| FIAB_HD020100UV02 Patient Billing Post Event |
Description: This model includes the posting of financial transactions against those accounts (e.g. lab charge). Posting of charges is supplied through a financial transaction. In strictest accounting terms, the financial transaction would have a debit and credit association to 2 accounts (the debit account and the credit account). In this model, only 1 is specified. The financial transaction is supported by a costing component (invoice element), which is further supported by the actual service that was performed or the product that was supplied (billable). To add to the balance of a patient billing account, the ActFinancialTransactionCode should be "CHRG" with a positive amount. To reduce this balance, the code would be "REV", again with a positive amount Description: Entry point for post financial transaction messages. (Link to Excel View) Derived from RMIM: FIAB_RM020000UV02 |
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| FinancialTransaction [Constraint: " Amount must be >=0 "] |
Design Comments: To add to the balance of a patient billing account, the ActFinancialTransactionCode should be "CHRG" with a positive amount. To reduce this balance, the code would be "REV", again with a positive amount. |
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| classCode [1..1] (M) Act (CS) {CNE:V:ActClassFinancialTransaction, root= "XACT"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [0..*] Act (DSET<II>) |
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| code [0..1] Act (CD) {CWE:V:ActFinancialTransactionCode} |
Design Comments: type of transaction e.g. a charge, reversal, or payment |
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| effectiveTime [0..1] Act (QSET<TS>) |
Design Comments: transaction post date |
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| amt [0..1] FinancialTransaction (MO) |
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| reason [1..*] (FinancialTransactionReason) |
Design Comments: Allows for posting 1 charge for multiple services |
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| reference [0..1] (Reference) |
Design Comments: To reference a transaction that is being reversed. |
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| credit [0..1] (Credit) |
Design Comments: Used to indicate which org should be charged for a particular transaction (e.g. employer) when that org is different than the insurance company. |
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| outboundRelationship [0..1] (Posting) |
Design Comments: In reality, the financial transaction is either a credit or a debit to the account. In this case, only 1 is specified per financial transaction |
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| FinancialTransactionReason |
Design Comments: Allows for posting 1 charge for multiple services |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipReason, root= "RSON"} |
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| invoiceElement [1..1] (InvoiceElement) |
Design Comments: The service information (e.g. what was performed) is noted in A_Billable. The price of a service is noted in InvoiceElement. What is posted or charged is noted in FinancialTransaction. Where it was posted to is noted in Account. |
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| InvoiceElement |
Design Comments: The service information (e.g. what was performed) is noted in A_Billable. The price of a service is noted in InvoiceElement. What is posted or charged is noted in FinancialTransaction. Where it was posted to is noted in Account. |
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| classCode [1..1] (M) Act (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [0..*] Act (DSET<II>) |
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| effectiveTime [0..1] Act (TS) |
Design Comments: date that the invoice element is effective |
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| unitQuantity [0..1] InvoiceElement (RTO<PQ,PQ>) |
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| unitPriceAmt [0..1] InvoiceElement (RTO<MO,PQ>) |
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| netAmt [0..1] InvoiceElement (MO) |
Design Comments: amount of the invoice element = unit quantity * unit price amount |
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| factorNumber [0..1] InvoiceElement (REAL) |
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| pointsNumber [0..1] InvoiceElement (REAL) |
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| reason [0..*] (InvoiceElementReason) | |||||||||
| InvoiceElementReason | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipReason, root= "RSON"} |
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| billableActChoice [1..1] (A_BillableUniversal) | |||||||||
| Reference |
Design Comments: To reference a transaction that is being reversed. |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipRefersTo, root= "REFR"} |
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| referencedFinancialTransaction [1..1] (ReferencedFinancialTransaction) | |||||||||
| ReferencedFinancialTransaction | |||||||||
| classCode [1..1] (M) Act (CS) {CNE:V:ActClassFinancialTransaction, root= "XACT"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [0..*] Act (DSET<II>) |
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| Credit |
Design Comments: Used to indicate which org should be charged for a particular transaction (e.g. employer) when that org is different than the insurance company. |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipHasCredit, root= "CREDIT"} |
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| account [1..1] (A_AccountPayorUniversal) | |||||||||
| Posting |
Design Comments: In reality, the financial transaction is either a credit or a debit to the account. In this case, only 1 is specified per financial transaction |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:D:} |
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| account [1..1] (Account) | |||||||||
| Account | |||||||||
| classCode [1..1] (M) Act (CS) {CNE:V:ActClassAccount, root= "ACCT"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [1..*] Act (DSET<II>) |
Design Comments: bank account, transit number, etc. |
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| code [0..1] Act (CD) {CWE:V:ActAccountCode} |
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| title [0..1] Act (ST) |
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| statusCode [1..1] Act (CS) {CNE:D:ActStatus} |
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| effectiveTime [0..1] Act (IVL<TS>) |
Design Comments: e.g.expiry date on credit card |
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| balanceAmt [0..1] Account (MO) |
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| currencyCode [0..1] Account (CD) {CWE:D:Currency} |
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| interestRateQuantity [0..1] Account (RTO<MO,PQ>) |
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| allowedBalanceQuantity [0..1] Account (IVL<MO>) |
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| subject [1..1] (Subject) |
Design Comments: The named party for the account. For a patient billing account, this is the patient |
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| component [0..*] (Component) |
Design Comments: Used to reference sub-accounts |
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| pertainsTo [0..*] (PertinentInformation) | |||||||||
| Subject |
Design Comments: The named party for the account. For a patient billing account, this is the patient |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationTargetSubject, root= "SBJ"} |
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| patientRole [1..1] (PatientRole) | |||||||||
| PatientRole | |||||||||
| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassPatient, root= "PAT"} |
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| id [0..*] Role (DSET<II>) |
Design Comments: patient identifier |
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| confidentialityCode [0..*] Role (DSET<CD>) {CWE:D:Confidentiality} |
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| veryImportantPersonCode [0..1] Patient (CD) {CWE:D:PatientImportance} |
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| patientPerson [0..1] (E_PersonUniversal) |
Design Comments: Guarantor is scoped by the patient. Patient is also the subject of the account. |
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| Component |
Design Comments: Used to reference sub-accounts |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipHasComponent, root= "COMP"} |
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| account [1..1] (Account) | |||||||||
| PertinentInformation | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipPertains, root= "PERT"} |
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| encounter [1..1] (A_EncounterUniversal) | |||||||||