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1a. Project Name

KSA Healthcare Financial Services Implementation Guide PSS

1b. Project ID

1635

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?

No

1e. Today's Date

1f. Name of standard being reaffirmed

1g. Project Artifact Information

1h. ISO/IEC Standard to Adopt

1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption?

1j. Unit of Measure

2a. Primary/Sponsor WG

Financial Management

2d. Project Facilitator

Paul Knapp

2e. Other Interested Parties (and roles)

2f. Modeling Facilitator

Paul Knapp

2g. Publishing Facilitator

Paul Knapp

2h. Vocabulary Facilitator

2i. Domain Expert Representative

Paul Knapp, Benoit Schoeffler

2j. Business Requirements Analyst

2k. Conformance Facilitator

Paul Knapp

2l. Other Facilitators

2m. Implementers

All private healthcare insurers in KSA: (eg BUPA, Al Rajhi)
All private healthcare providers in KSA:

3a. Project Scope

The Kingdom of Saudi Arabia has two complimentary healthcare systems: a private system which covers expatriates and Saudi citizens working in private industry, and a public system which covers all other Saudi citizens. This project will address the private market to support the eligibility checking, prior authorization, claims and other supporting information exchanges to standardize the these information exchanges for the approximately 28 payors and 5000+ private provider organizations serving the 12+ million beneficiaries in the private market. In the future the public system covering another 20+ million beneficiaries is expected to adopt these standards.
The project goals and general approach was presented at the May 2015 WGM in Paris under the project name: Saudi Health Insurance Bus (SHIB).
Testing/reference implementation(s) are being used to both test the standards and to allow implementers to test their solutions.

Attachments

3b. Project Need

Currently eClaims information is exchanged on paper and proprietary electronic formats and does not use standardized terminology. These standards are needed to modernize and provide an efficient interoperable framework for eClaims exchanges.
A clearinghouse, currently named the Uniplat, is being established as the central connection point for all providers and payors, and will servce to validate and store and forward eClaims information exchanges.
This Implementation Guide is being developed under the Financial Management Work Group to allow for balloting within a larger community for this initial Saudi FHIR implementation Guide.
Given the overall project timelines, this implementation guide is being developed in parallel with the actual implementation. In lieu of a second Connectathon the concepts of this implementation guide are being conducted in a pilot implementation in Saudi Arabia in the late fall, prior to submission of the guide for ballot.

3c. Security Risk

No

3d. External Drivers

The Saudi Council for Cooperative Health Insurance (CCHI) project operated by Sehati for Health Information Services.

3e. Objectives/Deliverables and Target Dates

September 2020 WGM: FHIR Connectathon
November 2020: Project Pilot (in lieu of 2nd connectathon)
January 2021 Ballot: STU Ballot
April/May 2021: STU Publication

3f. Common Names / Keywords / Aliases:

Uniplat Financial Services, SHIB

3g. Lineage

3h. Project Dependencies

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/FM/KSA+Healthcare+Financial+Services+Implementation+Guide

3j. Backwards Compatibility

No

3k. Additional Backwards Compatibility Information (if applicable)

3l. Using Current V3 Data Types?

N/A

3l. Reason for not using current V3 data types?

3m. External Vocabularies

Yes

3n. List of Vocabularies

ICD10-AM/ACHI/AR-DRG, SNOMED, SFDA drugs and devices, FDI-tooth codes and surfaces, ICF (WHO for functional assessments), URG, various billing codes.

3o. Earliest prior release and/or version to which the compatibility applies

4a. Products

FHIR Extensions, FHIR Implementation Guide, FHIR Profiles

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

FHIR R4

4c. FHIR Profiles Version

4d. Please define your New Product Definition

4d. Please define your New Product Family

5a. Project Intent

Implementation Guide (IG) will be created/modified

5a. White Paper Type

5a. Is the project adopting/endorsing an externally developed IG?

No

5a. Externally developed IG is to be (select one)

5a. Specify external organization

5a. Revising Current Standard Info

5b. Project Ballot Type

STU to Normative

5c. Additional Ballot Info

5d. Joint Copyright

No

5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval.

no

6a. External Project Collaboration

Council for Cooperative Health Insurance (KSA)

6b. Content Already Developed

5

6c. Content externally developed?

No

6d. List Developers of Externally Developed Content

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Payors

6f. Other Stakeholders

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Lab, HIS

6g. Other Vendors

6h. Providers

Emergency Services, Medical Imaging Service, Healthcare Institutions (hospitals, long term care, home care, mental health)

6h. Other Providers

6i. Realm

Other HL7 Affiliate Specific

7d. US Realm Approval Date

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Jun 02, 2020

7c. Co-Sponsor Approval Date

7c. Co-Sponsor 2 Approval Date

7c. Co-Sponsor 3 Approval Date

7c. Co-Sponsor 4 Approval Date

7c. Co-Sponsor 5 Approval Date

7c. Co-Sponsor 6 Approval Date

7c. Co-Sponsor 7 Approval Date

7c. Co-Sponsor 8 Approval Date

7c. Co-Sponsor 9 Approval Date

7c. Co-Sponsor 10 Approval Date

7e. CDA MG Approval Date

7f. FMG Approval Date

7g. V2 MG Approval Date

7h. Architecture Review Board Approval Date

7i. Steering Division Approval Date

7j. TSC Approval Date



 Show Changes

Version

4

Modifier

Dave Hamill

Modify Date

Jun 24, 2020 21:49

1a. Project Name

KSA Healthcare Financial Services Implementation Guide PSS

1b. Project ID

1635

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Financial Management

2d. Project Facilitator

Paul Knapp

2f. Modeling Facilitator

Paul Knapp

2g. Publishing Facilitator

Paul Knapp

2i. Domain Expert Representative

Paul Knapp, Benoit Schoeffler

2k. Conformance Facilitator

Paul Knapp

2m. Implementers

All private healthcare insurers in KSA: (eg BUPA, Al Rajhi)
All private healthcare providers in KSA:

3a. Project Scope

The Kingdom of Saudi Arabia has two complimentary healthcare systems: a private system which covers expatriates and Saudi citizens working in private industry, and a public system which covers all other Saudi citizens. This project will address the private market to support the eligibility checking, prior authorization, claims and other supporting information exchanges to standardize the these information exchanges for the approximately 28 payors and 5000+ private provider organizations serving the 12+ million beneficiaries in the private market. In the future the public system covering another 20+ million beneficiaries is expected to adopt these standards.
The project goals and general approach was presented at the May 2015 WGM in Paris under the project name: Saudi Health Insurance Bus (SHIB).
Testing/reference implementation(s) are being used to both test the standards and to allow implementers to test their solutions.

3b. Project Need

Currently eClaims information is exchanged on paper and proprietary electronic formats and does not use standardized terminology. These standards are needed to modernize and provide an efficient interoperable framework for eClaims exchanges.
A clearinghouse, currently named the Uniplat, is being established as the central connection point for all providers and payors, and will servce to validate and store and forward eClaims information exchanges.
This Implementation Guide is being developed under the Financial Management Work Group to allow for balloting within a larger community for this initial Saudi FHIR implementation Guide.
Given the overall project timelines, this implementation guide is being developed in parallel with the actual implementation. In lieu of a second Connectathon the concepts of this implementation guide are being conducted in a pilot implementation in Saudi Arabia in the late fall, prior to submission of the guide for ballot.

3c. Security Risk

No

3d. External Drivers

The Saudi Council for Cooperative Health Insurance (CCHI) project operated by Sehati for Health Information Services.

3e. Objectives/Deliverables and Target Dates

September 2020 WGM: FHIR Connectathon
November 2020: Project Pilot (in lieu of 2nd connectathon)
January 2021 Ballot: STU Ballot
April/May 2021: STU Publication

3f. Common Names / Keywords / Aliases:

Uniplat Financial Services, SHIB

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/FM/KSA+Healthcare+Financial+Services+Implementation+Guide

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

Yes

3n. List of Vocabularies

ICD10-AM/ACHI/AR-DRG, SNOMED, SFDA drugs and devices, FDI-tooth codes and surfaces, ICF (WHO for functional assessments), URG, various billing codes.

4a. Products

FHIR Extensions, FHIR Implementation Guide, FHIR Profiles

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

FHIR R4

5a. Project Intent

Implementation Guide (IG) will be created/modified

5a. Is the project adopting/endorsing an externally developed IG?

No

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

Council for Cooperative Health Insurance (KSA)

6b. Content Already Developed

5

6c. Content externally developed?

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Lab, HIS

6h. Providers

Emergency Services, Medical Imaging Service, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

Other HL7 Affiliate Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Jun 02, 2020

Version

3

Modifier

Paul Knapp

Modify Date

Jun 02, 2020 16:44

1a. Project Name

KSA Healthcare Financial Services Implementation Guide PSS

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Financial Management

2d. Project Facilitator

Paul Knapp

2f. Modeling Facilitator

Paul Knapp

2g. Publishing Facilitator

Paul Knapp

2i. Domain Expert Representative

Paul Knapp, Benoit Schoeffler

2k. Conformance Facilitator

Paul Knapp

2m. Implementers

All private healthcare insurers in KSA: (eg BUPA, Al Rajhi)
All private healthcare providers in KSA:

3a. Project Scope

The Kingdom of Saudi Arabia has two complimentary healthcare systems: a private system which covers expatriates and Saudi citizens working in private industry, and a public system which covers all other Saudi citizens. This project will address the private market to support the eligibility checking, prior authorization, claims and other supporting information exchanges to standardize the these information exchanges for the approximately 28 payors and 5000+ private provider organizations serving the 12+ million beneficiaries in the private market. In the future the public system covering another 20+ million beneficiaries is expected to adopt these standards.
The project goals and general approach was presented at the May 2015 WGM in Paris under the project name: Saudi Health Insurance Bus (SHIB).
Testing/reference implementation(s) are being used to both test the standards and to allow implementers to test their solutions.

3b. Project Need

Currently eClaims information is exchanged on paper and proprietary electronic formats and does not use standardized terminology. These standards are needed to modernize and provide an efficient interoperable framework for eClaims exchanges.
A clearinghouse, currently named the Uniplat, is being established as the central connection point for all providers and payors, and will servce to validate and store and forward eClaims information exchanges.
This Implementation Guide is being developed under the Financial Management Work Group to allow for balloting within a larger community for this initial Saudi FHIR implementation Guide.
Given the overall project timelines, this implementation guide is being developed in parallel with the actual implementation. In lieu of a second Connectathon the concepts of this implementation guide are being conducted in a pilot implementation in Saudi Arabia in the late fall, prior to submission of the guide for ballot.

3c. Security Risk

No

3d. External Drivers

The Saudi Council for Cooperative Health Insurance (CCHI) project operated by Sehati for Health Information Services.

3e. Objectives/Deliverables and Target Dates

September 2020 WGM: FHIR Connectathon
November 2020: Project Pilot (in lieu of 2nd connectathon)
January 2021 Ballot: STU Ballot
April/May 2021: STU Publication

3f. Common Names / Keywords / Aliases:

Uniplat Financial Services, SHIB

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/FM/KSA+Healthcare+Financial+Services+Implementation+Guide

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

Yes

3n. List of Vocabularies

ICD10-AM/ACHI/AR-DRG, SNOMED, SFDA drugs and devices, FDI-tooth codes and surfaces, ICF (WHO for functional assessments), URG, various billing codes.

4a. Products

FHIR Extensions, FHIR Implementation Guide, FHIR Profiles

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

FHIR R4

5a. Project Intent

Implementation Guide (IG) will be created/modified

5a. Is the project adopting/endorsing an externally developed IG?

No

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

Council for Cooperative Health Insurance (KSA)

6b. Content Already Developed

5

6c. Content externally developed?

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Lab, HIS

6h. Providers

Emergency Services, Medical Imaging Service, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

Other HL7 Affiliate Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Jun 02, 2020

Version

2

Modifier

Paul Knapp

Modify Date

Jun 01, 2020 21:27

1a. Project Name

KSA Healthcare Financial Services Implementation Guide PSS

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Financial Management

2d. Project Facilitator

Paul Knapp

2f. Modeling Facilitator

Paul Knapp

2g. Publishing Facilitator

Paul Knapp

2i. Domain Expert Representative

Paul Knapp, Benoit Schoeffler

2k. Conformance Facilitator

Paul Knapp

2m. Implementers

All private healthcare insurers in KSA: (eg BUPA, Al Rajhi)
All private healthcare providers in KSA:

3a. Project Scope

The Kingdom of Saudi Arabia has two complimentary healthcare systems: a private system which covers expatriates and Saudi citizens working in private industry, and a public system which covers all other Saudi citizens. This project will address the private market to support the eligibility checking, prior authorization, claims and other supporting information exchanges to standardize the these information exchanges for the approximately 28 payors and 5000+ private provider organizations serving the 12+ million beneficiaries in the private market. In the future the public system covering another 20+ million beneficiaries is expected to adopt these standards.
The project goals and general approach was presented at the May 2015 WGM in Paris under the project name: Saudi Health Insurance Bus (SHIB).

3b. Project Need

Currently eClaims information is exchanged on paper and proprietary electronic formats and does not use standardized terminology. These standards are needed to modernize and provide an efficient interoperable framework for eClaims exchanges.
A clearinghouse, currently named the Uniplat, is being established as the central connection point for all providers and payors, and will servce to validate and store and forward eClaims information exchanges.
This Implementation Guide is being developed under the Financial Management Work Group to allow for balloting within a larger community for this initial Saudi FHIR implementation Guide.

3c. Security Risk

No

3d. External Drivers

The Saudi Council for Cooperative Health Insurance (CCHI) project operated by Sehati for Health Information Services.

3e. Objectives/Deliverables and Target Dates

September 2020 WGM: FHIR Connectathon
November 2020: Project Pilot
January 2021 Ballot: STU Ballot
April 2021: STU Publication

3f. Common Names / Keywords / Aliases:

Uniplat Financial Services, SHIB

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/FM/KSA+Healthcare+Financial+Services+Implementation+Guide

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

Yes

3n. List of Vocabularies

ICD10-AM/ACHI/AR-DRG, SNOMED, SFDA drugs and devices, FDI-tooth codes and surfaces, ICF (WHO for functional assessments), URG, various billing codes.

4a. Products

FHIR Extensions, FHIR Implementation Guide, FHIR Profiles

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

FHIR R4

5a. Project Intent

Implementation Guide (IG) will be created/modified

5a. Is the project adopting/endorsing an externally developed IG?

No

5b. Project Ballot Type

STU to Normative

6a. External Project Collaboration

Council for Cooperative Health Insurance (KSA)

6b. Content Already Developed

5

6c. Content externally developed?

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Lab, HIS

6h. Providers

Emergency Services, Medical Imaging Service, Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

Other HL7 Affiliate Specific

7a. Management Group(s) to Review PSS

FHIR

Version

1

Modifier

Paul Knapp

Modify Date

Jun 01, 2020 21:16

1a. Project Name

KSA Healthcare Financial Services Implementation Guide PSS

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Financial Management

2d. Project Facilitator

Paul Knapp

2f. Modeling Facilitator

Paul Knapp

2g. Publishing Facilitator

Paul Knapp

2i. Domain Expert Representative

Paul Knapp, Benoit Schoeffler

2k. Conformance Facilitator

Paul Knapp

2m. Implementers

All private healthcare insurers in KSA: (eg BUPA, Al Rajhi)
All private healthcare providers in KSA:

3a. Project Scope

The Kingdom of Saudi Arabia has two complimentary healthcare systems: a private system which covers expatriates and Saudi citizens working in private industry, and a public system which covers all other Saudi citizens. This project will address the private market to support the eligibility checking, prior authorization, claims and other supporting information exchanges to standardize the these information exchanges for the approximately 28 payors and 5000+ private provider organizations serving the 12+ million beneficiaries in the private market. In the future the public system covering another 20+ million beneficiaries is expected to adopt these standards.
The project goals and general approach was presented at the May 2015 WGM in Paris under the project name: Saudi Health Insurance Bus (SHIB).

3b. Project Need

Currently eClaims information is exchanged on paper and proprietary electronic formats and does not use standardized terminology. These standards are needed to modernize and provide an efficient interoperable framework for eClaims exchanges.
A clearinghouse, currently named the Uniplat, is being established as the central connection point for all providers and payors, and will servce to validate and store and forward eClaims information exchanges.
This Implementation Guide is being developed under the Financial Management Work Group to allow for balloting within a larger community for this initial Saudi FHIR implementation Guide.

3c. Security Risk

No

3d. External Drivers

The Saudi Council for Cooperative Health Insurance (CCHI) project operated by Sehati for Health Information Services.

3e. Objectives/Deliverables and Target Dates

September 2020 WGM: FHIR Connectathon
November 2020: Project Pilot
January 2021 Ballot: STU Ballot
April 2021: STU Publication

3f. Common Names / Keywords / Aliases:

Uniplat Financial Services, SHIB

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/FM/KSA+Healthcare+Financial+Services+Implementation+Guide

3j. Backwards Compatibility

No

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

Yes

3n. List of Vocabularies

ICD10-AM/ACHI/AR-DRG, SNOMED, SFDA drugs and devices, FDI-tooth codes and surfaces, ICF (WHO for functional assessments), URG, various billing codes.

4a. Products

FHIR Extensions, FHIR Implementation Guide, FHIR Profiles

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

FHIR R4

5a. Project Intent

Implementation Guide (IG) will be created/modified

5a. Is the project adopting/endorsing an externally developed IG?

No

5b. Project Ballot Type

STU to Normative

6a. External Project Collaboration

Council for Cooperative Health Insurance (KSA)

6b. Content Already Developed

5

6c. Content externally developed?

No

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Clinical and Public Health Laboratories, Payors

6g. Vendors

Pharmaceutical, EHR, PHR, Health Care IT, Lab, HIS

6h. Providers

Emergency Services, Medical Imaging Service, Healthcare Institutions (hospitals, long term care, home care, mental health)

7a. Management Group(s) to Review PSS

FHIR