Health Cloud Financial System API - Implementation Template
Field mappings
MemberPlan
See src/main/resources/dw/CoverageEligibilityResponseLib.dwl for a mapping example.
| FHIR Field | Field | Notes |
|---|---|---|
| status | Status | |
| servicedPeriod.start or servicedDate | EffectiveFrom | |
| servicedPeriod.end | EffectiveTo | |
| insurance[x].subscriber | Subscriber | |
| insurance[x].payor[x] | Payer | |
| requestor | PrimaryCarePhysician | |
| identifier.value | SourceSystemIdentifier | |
| identifier.system | SourceSystem |
CoverageBenefit
See src/main/resources/dw/CoverageEligibilityResponseLib.dwl for a mapping example.
| FHIR Field | Field | Notes |
|---|---|---|
| item.category[x].coding[x].code | CoverageType | |
| insurance[x].item[x].benefit[x].allowedMoney.value | IndividualInNetworkDeductibleLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | IndividualInNetworkDeductibleApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | IndividualInNetworkDeductibleRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | IndividualOutofNetworkDeductibleLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | IndividualOutofNetworkDeductibleApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | IndividualOutofNetworkDeductibleRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | FamilyInNetworkDeductibleLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | FamilyInNetworkDeductibleApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | FamilyInNetworkDeductibleRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | FamilyOutofNetworkDeductibleLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | FamilyOutofNetworkDeductibleApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | FamilyOutofNetworkDeductibleRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | IndividualInNetworkOutofPocketLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | IndividualInNetworkOutofPocketApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | IndividualInNetworkOutofPocketRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | IndividualOutofNetworkOutofPocketLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | IndividualOutofNetworkOutofPocketApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | IndividualOutofNetworkOutofPocketRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | FamilyInNetworkOutofPocketLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | FamilyInNetworkOutofPocketApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | FamilyInNetworkOutofPocketRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | FamilyOutofNetworkOutofPocketLimit | |
| insurance[x].item[x].benefit[x].usedMoney.value | FamilyOutofNetworkOutofPocketApplied | |
| insurance[x].item[x].benefit[x].allowedMoney.value - insurance[x].item[x].benefit[x].usedMoney.value | FamilyOutofNetworkOutofPocketRemaining | |
| insurance[x].item[x].benefit[x].allowedMoney.value | InNetworkLifetimeMaximum | |
| insurance[x].item[x].benefit[x].allowedMoney.value | OutofNetworkLifetimeMaximum | |
| insurance[x].item[x].benefit[x].allowedUnsignedInt | InNetworkCoinsurancePercentage | |
| insurance[x].item[x].benefit[x].allowedUnsignedInt | OutofNetworkCoinsurancePercentage |