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8.12 Resource Account - Content

Patient Administration Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Device , Patient , Practitioner

A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc.

The Account resource acts as a central record against which charges, payments, and adjustments are applied. It contains information about which parties are responsible for payment of the account.

While the Account does conceptually have a balance, expressing that balance directly as a resource property is challenging due to the complexity of pricing contracts. An operation to retrieve the current balance of an account is in consideration as future work.

The Account itself does not include information about the charges, payments or adjustments, but rather those resources, such as ChargeItem point to the account to which they apply. Payment and adjustment resources have not yet been developed.

The Account resource can be considered a "bucket" to which ChargeItem resources are linked. These charges are processed by a billing system, which determines the responsible parties for the balance of the account. The billing system then submits claims or sends statements to the appropriate parties. Once payment is received, an adjustment is applied to the Account. The internal calculation of balances and allocation of responsibility is expected to be internal to the billing systems. Only the inputs and outputs of the billing process is communicated in the relevant financial FHIR resources.

This resource is referenced by itself, ChargeItem , Encounter , EpisodeOfCare and Invoice .

This resource does not implement any patterns.

Structure

Name Flags Card. Type Description & Constraints doco
. . Account TU DomainResource Tracks balance, charges, for patient or cost center
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Account number
. . . status ?! Σ 1..1 code active | inactive | entered-in-error | on-hold | unknown
AccountStatus ( Required )
. . . type Σ 0..1 CodeableConcept E.g. patient, expense, depreciation
Account Types ( Example )
. . . name Σ 0..1 string Human-readable label
. . . subject Σ 0..* Reference ( Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization ) The entity that caused the expenses
. . . servicePeriod Σ 0..1 Period Transaction window
. . . coverage Σ 0..* BackboneElement The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
. . . . coverage Σ 1..1 Reference ( Coverage ) The party(s), such as insurances, that may contribute to the payment of this account
. . . . priority Σ 0..1 positiveInt The priority of the coverage in the context of this account
. . . owner Σ 0..1 Reference ( Organization ) Entity managing the Account
. . . description Σ 0..1 string Explanation of purpose/use
. . . guarantor 0..* BackboneElement The parties ultimately responsible for balancing the Account
. . . . party 1..1 Reference ( Patient | RelatedPerson | Organization ) Responsible entity
. . . . onHold 0..1 boolean Credit or other hold applied
. . . . period 0..1 Period Guarantee account during
. . . partOf 0..1 Reference ( Account ) Reference to a parent Account

doco Documentation for this format

UML Diagram ( Legend )

Account ( DomainResource ) Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number) identifier : Identifier [0..*] Indicates whether the account is presently used/usable or not (this element modifies the meaning of other elements) status : code [1..1] « Indicates whether the account is available to be used. (Strength=Required) AccountStatus ! » Categorizes the account for reporting and searching purposes type : CodeableConcept [0..1] « The usage type of this account, permits categorization of accounts. (Strength=Example) AccountTypes ?? » Name used for the account when displaying it to humans in reports, etc name : string [0..1] Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Account subject : Reference [0..*] « Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization » The date range of services associated with this account servicePeriod : Period [0..1] Indicates the service area, hospital, department, etc. with responsibility for managing the Account owner : Reference [0..1] « Organization » Provides additional information about what the account tracks and how it is used description : string [0..1] Reference to a parent Account partOf : Reference [0..1] « Account » Coverage The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay). A coverage may only be responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing coverage : Reference [1..1] « Coverage » The priority of the coverage in the context of this account priority : positiveInt [0..1] Guarantor The entity who is responsible party : Reference [1..1] « Patient | RelatedPerson | Organization » A guarantor may be placed on credit hold or otherwise have their role temporarily suspended onHold : boolean [0..1] The timeframe during which the guarantor accepts responsibility for the account period : Period [0..1] The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account coverage [0..*] The parties responsible for balancing the account if other payment options fall short guarantor [0..*]

XML Template

<Account xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Account number --></identifier>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error | on-hold | unknown -->
 <type><!-- 0..1 CodeableConcept E.g. patient, expense, depreciation --></type>
 <name value="[string]"/><!-- 0..1 Human-readable label -->
 <|
   </subject>

 <subject><!-- 0..* Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) The entity that caused the expenses --></subject>
 <servicePeriod><!-- 0..1 Period Transaction window --></servicePeriod>
 <coverage>  <!-- 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account -->
  <coverage><!-- 1..1 Reference(Coverage) The party(s), such as insurances, that may contribute to the payment of this account --></coverage>
  <priority value="[positiveInt]"/><!-- 0..1 The priority of the coverage in the context of this account -->
 </coverage>
 <owner><!-- 0..1 Reference(Organization) Entity managing the Account --></owner>
 <description value="[string]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <</party>

  <party><!-- 1..1 Reference(Organization|Patient|RelatedPerson) Responsible entity --></party>

  <onHold value="[boolean]"/><!-- 0..1 Credit or other hold applied -->
  <period><!-- 0..1 Period Guarantee account during --></period>
 </guarantor>
 <partOf><!-- 0..1 Reference(Account) Reference to a parent Account --></partOf>
</Account>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:Account;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Account.identifier [ Identifier ], ... ; # 0..* Account number
  fhir:Account.status [ code ]; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:Account.type [ CodeableConcept ]; # 0..1 E.g. patient, expense, depreciation
  fhir:Account.name [ string ]; # 0..1 Human-readable label
  fhir:|
  

  fhir:Account.subject [ Reference(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ], ... ; # 0..* The entity that caused the expenses
  fhir:Account.servicePeriod [ Period ]; # 0..1 Transaction window
  fhir:Account.coverage [ # 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    fhir:Account.coverage.coverage [ Reference(Coverage) ]; # 1..1 The party(s), such as insurances, that may contribute to the payment of this account
    fhir:Account.coverage.priority [ positiveInt ]; # 0..1 The priority of the coverage in the context of this account
  ], ...;
  fhir:Account.owner [ Reference(Organization) ]; # 0..1 Entity managing the Account
  fhir:Account.description [ string ]; # 0..1 Explanation of purpose/use
  fhir:Account.guarantor [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:

    fhir:Account.guarantor.party [ Reference(Organization|Patient|RelatedPerson) ]; # 1..1 Responsible entity

    fhir:Account.guarantor.onHold [ boolean ]; # 0..1 Credit or other hold applied
    fhir:Account.guarantor.period [ Period ]; # 0..1 Guarantee account during
  ], ...;
  fhir:Account.partOf [ Reference(Account) ]; # 0..1 Reference to a parent Account
]

Changes since R3

Account
Account.status
  • Min Cardinality changed from 0 to 1 Change value set from http://hl7.org/fhir/ValueSet/account-status to http://hl7.org/fhir/ValueSet/account-status|4.0.1 Account.subject Max Cardinality changed from 1 to * Type Reference: Added Target Type PractitionerRole Account.servicePeriod Renamed from period http://hl7.org/fhir/ValueSet/account-status|4.0.0 to servicePeriod Account.partOf Added Element Account.active deleted Account.balance deleted http://hl7.org/fhir/ValueSet/account-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and all r3 resources are valid.)

Structure

Name Flags Card. Type Description & Constraints doco
. . Account TU DomainResource Tracks balance, charges, for patient or cost center
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Account number
. . . status ?! Σ 1..1 code active | inactive | entered-in-error | on-hold | unknown
AccountStatus ( Required )
. . . type Σ 0..1 CodeableConcept E.g. patient, expense, depreciation
Account Types ( Example )
. . . name Σ 0..1 string Human-readable label
. . . subject Σ 0..* Reference ( Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization ) The entity that caused the expenses
. . . servicePeriod Σ 0..1 Period Transaction window
. . . coverage Σ 0..* BackboneElement The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
. . . . coverage Σ 1..1 Reference ( Coverage ) The party(s), such as insurances, that may contribute to the payment of this account
. . . . priority Σ 0..1 positiveInt The priority of the coverage in the context of this account
. . . owner Σ 0..1 Reference ( Organization ) Entity managing the Account
. . . description Σ 0..1 string Explanation of purpose/use
. . . guarantor 0..* BackboneElement The parties ultimately responsible for balancing the Account
. . . . party 1..1 Reference ( Patient | RelatedPerson | Organization ) Responsible entity
. . . . onHold 0..1 boolean Credit or other hold applied
. . . . period 0..1 Period Guarantee account during
. . . partOf 0..1 Reference ( Account ) Reference to a parent Account

doco Documentation for this format

UML Diagram ( Legend )

Account ( DomainResource ) Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number) identifier : Identifier [0..*] Indicates whether the account is presently used/usable or not (this element modifies the meaning of other elements) status : code [1..1] « Indicates whether the account is available to be used. (Strength=Required) AccountStatus ! » Categorizes the account for reporting and searching purposes type : CodeableConcept [0..1] « The usage type of this account, permits categorization of accounts. (Strength=Example) AccountTypes ?? » Name used for the account when displaying it to humans in reports, etc name : string [0..1] Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Account subject : Reference [0..*] « Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization » The date range of services associated with this account servicePeriod : Period [0..1] Indicates the service area, hospital, department, etc. with responsibility for managing the Account owner : Reference [0..1] « Organization » Provides additional information about what the account tracks and how it is used description : string [0..1] Reference to a parent Account partOf : Reference [0..1] « Account » Coverage The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay). A coverage may only be responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing coverage : Reference [1..1] « Coverage » The priority of the coverage in the context of this account priority : positiveInt [0..1] Guarantor The entity who is responsible party : Reference [1..1] « Patient | RelatedPerson | Organization » A guarantor may be placed on credit hold or otherwise have their role temporarily suspended onHold : boolean [0..1] The timeframe during which the guarantor accepts responsibility for the account period : Period [0..1] The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account coverage [0..*] The parties responsible for balancing the account if other payment options fall short guarantor [0..*]

XML Template

<Account xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Account number --></identifier>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error | on-hold | unknown -->
 <type><!-- 0..1 CodeableConcept E.g. patient, expense, depreciation --></type>
 <name value="[string]"/><!-- 0..1 Human-readable label -->
 <|
   </subject>

 <subject><!-- 0..* Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) The entity that caused the expenses --></subject>
 <servicePeriod><!-- 0..1 Period Transaction window --></servicePeriod>
 <coverage>  <!-- 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account -->
  <coverage><!-- 1..1 Reference(Coverage) The party(s), such as insurances, that may contribute to the payment of this account --></coverage>
  <priority value="[positiveInt]"/><!-- 0..1 The priority of the coverage in the context of this account -->
 </coverage>
 <owner><!-- 0..1 Reference(Organization) Entity managing the Account --></owner>
 <description value="[string]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <</party>

  <party><!-- 1..1 Reference(Organization|Patient|RelatedPerson) Responsible entity --></party>

  <onHold value="[boolean]"/><!-- 0..1 Credit or other hold applied -->
  <period><!-- 0..1 Period Guarantee account during --></period>
 </guarantor>
 <partOf><!-- 0..1 Reference(Account) Reference to a parent Account --></partOf>
</Account>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:Account;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Account.identifier [ Identifier ], ... ; # 0..* Account number
  fhir:Account.status [ code ]; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:Account.type [ CodeableConcept ]; # 0..1 E.g. patient, expense, depreciation
  fhir:Account.name [ string ]; # 0..1 Human-readable label
  fhir:|
  

  fhir:Account.subject [ Reference(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ], ... ; # 0..* The entity that caused the expenses
  fhir:Account.servicePeriod [ Period ]; # 0..1 Transaction window
  fhir:Account.coverage [ # 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    fhir:Account.coverage.coverage [ Reference(Coverage) ]; # 1..1 The party(s), such as insurances, that may contribute to the payment of this account
    fhir:Account.coverage.priority [ positiveInt ]; # 0..1 The priority of the coverage in the context of this account
  ], ...;
  fhir:Account.owner [ Reference(Organization) ]; # 0..1 Entity managing the Account
  fhir:Account.description [ string ]; # 0..1 Explanation of purpose/use
  fhir:Account.guarantor [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:

    fhir:Account.guarantor.party [ Reference(Organization|Patient|RelatedPerson) ]; # 1..1 Responsible entity

    fhir:Account.guarantor.onHold [ boolean ]; # 0..1 Credit or other hold applied
    fhir:Account.guarantor.period [ Period ]; # 0..1 Guarantee account during
  ], ...;
  fhir:Account.partOf [ Reference(Account) ]; # 0..1 Reference to a parent Account
]

Changes since Release 3

Account
Account.status
  • Min Cardinality changed from 0 to 1 Change value set from http://hl7.org/fhir/ValueSet/account-status to http://hl7.org/fhir/ValueSet/account-status|4.0.1 Account.subject Max Cardinality changed from 1 to * Type Reference: Added Target Type PractitionerRole Account.servicePeriod Renamed from period http://hl7.org/fhir/ValueSet/account-status|4.0.0 to servicePeriod Account.partOf Added Element Account.active deleted Account.balance deleted http://hl7.org/fhir/ValueSet/account-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and all r3 resources are valid.)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis a

Path Definition Type Reference
Account.status Indicates whether the account is available to be used. Required AccountStatus
Account.type The usage type of this account, permits categorization of accounts. Example AccountTypes

Search parameters for 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
identifier token Account number Account.identifier
name string Human-readable label Account.name
owner reference Entity managing the Account Account.owner
( Organization )
patient reference The entity that caused the expenses Account.subject.where(resolve() is Patient)
( Patient )
period date Transaction window Account.servicePeriod
status token active | inactive | entered-in-error | on-hold | unknown Account.status
subject reference The entity that caused the expenses Account.subject
( Practitioner , Organization , Device , Patient , HealthcareService , PractitionerRole , Location )
type token E.g. patient, expense, depreciation Account.type