Chapter 06: Financial Management
This chapter covers charges, accounts and insurance. It defines what a patient is billed for and who pays.
This chapter covers the money side of a patient's care. It covers the charges posted to a patient's account, such as a procedure or a supply. It also covers insurance details and the person responsible for the bill. The main message type is DFT, which posts a charge. The FT1 segment carries a charge and the IN1 segment carries an insurance policy. Nothing clinical is in this chapter.
What is in this chapter
- 8 trigger eventsthe real-world things that cause one of these messages to be sent
- 16 segmentsthe lines these messages are built from, and the fields on each
- 77 code tablesthe value sets the fields in this chapter draw from
- 2 message typesBAR, DFT
Message types defined here
BARAdd/change billing account6 structures, fired by 6 trigger events.
DFTDetail financial transactions2 structures, fired by 2 trigger events.
Segments defined here
These 16 segments are defined in chapter 06. Messages in other chapters may still carry them.
ABSAbstract SegmentACCAccident SegmentBLCBlood Code SegmentDG1Diagnosis SegmentDRGDiagnosis Related Group SegmentFT1Financial Transaction SegmentGP1Grouping/Reimbursement - VisitGP2Grouping/Reimbursement - Procedure Line ItemGT1Guarantor SegmentIN1Insurance SegmentIN2Insurance Additional Information SegmentIN3Insurance Additional Information, Certification SegmentPR1Procedures SegmentRMIRisk Management Incident SegmentUB1UB82 Data SegmentUB2UB92 Data Segment
Trigger events
A trigger event is the thing that happens in the hospital and causes a message to be sent. Chapter 06 defines 8 of them.
P01Add Patient AccountP02Purge Patient AccountsP03Post Detail Financial TransactionsP05Update AccountP06End AccountP10BAR/ACK -Transmit Ambulatory Payment Classification(APC)P11Post Detail Financial Transactions - ExpandedP12Update Diagnosis/Procedure