HL7 FHIR Data Migration for Payers

The majority of the X12-05010 HIPAA messages are Request/Response.
The HL7 FHIR Financial Resources that provide the same results, are also Request/Response.

One example is the HIPPA 270/271 and the HL7 FHIR CoverageEligibilityRequest and CoverageEligibilityResponse


If your FHIR Server received anCoverageEligibilityRequest, it would be rejected if any of the Resources that have reference values do not exist.


The following is a sample CoverageEligibilityRequest

The following is the order in which the Resources must be created and saved to the HL7 FHIR Server Repository in order to to validate the above sample.

  1. InsurancePlan resources are created.
  2. Practitioner resources are created.
  3. Insurer resources are created.
  4. Organization resources are created for each Practitioner
  5. Subscriber resources are created for both primary and dependent.
  6. Patient resources are created for each person.
  7. Location resources are created for each Patient and Organization
  8. Patient resources are enrolled using an EnrollmentRequest resource.
  9. Coverage resources are created using the EnrollmentRequest resource.

In addition, each of the above resources have dependencies

You would not be able to return the CoverageEligibilityResponse until you have mapped the required data to the required FHIR Resources

Most of the HIPPA messages are Request Response. Upon receipt of the HIPPA message, you would get a 201 status code. The CoverageEligibilityResponse would need to be manually created. Since the FHIR server does not support sending a message without a trigger, it would need to be created manually. The Requester would need to create a Subscription Resource. This can be handled by an API application. The application could post the CoverageEligibilityResponse to the FHIR Server and also Post it to the Requester

Summary

  • Every FHIR REST operation meessage that contains an identifier, i.e. Organization/6585, requires that the Resources exist in the FHIR Repositiry. Otherwise, it will be rejected.
  • The key to doing a data migration is understaning how the FHIR Resources relate to each other.
  • This is a fairly simple sample. If you are planning on implementing FHIR, then you will need to take the Training sessions or hire an SME to handle the migration.
  • If you have any questions, please do not hesitate to contact me.
Last modified: February 24, 2020

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