Account
Defines the ID Core constraints and extensions on the Account resource for the minimal set of data to query and retrieve the guarantor information.
Usage
This profile is used by providers and payors, insurers, to exchange the detail of service and patient benefit covered by the payor.
The primary uses of this resource is to support verification of electronic claims, the exchange of information relating to the proposed or actual provision of healthcare-related goods and services for patients to their benefit payors, insurers and national health programs, for treatment payment planning and reimbursement.
URL
Type | URL |
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Canonical | https://fhir.kemkes.go.id/r4/StructureDefinition/Account |
Structure
Snapshot
Account | I | DomainResource | |
id | Σ | 0..1 | string |
meta | Σ | 0..1 | Meta |
implicitRules | Σ ?! | 0..1 | uri |
language | 0..1 | codeBinding | |
text | 0..1 | Narrative | |
contained | 0..* | Resource | |
identifier | Σ | 0..* | Identifier |
status | Σ ?! | 1..1 | codeBinding |
type | Σ | 0..1 | CodeableConcept |
name | Σ | 0..1 | string |
subject | Σ I | 0..* | Reference(Patient | | Practitioner | PractitionerRole | Location | HealthcareService | Organization) |
servicePeriod | Σ I | 0..1 | Period |
coverage | Σ | 0..* | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
coverage | Σ I | 1..1 | Reference(Coverage) |
priority | Σ | 0..1 | positiveInt |
owner | Σ I | 0..1 | Reference(Organization) |
description | Σ | 0..1 | string |
guarantor | 0..* | BackboneElement | |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
party | I | 1..1 | Reference(Patient | RelatedPerson | Organization) |
onHold | 0..1 | boolean | |
period | I | 0..1 | Period |
partOf | I | 0..1 | Reference(Account) |
Examples
Dictionary
Account | |
Definition | 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. |
Cardinality | 0...* |
Alias | Cost center, Record |
Invariants |
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Mappings |
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Account.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Cardinality | 0...1 |
Type | string |
Summary | True |
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
Account.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Cardinality | 0...1 |
Type | Meta |
Summary | True |
Invariants |
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Mappings |
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Account.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Cardinality | 0...1 |
Type | uri |
Modifier | True |
Summary | True |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
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Account.language | |
Definition | The base language in which the resource is written. |
Cardinality | 0...1 |
Type | code |
Binding | A human language. |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
Invariants |
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Mappings |
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Account.text | |
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Cardinality | 0...1 |
Type | Narrative |
Alias | narrative, html, xhtml, display |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
Invariants |
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Account.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. |
Cardinality | 0...* |
Type | Resource |
Alias | inline resources, anonymous resources, contained resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. |
Mappings |
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Account.identifier | |
Definition | Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number). |
Cardinality | 0...* |
Type | Identifier |
Summary | True |
Invariants |
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Mappings |
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Account.status | |
Definition | Indicates whether the account is presently used/usable or not. |
Cardinality | 1...1 |
Type | code |
Binding | Indicates whether the account is available to be used. |
Modifier | True |
Summary | True |
Comments | This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid. |
Invariants |
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Mappings |
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Account.type | |
Definition | Categorizes the account for reporting and searching purposes. |
Cardinality | 0...1 |
Type | CodeableConcept |
Binding | The usage type of this account, permits categorization of accounts. |
Summary | True |
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. |
Invariants |
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Mappings |
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Account.name | |
Definition | Name used for the account when displaying it to humans in reports, etc. |
Cardinality | 0...1 |
Type | string |
Summary | True |
Alias | Title |
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size |
Invariants |
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Mappings |
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Account.subject | |
Definition | 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. |
Cardinality | 0...* |
Type | Reference(Patient | | Practitioner | PractitionerRole | Location | HealthcareService | Organization) |
Summary | True |
Alias | target |
Comments | Accounts can be applied to non-patients for tracking other non-patient related activities, such as group services (patients not tracked, and costs charged to another body), or might not be allocated. |
Invariants |
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Mappings |
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Account.servicePeriod | |
Definition | The date range of services associated with this account. |
Cardinality | 0...1 |
Type | Period |
Summary | True |
Comments | It is possible for transactions to be posted outside the service period, as long as the service was provided within the defined service period. |
Invariants |
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Mappings |
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Account.coverage | |
Definition | The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account. |
Cardinality | 0...* |
Type | BackboneElement |
Summary | True |
Comments | Typically. this may be some form of insurance, internal charges, or self-pay. Local or jurisdictional business rules may determine which coverage covers which types of billable items charged to the account, and in which order. Where the order is important, a local/jurisdictional extension may be defined to specify the order for the type of charge. |
Invariants |
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Mappings |
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Account.coverage.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Cardinality | 0...1 |
Type | string |
Mappings |
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Account.coverage.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Cardinality | 0...* |
Type | Extension |
Alias | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | Unordered, Open, by url(Value) |
Invariants |
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Mappings |
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Account.coverage.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Cardinality | 0...* |
Type | Extension |
Modifier | True |
Summary | True |
Alias | extensions, user content, modifiers |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants |
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Mappings |
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Account.coverage.coverage | |
Definition | 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. |
Cardinality | 1...1 |
Type | Reference(Coverage) |
Summary | True |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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Account.coverage.priority | |
Definition | The priority of the coverage in the context of this account. |
Cardinality | 0...1 |
Type | positiveInt |
Summary | True |
Alias | coordination of benefit priority |
Comments | It is common in some jurisdictions for there to be multiple coverages allocated to an account, and a sequence is required to order the settling of the account (often with insurance claiming). |
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Account.owner | |
Definition | Indicates the service area, hospital, department, etc. with responsibility for managing the Account. |
Cardinality | 0...1 |
Type | Reference(Organization) |
Summary | True |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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Account.description | |
Definition | Provides additional information about what the account tracks and how it is used. |
Cardinality | 0...1 |
Type | string |
Summary | True |
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size |
Invariants |
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Mappings |
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Account.guarantor | |
Definition | The parties responsible for balancing the account if other payment options fall short. |
Cardinality | 0...* |
Type | BackboneElement |
Invariants |
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Mappings |
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Account.guarantor.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Cardinality | 0...1 |
Type | string |
Mappings |
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Account.guarantor.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Cardinality | 0...* |
Type | Extension |
Alias | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | Unordered, Open, by url(Value) |
Invariants |
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Mappings |
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Account.guarantor.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Cardinality | 0...* |
Type | Extension |
Modifier | True |
Summary | True |
Alias | extensions, user content, modifiers |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants |
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Mappings |
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Account.guarantor.party | |
Definition | The entity who is responsible. |
Cardinality | 1...1 |
Type | Reference(Patient | RelatedPerson | Organization) |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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Account.guarantor.onHold | |
Definition | A guarantor may be placed on credit hold or otherwise have their role temporarily suspended. |
Cardinality | 0...1 |
Type | boolean |
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Account.guarantor.period | |
Definition | The timeframe during which the guarantor accepts responsibility for the account. |
Cardinality | 0...1 |
Type | Period |
Comments | A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. |
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Account.partOf | |
Definition | Reference to a parent Account. |
Cardinality | 0...1 |
Type | Reference(Account) |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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