This page is part of the FHIR Specification v4.1.0: R4B Ballot. About the R4B version of FHIR. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

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.

8.12.1 Scope and Usage

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.

8.12.2 Boundaries and Relationships

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.

8.12.3 Background and Context

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.

8.12.4 References

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
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
Documentation for this format

UML Diagram (Legend)

XML Template

<Account xmlns="http://hl7.org/fhir"> 
 <!-- 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><!-- 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><!-- 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>

JSON Template

{
  "resourceType" : "Account",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Account number
  "status" : "<code>", // R!  active | inactive | entered-in-error | on-hold | unknown
  "type" : { CodeableConcept }, // E.g. patient, expense, depreciation
  "name" : "<string>", // Human-readable label
  "subject" : [{ Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) }], // The entity that caused the expenses
  "servicePeriod" : { Period }, // Transaction window
  "coverage" : [{ // The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    "coverage" : { Reference(Coverage) }, // R!  The party(s), such as insurances, that may contribute to the payment of this account
    "priority" : "<positiveInt>" // The priority of the coverage in the context of this account
  }],
  "owner" : { Reference(Organization) }, // Entity managing the Account
  "description" : "<string>", // Explanation of purpose/use
  "guarantor" : [{ // The parties ultimately responsible for balancing the Account
    "party" : { Reference(Organization|Patient|RelatedPerson) }, // R!  Responsible entity
    "onHold" : <boolean>, // Credit or other hold applied
    "period" : { Period } // Guarantee account during
  }],
  "partOf" : { Reference(Account) } // Reference to a parent Account
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ 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: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: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

Change value set from http://hl7.org/fhir/ValueSet/account-status|4.0.0 to 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
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
Documentation for this format

UML Diagram (Legend)

XML Template

<Account xmlns="http://hl7.org/fhir"> 
 <!-- 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><!-- 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><!-- 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>

JSON Template

{
  "resourceType" : "Account",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Account number
  "status" : "<code>", // R!  active | inactive | entered-in-error | on-hold | unknown
  "type" : { CodeableConcept }, // E.g. patient, expense, depreciation
  "name" : "<string>", // Human-readable label
  "subject" : [{ Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) }], // The entity that caused the expenses
  "servicePeriod" : { Period }, // Transaction window
  "coverage" : [{ // The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    "coverage" : { Reference(Coverage) }, // R!  The party(s), such as insurances, that may contribute to the payment of this account
    "priority" : "<positiveInt>" // The priority of the coverage in the context of this account
  }],
  "owner" : { Reference(Organization) }, // Entity managing the Account
  "description" : "<string>", // Explanation of purpose/use
  "guarantor" : [{ // The parties ultimately responsible for balancing the Account
    "party" : { Reference(Organization|Patient|RelatedPerson) }, // R!  Responsible entity
    "onHold" : <boolean>, // Credit or other hold applied
    "period" : { Period } // Guarantee account during
  }],
  "partOf" : { Reference(Account) } // Reference to a parent Account
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ 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: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: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

Change value set from http://hl7.org/fhir/ValueSet/account-status|4.0.0 to 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 dependency analysis

8.12.5.1 Terminology Bindings

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

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

8.12.6 Search Parameters

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) (Practitioner, Organization, Device, Patient, HealthcareService, PractitionerRole, Location)
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