Implementation Guide
23.1.0 - R4 APIs

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Logical Model: Profile - Athena Custom Deductible

Official URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-deductible-profile Version: 23.1.0
Active as of 2023-03-01 Computable Name: Deductible

The Deductible is providing details of payor for deductible amounts and insurance amount distribution, such as for goods and services rendered by a provider to patients covered by insurance plans offered by that payor.


This Deductible profile is part of the custom resource profiles supported by the API server used with the athenaPractice product starting with version 23.0. This is not a FHIR Conformant Resource. It further describes read and search capabilities of these products.
Note: Create and Update operations are NOT supported for this resource.

Overview

This resource is used to extract the Deductible information of a patient.

Scope and Usage

The Deductible resource provides adjustment the details associated with a Deductible by the payor for receivable amounts, such as for goods and services rendered by a provider to patients covered by insurance plans offered by that payor. All elements listed in the differential profile view are Supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

Source

The Deductible information is extracted from PatientVisit, PatientProfile, Batch, Transactions, MedLists, TransactionDistributions, PatientVisitProcs, InsuranceCarriers, InsuranceGroup tables.

Example

Example for the athena-deductible-profile Profile.

Deductible Example

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-deductible-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
... pid S 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference 0..1 string Reference to the Patient
.... display 0..1 string Patient name
... patientProfileId SΣ 1..1 integer Patient specific id for practice management data including financial information
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure Code
... payer 0..1 string Information of Payer
... paymentSource 0..1 string Payor type indentification
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... batchName 0..1 integer The batch associated to the Deductible file.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Eligibility of cardnumber for payment processing
... checkDate 0..1 dateTime Reference the payment date.
... notes 0..1 string The note associated with the transaction.
... financialClass 0..1 string The actual contents of Financial class.
... insuranceCarrier 0..1 Reference(Organization) Insurance carrier reference
.... reference 0..1 string Insurance Carrier Id refering to Organization
.... display 0..1 string Insurance carrier Name
... insuranceDeductible 0..1 Money The Deductible amount distribution
.... value 0..1 decimal Insurance deductible amount
.... currency 0..1 code Currency
... patientDeductible 0..1 Money The total amount of the distribution when the source is patient
.... value 0..1 decimal Patient deductible value.
.... currency 0..1 code Currency

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-deductible-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
... pid S 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference ΣC 0..1 string Reference to the Patient
.... display Σ 0..1 string Patient name
... patientProfileId SΣ 1..1 integer Patient specific id for practice management data including financial information
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure Code
... payer 0..1 string Information of Payer
... paymentSource 0..1 string Payor type indentification
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... batchName 0..1 integer The batch associated to the Deductible file.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Eligibility of cardnumber for payment processing
... checkDate 0..1 dateTime Reference the payment date.
... notes 0..1 string The note associated with the transaction.
... financialClass 0..1 string The actual contents of Financial class.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier reference
ref-1: SHALL have a contained resource if a local reference is provided
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... display Σ 0..1 string Insurance carrier Name
... insuranceDeductible 0..1 Money The Deductible amount distribution
.... value Σ 0..1 decimal Insurance deductible amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientDeductible 0..1 Money The total amount of the distribution when the source is patient
.... value Σ 0..1 decimal Patient deductible value.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-deductible-profile.insuranceDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-deductible-profile.patientDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-deductible-profile.patient, athena-deductible-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-deductible-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
... pid S 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Reference to the Patient
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Patient name
... patientProfileId SΣ 1..1 integer Patient specific id for practice management data including financial information
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure Code
... payer 0..1 string Information of Payer
... paymentSource 0..1 string Payor type indentification
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... batchName 0..1 integer The batch associated to the Deductible file.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Eligibility of cardnumber for payment processing
... checkDate 0..1 dateTime Reference the payment date.
... notes 0..1 string The note associated with the transaction.
... financialClass 0..1 string The actual contents of Financial class.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier reference
ref-1: SHALL have a contained resource if a local reference is provided
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Insurance carrier Name
... insuranceDeductible 0..1 Money The Deductible amount distribution
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Insurance deductible amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientDeductible 0..1 Money The total amount of the distribution when the source is patient
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Patient deductible value.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-deductible-profile.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-deductible-profile.insuranceCarrier.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-deductible-profile.insuranceDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-deductible-profile.patientDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-deductible-profile.patient, athena-deductible-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from Base

Summary

Mandatory: 0 element(4 nested mandatory elements)
Must-Support: 3 elements

Differential View

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-deductible-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
... pid S 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference 0..1 string Reference to the Patient
.... display 0..1 string Patient name
... patientProfileId SΣ 1..1 integer Patient specific id for practice management data including financial information
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure Code
... payer 0..1 string Information of Payer
... paymentSource 0..1 string Payor type indentification
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... batchName 0..1 integer The batch associated to the Deductible file.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Eligibility of cardnumber for payment processing
... checkDate 0..1 dateTime Reference the payment date.
... notes 0..1 string The note associated with the transaction.
... financialClass 0..1 string The actual contents of Financial class.
... insuranceCarrier 0..1 Reference(Organization) Insurance carrier reference
.... reference 0..1 string Insurance Carrier Id refering to Organization
.... display 0..1 string Insurance carrier Name
... insuranceDeductible 0..1 Money The Deductible amount distribution
.... value 0..1 decimal Insurance deductible amount
.... currency 0..1 code Currency
... patientDeductible 0..1 Money The total amount of the distribution when the source is patient
.... value 0..1 decimal Patient deductible value.
.... currency 0..1 code Currency

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-deductible-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
... pid S 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference ΣC 0..1 string Reference to the Patient
.... display Σ 0..1 string Patient name
... patientProfileId SΣ 1..1 integer Patient specific id for practice management data including financial information
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure Code
... payer 0..1 string Information of Payer
... paymentSource 0..1 string Payor type indentification
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... batchName 0..1 integer The batch associated to the Deductible file.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Eligibility of cardnumber for payment processing
... checkDate 0..1 dateTime Reference the payment date.
... notes 0..1 string The note associated with the transaction.
... financialClass 0..1 string The actual contents of Financial class.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier reference
ref-1: SHALL have a contained resource if a local reference is provided
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... display Σ 0..1 string Insurance carrier Name
... insuranceDeductible 0..1 Money The Deductible amount distribution
.... value Σ 0..1 decimal Insurance deductible amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientDeductible 0..1 Money The total amount of the distribution when the source is patient
.... value Σ 0..1 decimal Patient deductible value.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-deductible-profile.insuranceDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-deductible-profile.patientDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-deductible-profile.patient, athena-deductible-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-deductible-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
... pid S 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Reference to the Patient
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Patient name
... patientProfileId SΣ 1..1 integer Patient specific id for practice management data including financial information
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure Code
... payer 0..1 string Information of Payer
... paymentSource 0..1 string Payor type indentification
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... batchName 0..1 integer The batch associated to the Deductible file.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Eligibility of cardnumber for payment processing
... checkDate 0..1 dateTime Reference the payment date.
... notes 0..1 string The note associated with the transaction.
... financialClass 0..1 string The actual contents of Financial class.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier reference
ref-1: SHALL have a contained resource if a local reference is provided
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Insurance carrier Name
... insuranceDeductible 0..1 Money The Deductible amount distribution
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Insurance deductible amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientDeductible 0..1 Money The total amount of the distribution when the source is patient
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Patient deductible value.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-deductible-profile.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-deductible-profile.insuranceCarrier.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-deductible-profile.insuranceDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-deductible-profile.patientDeductible.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-deductible-profile.patient, athena-deductible-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from Base

Summary

Mandatory: 0 element(4 nested mandatory elements)
Must-Support: 3 elements

 

Other representations of profile: CSV, Excel

Notes:

Supported Interactions

The Interactions supported by this resource are listed below.

Search Parameters

Search parameters are executed as specified in the HL7 FHIR RESTful API implementation definition. To search for Deductible resources, an application shall perform an HTTP GET, specifying the query parameters associated with the resource.

GET [base]/customresource/Deductible?{search-parameters}

Where:

Name Description
[base] Specifies the base URL of the FHIR Server, e.g., https://ap22sandbox.athenahealth.com/demoAPIServer
_id (token) The ID of the resource
patientProfileId known id of the patient.
patient (reference) The patient this person is related to.
[_include] Specifies the supported hl7 resources include which are defined as reference in examples. Note: The Patient and Organization resources are supported via the _include parameter.
HTTP Response Codes

The following HTTP response codes are returned by this API call:

200 OK The query was performed and any results found are contained within the body of the HTTP response. Note: The search API will return 200 OK when the query itself is successful, regardless of whether or not any matching results were found.
401 Unauthorized Authorization is required for this request, and either the Authorization header is missing or the supplied user credentials in the Authorization header are not valid or have expired. The body of the HTTP response will contain an OperationOutcome resource that indicates that Authorization is required.
500 Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.