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8.34 Resource Invoice - Content

Financial Management icon Work GroupMaturity Level: 0 Trial UseSecurity Category: Patient Compartments: Device, Group, Patient, Practitioner, RelatedPerson

Invoice containing collected ChargeItems from an Account with calculated individual and total price for Billing purpose.



8.34.1 Scope and Usage

Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. An invoice is a financial document issued by a healthcare provider to a patient or a payer indicating the goods and services (ChargeItems) performed with their quantities and prices.

Example implementations:

  • Any solution that tracks billing information and needs to issue invoices
  • Private Insurance Providers who want to deliver structured information to patients to increase cost transparency
  • Patient apps that want to include information on the amount and reason of the charged costs for the healthcare services a patient received

8.34.2 Boundaries and Relationships

The existing Claim resource is constricted to use cases where Claims are sent to insurances for reimbursement, in a message-like style. It neither references ChargeItems nor Accounts.

Competing invoicing standards such as EDIFACT or X12 are aiming at inter-organizational exchange and do not offer human readable representations or traceable links to services rendered which is a requirement for invoicing towards patients. This resource is used where existing ChargeItems in an Account are collected to create an Invoice to be sent out to Individuals or Organizations in a structured way. The invoice is the hospital's view, whereas the Claim is the payer's view on the performed services.

Since the individual ChargeItem resources that make up the line items of the Invoice do not carry any pricing information, ChargeItemDefinitions will have to be applied to the ChargeItems in order to calculate the price components for the Invoice depending on the context of the ChargeItem

8.34.3 References to this Resource

8.34.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Invoice TU DomainResource Invoice containing ChargeItems from an Account

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 0..* Identifier Business Identifier for item

... status ?!Σ 1..1 code draft | issued | balanced | cancelled | entered-in-error
Binding: Invoice Status (Required)
... cancelledReason 0..1 string Reason for cancellation of this Invoice
... subject Σ 0..1 Reference(Patient | Group) Recipient(s) of goods and services
... recipient Σ 0..1 Reference(Organization | Patient | RelatedPerson) Recipient of this invoice
... date 0..1 dateTime DEPRICATED
... creation Σ 0..1 dateTime When posted
... period[x] Σ 0..1 Billing date or period
.... periodDate date
.... periodPeriod Period
... participant 0..* BackboneElement Participant in creation of this Invoice

.... role 0..1 CodeableConcept Type of involvement in creation of this Invoice
.... actor 1..1 Reference(Practitioner | Organization | Patient | PractitionerRole | Device | RelatedPerson) Individual who was involved
... issuer 0..1 Reference(Organization) Issuing Organization of Invoice
... account 0..1 Reference(Account) Account that is being balanced
... lineItem 0..* BackboneElement Line items of this Invoice

.... sequence 0..1 positiveInt Sequence number of line item
.... serviced[x] 0..1 Service data or period
..... servicedDate date
..... servicedPeriod Period
.... chargeItem[x] 1..1 Reference to ChargeItem containing details of this line item or an inline billing code
..... chargeItemReference Reference(ChargeItem)
..... chargeItemCodeableConcept CodeableConcept
.... priceComponent 0..* MonetaryComponent Components of total line item price

... totalPriceComponent 0..* MonetaryComponent Components of Invoice total

... totalNet Σ 0..1 Money Net total of this Invoice
... totalGross Σ 0..1 Money Gross total of this Invoice
... paymentTerms 0..1 markdown Payment details
... note 0..* Annotation Comments made about the invoice


doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

8.34.4.1 Terminology Bindings

Path ValueSet Type Documentation
Invoice.status InvoiceStatus Required

Codes identifying the lifecycle stage of an Invoice.



8.34.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
account reference Account that is being balanced Invoice.account
(Account)
date date Invoice date / posting date Invoice.date 26 Resources
identifier token Business Identifier for item Invoice.identifier 65 Resources
issuer reference Issuing Organization of Invoice Invoice.issuer
(Organization)
participant reference Individual who was involved Invoice.participant.actor
(Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson)
participant-role token Type of involvement in creation of this Invoice Invoice.participant.role
patient reference Recipient(s) of goods and services Invoice.subject.where(resolve() is Patient)
(Patient)		 65 Resources
recipient reference Recipient of this invoice Invoice.recipient
(Organization, Patient, RelatedPerson)
status token draft | issued | balanced | cancelled | entered-in-error Invoice.status
subject reference Recipient(s) of goods and services Invoice.subject
(Group, Patient)
totalgross quantity Gross total of this Invoice Invoice.totalGross
totalnet quantity Net total of this Invoice Invoice.totalNet
type token Type of Invoice Invoice.type 11 Resources