Dear Implementor,
To support the vision of Pradhan Mantri Jan Arogya Yojana (PMJAY), NHA has created a standardized health claim platform based on the Health Claim Exchange Specification (HCX) to enable automation of the health claim-related information exchange between payers, providers, beneficiaries, and other relevant entities. The specification provides an interoperable, machine-readable, auditable, verifiable, and open standard-based structure protocol for communication between the entities.
The FHIR Implementation Guide for ABDM has been updated to support HCX specifications. The preview of the IG is hosted at - https://www.nrces.in/preview/ndhm/fhir/r4/hcx-profile.html For HCX, a new record named ‘InsuranceRecord’ and related profiles and value sets have been introduced under the section HCX profiles. Following is major the change log including other additional updates to the Implementation Guide:
Health Claim Exchange Support
- New Menu/Tab for HCX Profiles
- New record type InsuranceRecord (Same as other HI Types).
- Profiling of Insurance related resources: {Claim, ClaimResponse, CoverageEligibilityRequest, CoverageEligibilityResponse, PaymentNotice, PaymentReconciliation}
- Code System introduced to cover PMJAY use cases {PMJAY-Modifier, PMJAY Benefit Category, PMJAY-ProductorService, PMJAY-ProgramCode, PMJAY-Procedure, PMJAY-ProcedureType, PMJAY-SupportingInfoCategory}
- Value sets added: {PMJAY-BenefitCategory-2022, PMJAY-ProductorService-2022, PMJAY-ProgramCode-2022, PMJAY-Modifier-2022, PMJAY-Procedure-2022, PMJAY-ProcedureType-2022, PMJAY-Category-2022, ProductOrService, BenefitCategory}
History Template introduce to support previous IG versions
Immunization Record
- Addition of BrandName extension as MUST SUPPORT as per WHO Digital Documentation of COVID-19 Certificates (DDCC)
- Made Location and protocolApplied.doseNumber[x] elements MUST SUPPORT
- Removed fixed value of vaccineCode.coding.system element and changed the type of Value Set binding to Preferred
- Added examples Bundle-ImmunizationRecord-for-WHO-DDCC and Immunization-example-WHO-DDCC
OPConsultRecord
- Introduced the OtherObservation Section to enable recording other supporting observations in the national programs like RCH, NCD, etc.
Please review/test these changes and do share your inputs/feedback/concerns/comments to the below email ids before August 12, 2022:
nrc-help@cdac.in / integration.support@nha.gov.in
Based on the inputs/comments the updated IG will be finally published for production use.
Regards,
Manisha