Invoice
Invoice
Introduction
The Invoice data model is a pivotal component within healthcare information systems, designed to manage and record detailed information about fee billing for healthcare services provided to patients. This model primarily focuses on capturing data related to healthcare transactions, especially those detailed in the FT1 (Financial Transaction) segments of HL7 messages. It plays a vital role in facilitating accurate billing, claims processing, and financial management within healthcare organizations.
Use Case
Developers can harness the capabilities of the Invoice data model to support various technical use cases, allowing for the efficient management of financial transactions related to healthcare services:
- Billing and Claims Processing: Developers can utilize this model to extract transaction details, including transaction code, type, and date, to support billing processes. This ensures that fees for healthcare services are accurately recorded and submitted as insurance claims.
- Revenue Cycle Management: Healthcare organizations rely on effective revenue cycle management. Developers can query this model to track transaction quantities, amounts, and descriptions, assisting in revenue forecasting and financial planning.
- Payment Processing: For insurance and patient payments, developers can use this model to capture payment reference IDs and payment amounts, streamlining the payment reconciliation process.
- Fee Schedule Compliance: Developers can cross-reference transaction data with fee schedules to ensure compliance with predefined pricing structures for healthcare services.
- Financial Reporting: Organizations require detailed financial reports. Developers can access transaction data to generate financial reports, including revenue breakdowns by service type, department, or patient.
- Patient Invoicing: Developers can use this model to generate itemized invoices for patients, detailing the services rendered, associated costs, and insurance coverage information.
- Cost Analysis: For healthcare cost analysis, developers can extract unit cost data, allowing organizations to assess the cost-effectiveness of different services and procedures.
- Audit Trails: Developers can query transaction reference keys and posting dates to maintain detailed audit trails, ensuring transparency and accountability in financial transactions.
- Insurance Reconciliation: Developers can reconcile insurance amounts with claims data, facilitating the verification of insurance payments against billed amounts.
- Patient Financial Services: In patient financial services, developers can use this model to support the financial counseling process, providing patients with transparent cost breakdowns and payment options.
- Compliance and Regulation: Developers can leverage this model to ensure compliance with financial regulations and healthcare billing standards. Transaction data can be used for audits and compliance reporting.
- Data Analytics: Researchers and analysts can query transaction data to perform data analytics, including assessing revenue trends, identifying billing discrepancies, and optimizing financial workflows.
- Departmental Cost Allocation: Developers can allocate costs to specific departments or service units by querying transaction data, aiding in financial planning and resource allocation.
- Duplicate Transaction Detection: Developers can identify and manage duplicate transactions or procedures, ensuring accurate billing and preventing overcharges.
Data Fields
| Attribute Name | Description | HL7 Mapping | Data Type | Label | Use Case |
|---|---|---|---|---|---|
| transaction_code | Transaction Code | FT1-7 | string | Transaction Code | This field is used to specify the type of financial transaction being recorded in the FT1 segment. It can indicate various financial activities, such as charges, payments, adjustments, or other financial events related to patient accounts. |
| transaction_type | Transaction Type | FT1-6 | string | Transaction Type | This field is used to specify the type or nature of the financial transaction being recorded in the FT1 segment. It indicates whether the transaction represents a charge, payment, adjustment, or another financial event related to patient accounts. |
| transaction_reference_key | Transaction Reference Key | FT1-31 | string | Transaction Reference Key | This field serves as a unique identifier or key for a specific financial transaction. It helps link and track financial transactions associated with patient accounts, services, or procedures. |
| transaction_date | Transaction Date | FT1-4 | date | Transaction Date | This field represents the date and time when a specific financial transaction occurred. It is used to record the timing of financial events related to patient accounts, services, or procedures. |
| insurance_amount | Insurance Amount | FT1-15-1-1 | string | Insurance Amount | This field represents a specific amount related to a financial transaction. This amount could be associated with insurance coverage, reimbursement, charges, or payments. |
| procedure_code | Procedure Code | FT1-25 | string | Procedure Code | This field is used to specify the code or identifier associated with a medical procedure or service. It indicates the type of service provided or billed for in the context of a financial transaction. |
| filler_order_number | Filler Order Number | FT1-23 | string | Filler Order Number | This field is used to specify an order or reference number associated with a particular medical service, test, or procedure. It helps identify and link the financial transaction to the corresponding order. |
| fee_schedule | Fee Schedule | FT1-17 | string | Fee Schedule | This field is used to specify the fee schedule or rate associated with a particular medical service, test, or procedure. It indicates the cost or reimbursement rate for the service. |
| transaction_amount_unit | Transaction Amount - Unit | FT1-12-1 | string | Transaction Amount - Unit | This field represents the unit of measurement associated with a financial transaction amount. It specifies the type of unit used to measure the transaction's quantity or size. |
| transaction_batch_id | Transaction Batch ID | FT1-3 | string | Transaction Batch ID | This field is used to identify a specific batch or group of financial transactions. It associates individual transactions with a batch for administrative and tracking purposes. |
| patient_type | Patient Type | FT1-18 | string | Patient Type | This field is used to classify the type of patient for whom a financial transaction is being recorded. It helps specify whether the transaction relates to an inpatient, outpatient, or other patient classification. |
| duplicate_procedure_reason | Medically Necessary Duplicate Procedure Reason | FT1-28 | string | Medically Necessary Duplicate Procedure Reason | This field is used to indicate the reason for recording a financial transaction related to a procedure or service that is considered a duplicate. It provides information about why the transaction is being recorded again. |
| transaction_description | Transaction Description | FT1-8 | string | Transaction Description | This field provides a textual description or explanation of the financial transaction being recorded. It helps to clarify the nature of the transaction. |
| transaction_quantity | Transaction Quantity | FT1-10 | string | Transaction Quantity | This field represents the numerical quantity associated with a financial transaction. It specifies how many units of a service or item are involved in the transaction. |
| payment_reference_id | Payment Reference ID | FT1-30 | string | Payment Reference ID | This field is used to provide a reference or identifier associated with a payment related to the financial transaction recorded in the FT1 segment. It helps link the transaction to a specific payment. |
| insurance_plan_id | Insurance Plan ID | FT1-14 | string | Insurance Plan ID | This field is used to specify the identifier or code associated with an insurance plan or policy that relates to a financial transaction. It helps link the transaction to a specific insurance plan. |
| unit_cost | Unit Cost | FT1-12-1 | string | Unit Cost | This field specifies the cost associated with each unit of a service, supply, or item involved in a financial transaction. It quantifies the expense associated with each unit. |
| xc_visit_id | XC visit id | Based on alternate_visit_id followed by visit_number followed by system generated ID | string | XC visit id | The "xc_visit_id" is a unique identifier used to group together all the interactions, procedures, tests, and check-ups associated with a single patient visit in a healthcare setting. This identifier helps in organising and managing various activities and data related to that specific patient encounter. |
| batch_id | Batch id | System Generated | string | Batch ID | "batch ID" is a unique identifier assigned to a group of messages that are logically grouped together for processing or transmission. Batching messages is a common practice in healthcare systems to efficiently manage and transmit multiple messages as a single unit |
| visit_number | Id of the visit | PV1-19-1 | string | Visit Number | The visit number serves as a unique identifier for a specific patient visit or encounter within a healthcare facility. It distinguishes one visit from another. |
| patient_id | Id of the patient | PID-3-1 | string | Patient ID | The patient ID is a unique identifier assigned to a patient within the healthcare system. It is used to accurately identify and link a patient's medical records, treatments, and history. |
| advanced_beneficiary_notice_code | Advanced Beneficiary Notice Code | FT1-5 | string | Advanced Beneficiary Notice Code | This field is used to indicate whether an advanced beneficiary notice (ABN) has been provided to the patient. An ABN is a form that informs Medicare beneficiaries of their financial responsibility for services that Medicare is not expected to cover. |
| transaction_id | Transaction ID | FT1-2-1 | string | Transaction ID | This field serves as a unique identifier for a financial transaction within a healthcare organisation's financial system. It distinguishes one transaction from another. |
| bundle_id | ID of bundle | MSH-10 | string | Bundle ID | “bundle ID" typically refers to a unique identifier assigned to a group or bundle of related messages or data elements. This identifier is used to associate multiple messages or pieces of information that are related to a specific patient, event, or transaction. |
| transaction_posting_date | Transaction Posting Date | FT1-27 | date | Transaction Posting Date | This field represents the date on which a financial transaction is recorded or posted in the healthcare organisation's financial system. It indicates when the transaction is officially logged. |
| alternate_visit_id | Alternative visit id | PV1-50/PID-18 | string | Alternate Visit Id | This field provides an alternate identifier for a patient's visit. It is used for tracking and cross-referencing patient visits and records, especially in scenarios requiring multiple identifiers or references. This field is recorded during patient registration and aids in accurate record linkage. |
| lineage | This is lineage attribute | Fixed - HL7 | string | Lineage | "lineage" refers to the information about the origin or source of a message. It helps trace the path of the message, indicating where it originated, how it was transmitted, and any intermediate systems or components it passed through before reaching its destination. |
| transaction_amount | Transaction Amount - Extended | FT1-11-1-1 | string | Transaction Amount - Extended | This field specifies the financial amount associated with a particular transaction. It quantifies the monetary value of the transaction. |
| assigned_patient_location | Assigned Patient Location | FT1-16 | string | Assigned Patient Location | This field specifies the location within the healthcare facility where a specific financial transaction is associated with the patient. It provides information about where the patient was when the transaction occurred. |
| invoice_id | This is invoice_id attribute | FT1+MSH-10 | string | Invoice ID | This field can be used to create a unique identifier for an invoice or financial transaction. Healthcare organisations may use such an identifier to manage and track invoices related to patient billing. |
| transaction_alt_description | Transaction Description - Alt | FT1-9 | string | Transaction Description - Alt | This field provides an alternative description or additional information about a financial transaction. It is used when a more detailed or specific description of the transaction is necessary. |
| encounter_id | Encounter ID | PV1+MSH-10 | string | Encounter ID | This unique identifier is used to associate various HL7 messages with a specific patient encounter or visit. It ensures that data and events are accurately linked to the correct patient's healthcare journey. |
| department_code | Department Code | FT1-13 | string | Department Code | This field identifies the specific department or unit within a healthcare organisation that is associated with a particular financial transaction. It indicates which department is responsible for the transaction. |
| ndc_code | NDC Code | FT1-29 | string | NDC Code | This field contains the National Drug Code, which is a unique identifier for medications and substances used in healthcare. It helps in identifying the specific medication or substance associated with a financial transaction. |
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