{
  "description": "CapabilityStatement for [Claims Requestor Actor](volume-1.html#claims-manager).\\n\\nThe Claims Manager processes claims requests from the Claims Requestor.  It follows internal business processes to create the claim that are beyond the scope of this profile.  It also responds to claim tracking requests to return the status of the requested claim.",
  "_filename": "CapabilityStatement-IHE.FAIS.ClaimsManager.json",
  "package_name": "ihe.iti.fais",
  "format": [ "application/fhir+xml", "application/fhir+json" ],
  "date": "2024-07-17",
  "publisher": "IHE IT Infrastructure Technical Committee",
  "fhirVersion": "4.0.1",
  "jurisdiction": [ {
    "coding": [ {
      "code": "001",
      "system": "http://unstats.un.org/unsd/methods/m49/m49.htm"
    } ]
  } ],
  "name": "IHE_FAIS_ClaimsManager",
  "type": null,
  "experimental": "false",
  "resourceType": "CapabilityStatement",
  "title": "IHE FAIS Claims Manager",
  "package_version": "1.0.0-comment",
  "status": "active",
  "id": "4649eced-68a8-4f9b-92cd-8450e0e0c58e",
  "kind": "requirements",
  "url": "https://profiles.ihe.net/ITI/FAIS/CapabilityStatement/IHE.FAIS.ClaimsManager",
  "version": "1.0.0-comment",
  "contact": [ {
    "telecom": [ {
      "value": "https://www.ihe.net/ihe_domains/it_infrastructure/",
      "system": "url"
    } ]
  }, {
    "telecom": [ {
      "value": "iti@ihe.net",
      "system": "email"
    } ]
  }, {
    "name": "IHE IT Infrastructure Technical Committee",
    "telecom": [ {
      "value": "iti@ihe.net",
      "system": "email"
    } ]
  } ],
  "rest": [ {
    "mode": "server",
    "resource": [ {
      "type": "CoverageEligibilityRequest",
      "operation": [ {
        "name": "submit",
        "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.CoverageEligibilityRequest.Submit",
        "documentation": "Submits a coverage eligibility request to check the coverage of a beneficiary.  FAIS Check Coverage Eligibility transaction [[ITI-YY4]](ITI-YY4.html)."
      } ],
      "documentation": "FAIS Check Coverage Eligibility transaction [[ITI-YY4]](ITI-YY4.html)",
      "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityRequest" ]
    }, {
      "type": "CoverageEligibilityResponse",
      "interaction": [ {
        "code": "read",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ]
      }, {
        "code": "search-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ]
      } ],
      "searchParam": [ {
        "name": "_lastUpdated",
        "type": "date",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "When the resource version last changed.  The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb."
      }, {
        "name": "_id",
        "type": "token",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "Logical id of this artifact"
      }, {
        "name": "status",
        "type": "token",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "The status of the response"
      }, {
        "name": "request",
        "type": "reference",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "The coverage eligiblity request"
      }, {
        "name": "patient",
        "type": "reference",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "The beneficiary"
      } ],
      "documentation": "FAIS Check Coverage Eligibility Status transaction [[ITI-YY7]](ITI-YY7.html)",
      "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse" ]
    }, {
      "type": "Claim",
      "operation": [ {
        "name": "submit",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Submit",
        "documentation": "Submits a claim.  FAIS Submit Claim transaction [[ITI-YY5]](ITI-YY5.html)."
      }, {
        "name": "cancel",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Cancel",
        "documentation": "Cancels a claim.  FAIS Cancel Claim transaction [[ITI-YY8]](ITI-YY8.html)."
      }, {
        "name": "reprocess",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "definition": "https://profiles.ihe.net/ITI/FAIS/OperationDefinition/IHE.FAIS.Claim.Reprocess",
        "documentation": "Re-processes a claim.  FAIS Re-process Claim transaction [[ITI-YY9]](ITI-YY9.html)."
      } ],
      "documentation": "Supports these transactions:\n* [Submit Claim [ITI-YY5]](ITI-YY5.html)\n* [Cancel Claim [ITI-YY8]](ITI-YY8.html)\n* [Re-process Claim [ITI-YY9]](ITI-YY9.html)",
      "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim" ]
    }, {
      "type": "ClaimResponse",
      "interaction": [ {
        "code": "read",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ]
      }, {
        "code": "search-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ]
      } ],
      "searchParam": [ {
        "name": "_lastUpdated",
        "type": "date",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "When the resource version last changed.  The values for this shall support these prefixes: gt, lt, ge, le, sa, and eb."
      }, {
        "name": "_id",
        "type": "token",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "Logical id of this artifact"
      }, {
        "name": "status",
        "type": "token",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "The status of the response"
      }, {
        "name": "request",
        "type": "reference",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "The coverage eligiblity request"
      }, {
        "name": "patient",
        "type": "reference",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
          "valueCode": "SHALL"
        } ],
        "documentation": "The beneficiary"
      } ],
      "documentation": "FAIS Track Claim transaction [[ITI-YY6]](ITI-YY6.html)",
      "supportedProfile": [ "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse" ]
    } ],
    "security": {
      "description": "Recommend [ATNA](https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html), encouraged [IHE-IUA](https://profiles.ihe.net/ITI/IUA/index.html) or [SMART-app-launch](http://www.hl7.org/fhir/smart-app-launch/)"
    },
    "interaction": [ {
      "code": "search-system",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation",
        "valueCode": "SHALL"
      } ]
    } ],
    "documentation": "FAIS Claims Manager rovides capability to receive claim submissions and respond to queries for claim responses."
  } ]
}