a “common use case” area which connects real-world business activities to their respective FHIR resources: https://hl7.org/fhir/R4/financial-module.html#uses
Best of all, it has a “relative order of use” section that lists the flow of events that occur in real life and how that flow maps to individual FHIR resources: https://hl7.org/fhir/R4/financial-module.html#order
The module is a great resource to get you started if you’re building an app or a solution that deals with payments and claims.
More info: https://hl7.org/fhir/R4/financial-module.html
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