eClaim, billing, insurance simulator

1

Hi!
I would like to go through the payment process, adjudication, creating claims, chargeItems, invoices, and effectively charge the client and different parties based on the coverages but I wonder if a simulator or application that behaves as a payor/insurance existed so that I can issue claims and get different claimResponses.
Do you know of such thing?
If no, what would you recommend to develop and test the billing process

Thanks

2

What country are you operating in?

3

Canada first, USA eventually

4

In Canada, no one is using FHIR for insurance at all as yet, though there’s some work in progress that may eventually lead to that. There’ll need to be IGs in place that define how claims should happen before we’ll start to see test servers stood up.

In the U.S., most claims processing is mandated to be done using X12 and NCPDP. FHIR is making inroads in the prior authorization space (take a look at the Da Vinci PAS guide). There’s no movement as yet in North America that I’m aware of around using FHIR for the invoicing process - most of the work there has come from Europe.

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5

Thanks LLoyd, good to know