The examples for invoice implementations are:
– 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
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 Charge Items 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 Charge Item resources that make up the line items of the Invoice do not carry any pricing information, Charge Item Definitions will have to be applied to the ChargeItems in order to calculate the price components for the Invoice depending on the context of the Charge Item.