Finance and Insurance Services

[JohnMoehrke]

Due to a lack of interoperability between Point of Service (PoS) systems of health care providers (e.g. Hospital Information Systems) and information systems of health care payers (e.g. Health Financing and Insurance System) there is a lack of automated payment processes for health services.

A PoS needs to communicate at several stages of the health care process with the payer of the service: a) to verify that occurred costs are covered for a patient (and to which extent) and b) claim the incurred costs for a delivered health care service from the payer. Depending on the number of patient visits and the nature of the coverage, this can create high data volumes at all process stages, e.g Nepal ca. 20 thousand hospital claims to the national health insurance per day. Manual entry and transfer of data results in costs for duplicated data entry and errors.

[JohnMoehrke]

https://github.com/IHE/IT-Infrastructure/blob/master/Proposals/2022-11-10.IHE_Profile_Proposal_FIS-Brief.DOCX

[JohnMoehrke]

Discussed ITI-Planning November 15, 2022

Recognized lack of experts in ITI on finance and insurance use-cases and solutions.

Actions: John

• Need to outreach to find more that might be interested. Use existing mailing lists,
• create a new topic-specific-mailing list to gather these interested parties.
• reach out to HL7 Finance workgroup, and their projects

[lukeaduncan]

https://guides.ohie.org/arch-spec/introduction/openhie-finance-and-insurance-services-workflows