FHIR R4 ChargeItemDefinition Library

Overview

This asset is a component of MuleSoft Accelerator for Healthcare.

MuleSoft Accelerator for Healthcare enables healthcare providers to unlock critical patient data to build a patient 360 within Salesforce Health Cloud, faster and easier than ever before. The solution includes pre-built APIs, connectors, integration templates, and prescriptive end-to-end reference architecture to bring patient demographics information and COVID-19 test results from any EHR into Health Cloud using HL7 V2 or FHIR standards.

The solution also provides a library of United States Core Data for Interoperability (USCDI) and FHIR R4 resources to help healthcare developers adhere to interoperability needs and jumpstart the development of healthcare digital transformation initiatives.

Use case covered

The ChargeItemDefinition resource provides the properties that apply to the (billing) codes necessary to calculate costs and prices. The properties may differ largely depending on type and realm, therefore this resource gives only a rough structure and requires profiling for each type of billing code system.

The ChargeItemDefinition holds all relevant billing information pertaining to a billing code or a product.

Many billing systems have rules associated with the code which may define whether a billing code is applicable in a specific context or whether certain billing details (surcharges, discounts) apply. ChargeItemDefinitions may also be used to hold pricing information pertaining to only one specific instance of a product (e.g. Device, Medication or Substance) which may be a requirement for custom made devices or medications or other products where prices vary by instance. Rules for applicability may include

• a billing code is only applicable in an outpatient setting
• a surcharge that applies only to services provided outside regular business hours
• a discount that applies only to patients up to the age of 14
• a billing code that may only be charged once per Encounter
• a billing code that can only be charged in combination with another code from the same billing system

A billing engine will apply the ChargeItemDefinitions to all ChargeItems within a specific Account in order to select all billable items an acquire the pricing details to create an Invoice. However, ChargeItems may be validated against a ChargeItemDefinition at any point in time, using the $apply-Operation

This library is used by FHIR R4 ChargeItemDefinition API.

More information about FHIR R4 ChargeItemDefinition specification can be found here.