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Purpose is to document answers provided to inquiries about FM WG and artifacts that may be useful to others.

  • What is the status of FM Domain standards?

The HL7 v.3 Accounting and Billing Domain (FIAB) and the complimentary domain for Claims and Reimbursement (FICR)were reaffirmed as an HL7/ANSI standard in 2011.

The FIAB topic covers the creation and management of patient billing accounts, primarily for the purpose of collecting charges and credits (financial transactions) to support the submission of a claim or invoice for reimbursement.

The FICR topic covers the conversion of a patient billing account invoices into various transactions between a healthcare provider and a health insurer/payer about reimbursement for services rendered to the patient.

FM has proposed an additional topic for Coverage [FICO], which includes A_Coverage CMETs.

Here is a summary about FICR and its relationship to FIAB and FICO:

The Claims and Reimbursement (CR) Domain is one of several areas within Healthcare Services for which HL7 is defining messaging standards. CR pertains to the invoicing (including authorization and eligibility verification), adjudication and payment (including adjustments and account queries) of Healthcare Services.

The CR domain is one of two financial domains that make up the Financial (FI) sub-section within the Administrative Management (AM) section. Financial Accounts and Billing (FIAB) is the domain for patient accounting (charges, etc.) whereas FICR deals with requests for payments (claims, invoices).

All HL7 v.3 FM topics map in part to HL7 v.2 Chapter 6 and 16, which cover most of the FM domain in the HL7 v.2 standard that are not within Patient Administration WG scope.

FM is currently working on FM FHIR resources for FIAB Invoices, which include Billable Services (based on v.3 A_Billable Service CMETs), and FICR eClaims and patient Explanation of Benefits.

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