Experience FHIR®

Experience FHIR®

Easily test and implement FHIR® APIs. Accelerate your interoperability journey.

FHIR®, or Fast Healthcare Interoperability Resources, provides a lightweight REST-based access layer for standard HL7-defined data models. If you're looking for more than specs, get in touch with us our FHIR® experts for implementation support.

  • Patient
  • Claim Response
  • Cost Sharing
  • Coverage
  • Encounter
  • Care Gaps
  • Allergy Intolerance
  • Medical Administration

Patient

The FHIR® Patient Resource defines demographic and administrative information of patients receiving care at a healthcare organization. It acts as a starting point for multiple client application workflows. Workflows often begin with patient query and selection, and the server ID runs additional queries for diagnostic and care-related information.

The Patient Resource contains data elements such as patient name, business identifiers (e.g. member ID), date of birth, and address. The read interaction accesses Patient Resource by a constant server ID. The read interaction allows client to store the server ID and retrieve latest patient demographics with a single request.

Claim Response

The Claim Response API summarizes where a claim stands within a payer’s adjudication cycle along with details of services received. It delivers results of claim adjudication submitted by provider / member for a set of products and services provided / received against the patient's insurance cover, for which payment is intended to be made.

It contains information about products and services received and adjudicated amount. Details include claim, encounter, coverage, patient, practitioner and organization resources to retrieve information on submitted claim, insurance coverage, visit-related information, products and services received, and billing provider information.

The API’s search interaction enables the client to look for latest submitted claim status. The client, having established the patient in question, now wishes to retrieve the details of member's latest claim status. CitiusTech’s sandbox supports search based on business identifiers of claims and members.

Cost Sharing

The Cost Sharing API enables member to access their current out-of-pocket and deductible information for a coverage period. It provides cost sharing (copay, co-insurance, deductible) information, and total amount paid for each cost sharing mechanism in the request coverage period.

It contains explanation of benefit, coverage, organization and patient FHIR® resources to retrieve member’s current out-of-pocket and deductible Information along with benefits availed, insurance coverage health plan details.

The search interaction enables the client to query for cost sharing details for a given member. The client, having established the patient in question, now wishes to retrieve the details of member's cost sharing information. CitiusTech’s sandbox supports search based on business identifier of member.

Coverage

The Coverage API provides broad identifiers and descriptors of an insurance plan (information on an insurance card) which may be used to pay, in part or in whole, for the provision of health care products and services.

Coverage API also shares information on whether an individual or organization besides the insurer is responsible for part payment of the health care costs. It contains coverage, organization and patient FHIR® resources to retrieve member’s existing benefits provided by health plan.

The search interaction enables the client to query for broad health plan benefits for a given member. The client, having established the patient in question, now wishes to retrieve the details of member's insurance coverage details. CitiusTech sandbox supports search based on business identifier of member.

Encounter

Member’s Encounter details with capitated providers OR Encounter API retrieves list of interactions between a patient and healthcare providers for the purpose of providing healthcare services or assessing the health status of a patient. it encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters).

Encounter API contains encounter, practitioner, organization, condition, procedure, episode-of-care resources for retrieving visit-related information such name of provider, diagnosis associated with encounter and services provided.

The search interaction enables the client to query for list of encounters for a given member. The client, having established the patient in question, now wishes to retrieve the list of encounters. Currently CitiusTech’s sandbox supports search based on business identifier of member.

Care Gaps

Care Gap API allows sharing lists of open care-gaps of members with attributed providers responsible for closing the gaps to ensure NCQA compliance. It retrieves information on open gaps-in-care along with impacted HEDIS hybrid measures.

The API contains measure report, measure composition, practitioner, organization, and patient FHIR® resources for retrieving open care-gaps related information such as name of open care-gap, gap expiry date and associated impacted HEDIS measure.

The search interaction enables the client to query for list of open care gaps for a given member. The client, having established the patient in question, now wishes to retrieve the list of open care gaps. Currently CitiusTech’s sandbox supports search based on business identifier of member.

Allergy Intolerance

The Allergy Intolerance API retrieves clinical information about a patient's allergic response to a substance. The Allergy Intolerance resource defines the substance that elicited the response, as well as when the reaction occurred, severity, and the type of reaction.

The API contains Allergy Intolerance and patient FHIR® resources for retrieving list of allergies information or evidence around a reaction event characterized by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure to the identified substance or class of substances.

The search interaction enables the client to query for all allergies associated with a given patient's medical history. The client, having established the patient in question, now wishes to retrieve the list of that patient's allergies. Currently CitiusTech’s sandbox supports search based patient identifiers.

Medical Administration

The Medication Administration API notifies drug intake to track the member’s medication adherence. This API retrieves data of list of self-administered drugs by the member along with intake status.

Medication Administration API contains encounter and patient FHIR® resources for retrieving list of medications and evidences around medication intake status.

The search interaction enables the client to query for medications and status of intake associated with a given patient. The client, having established the patient in question, now wishes to retrieve the list of that patient's medication and their intake status. Currently CitiusTech’s sandbox supports search based on business identifier of patient.

 
 
  • Support
    If you're looking for more than specs, get in touch with us our FHIR® experts for implementation support.
 
 

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