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Background

Providers’ Practice Management Systems generate patient statements once a month to request payment from their patients (after the claims, etc have been submitted and adjudicated. These patient statements are typically printed and mailed to patients.

 

Currently, Practice Management Systems support the following modes:

 

We want to send a notification to patients that they have a bill and then pull the live amount.

 

https://developers.instamed.com/consumer-billing/estatements-presentment/

In house printing (and portal)

 

 

 

 

 

 

 

 

Outsourced printing & mailing only

 

PMS generates a data file which a 3rd party parses, prints and mails statements, and optionally sends via eStatement

 

 

Outsourced Portal and Print/Mail [1] [2] [3]

 

 

 

Future Mode (Proposed) - Centralized Patient Account Ledger

 

 

 

Invoice / Balance Flow (Auto Pay)

 

Data Model

Patient Statement Request

Patient Statement

 

Column

Nullable

DataType

Length

Precision

PKRawPatientStatements

NO

bigint

NULL

19

FKClientIDProviderIDMapping

NO

int

NULL

10

Status

NO

varchar

25

NULL

StatementDate

NO

date

NULL

NULL

DueDate

YES

date

NULL

NULL

StatementNumber

YES

varchar

100

NULL

StatementAccountNumber

NO

varchar

80

NULL

AmountDue

NO

money

NULL

19

TotalCharge

YES

money

NULL

19

TotalDiscount

YES

money

NULL

19

TotalPayerPayment

YES

money

NULL

19

TotalPayerAdjustment

YES

money

NULL

19

TotalPatientPayment

YES

money

NULL

19

PatientResponsibility

YES

money

NULL

19

BalanceCurrent

YES

money

NULL

19

Balance30To60

YES

money

NULL

19

Balance60To90

YES

money

NULL

19

BalanceOver90

YES

money

NULL

19

ProviderRemitAddress1

NO

varchar

150

NULL

ProviderRemitAddress2

YES

varchar

55

NULL

ProviderRemitCity

NO

varchar

30

NULL

ProviderRemitStateOrProvince

NO

varchar

50

NULL

ProviderRemitZip1

NO

varchar

10

NULL

ProviderRemitZip2

YES

varchar

4

NULL

ProviderRemitCountry

YES

varchar

50

NULL

ProviderReturnAddress1

NO

varchar

150

NULL

ProviderReturnAddress2

YES

varchar

55

NULL

ProviderReturnCity

NO

varchar

30

NULL

ProviderReturnStateOrProvince

NO

varchar

50

NULL

ProviderReturnZip1

NO

varchar

10

NULL

ProviderReturnZip2

YES

varchar

4

NULL

ProviderReturnCountry

YES

varchar

50

NULL

ProviderOfficeAddress1

YES

varchar

150

NULL

ProviderOfficeAddress2

YES

varchar

55

NULL

ProviderOfficeCity

YES

varchar

30

NULL

ProviderOfficeStateOrProvince

YES

varchar

50

NULL

ProviderOfficeZip1

YES

varchar

10

NULL

ProviderOfficeZip2

YES

varchar

4

NULL

ProviderOfficeCountry

YES

varchar

50

NULL

RecipientFirstName

NO

varchar

25

NULL

RecipientMiddleName

YES

varchar

25

NULL

RecipientLastName

NO

varchar

80

NULL

RecipientAddress1

NO

varchar

150

NULL

RecipientAddress2

YES

varchar

55

NULL

RecipientCity

NO

varchar

30

NULL

RecipientStateOrProvince

NO

varchar

50

NULL

RecipientZip1

NO

varchar

10

NULL

RecipientZip2

YES

varchar

4

NULL

RecipientCountry

YES

varchar

50

NULL

RecipientPhone

YES

varchar

20

NULL

RecipientMobilePhone

YES

varchar

20

NULL

RecipientEmailAddress

YES

varchar

200

NULL

MessageHeader1

YES

varchar

150

NULL

MessageDetail1

YES

varchar

256

NULL

MessageHeader2

YES

varchar

150

NULL

MessageDetail2

YES

varchar

256

NULL

MessageHeader3

YES

varchar

150

NULL

MessageDetail3

YES

varchar

256

NULL

MessageHeader4

YES

varchar

150

NULL

MessageDetail4

YES

varchar

256

NULL

MessageHeader5

YES

varchar

150

NULL

MessageDetail5

YES

varchar

256

NULL

DynamicField1

YES

varchar

25

NULL

DynamicField2

YES

varchar

25

NULL

DynamicField3

YES

varchar

25

NULL

DynamicField4

YES

varchar

25

NULL

IsLocked

YES

bit

NULL

NULL

LockTime

YES

datetime

NULL

NULL

FKStatementFiles

YES

bigint

NULL

19

 

Visits

 

 

Column

Nullable

DataType

Length

Precision

PKRawPatientStatementVisits

NO

bigint

NULL

19

FKRawPatientStatementPatients

NO

bigint

NULL

19

VisitNumber

YES

varchar

80

NULL

StartDate

YES

date

NULL

NULL

EndDate

YES

date

NULL

NULL

TotalCharge

YES

money

NULL

19

TotalDiscount

YES

money

NULL

19

TotalPayerPayment

YES

money

NULL

19

TotalPayerAdjustment

YES

money

NULL

19

TotalPatientPayment

YES

money

NULL

19

PatientResponsibility

YES

money

NULL

19

TotalBalance

YES

money

NULL

19

LastPaymentDate

YES

date

NULL

NULL

ServiceProviderName

YES

varchar

150

NULL

MessageHeader1

YES

varchar

150

NULL

MessageDetail1

YES

varchar

256

NULL

MessageHeader2

YES

varchar

150

NULL

MessageDetail2

YES

varchar

256

NULL

MessageHeader3

YES

varchar

150

NULL

MessageDetail3

YES

varchar

256

NULL

MessageHeader4

YES

varchar

150

NULL

MessageDetail4

YES

varchar

256

NULL

MessageHeader5

YES

varchar

150

NULL

MessageDetail5

YES

varchar

256

NULL

 

 

Provider [4] [5]

 

 

Column

Nullable

DataType

Length

Precision

PKRawPatientStatementProviders

NO

bigint

NULL

19

FKRawPatientStatements

NO

bigint

NULL

19

ProviderName

NO

varchar

150

NULL

LocationAddress1

YES

varchar

150

NULL

LocationAddress2

YES

varchar

55

NULL

LocationCity

YES

varchar

30

NULL

LocationStateOrProvince

YES

varchar

50

NULL

LocationZip1

YES

varchar

10

NULL

LocationZip2

YES

varchar

4

NULL

LocationCountry

YES

varchar

50

NULL

 

 

Patient

 

 

Column

Nullable

DataType

Length

Precision

PKRawPatientStatementPatients

NO

bigint

NULL

19

FKRawPatientStatementProviders

NO

bigint

NULL

19

PatientFirstName

YES

varchar

25

NULL

PatientMiddleName

YES

varchar

25

NULL

PatientLastName

YES

varchar

80

NULL

PatientAccountNumber

NO

varchar

80

NULL

PatientDOB

YES

date

NULL

NULL

MasterPatientAccountID

YES

varchar

80

NULL

GuarantorID

YES

varchar

80

NULL

GuarantorFirstName

YES

varchar

25

NULL

GuarantorLastName

YES

varchar

80

NULL

InsuranceName

YES

varchar

150

NULL

InsuranceGroupPlan

YES

varchar

100

NULL

InsuranceIDNumber

YES

varchar

100

NULL

Insurance2Name

YES

varchar

150

NULL

Insurance2GroupPlan

YES

varchar

100

NULL

Insurance2IDNumber

YES

varchar

100

NULL

StartDate

YES

date

NULL

NULL

EndDate

YES

date

NULL

NULL

TotalCharge

YES

money

NULL

19

TotalDiscount

YES

money

NULL

19

TotalPayerPayment

YES

money

NULL

19

TotalPayerAdjustment

YES

money

NULL

19

TotalPatientPayment

YES

money

NULL

19

PatientResponsibility

YES

money

NULL

19

TotalBalance

YES

money

NULL

19

LastPaymentDate

YES

date

NULL

NULL

ServiceProviderName

YES

varchar

150

NULL

MessageHeader1

YES

varchar

150

NULL

MessageDetail1

YES

varchar

256

NULL

MessageHeader2

YES

varchar

150

NULL

MessageDetail2

YES

varchar

256

NULL

MessageHeader3

YES

varchar

150

NULL

MessageDetail3

YES

varchar

256

NULL

MessageHeader4

YES

varchar

150

NULL

MessageDetail4

YES

varchar

256

NULL

MessageHeader5

YES

varchar

150

NULL

MessageDetail5

YES

varchar

256

NULL

PatientPrefix

YES

varchar

25

NULL

PatientSuffix

YES

varchar

25

NULL

GuarantorPrefix

YES

varchar

25

NULL

GuarantorMiddleName

YES

varchar

25

NULL

GuarantorSuffix

YES

varchar

25

NULL

 

 

 

 

Line Items

 

Column

Nullable

DataType

Length

Precision

PKRawPatientStatementLineItems

NO

bigint

NULL

19

FKRawPatientStatementVisits

YES

bigint

NULL

19

FKRawPatientStatementPatients

YES

bigint

NULL

19

ServiceStartDate

YES

date

NULL

NULL

ServiceEndDate

YES

date

NULL

NULL

EventDate

YES

date

NULL

NULL

ProcedureCode

YES

varchar

10

NULL

ProcedureDescription

YES

varchar

200

NULL

LineItemType

NO

varchar

50

NULL

Amount

NO

money

NULL

19

 

Patient Statement Response

Statement Files

 

Column

Nullable

DataType

Length

Precision

PKStatementFiles

NO

bigint

NULL

19

FKClientIDProviderIDMapping

NO

int

NULL

10

Filename

NO

varchar

200

NULL

ReceivedDate

NO

datetime

NULL

NULL

Status

NO

varchar

25

NULL

AcceptedCount

NO

int

NULL

10

ErrorCount

NO

int

NULL

10

RejectionReason

YES

varchar

350

NULL

 


[1] Statements are typically sent at dunning intervals. Collection agency use cases should be added.

[2] Collection agencies may need to be notified that a statement has been paid.

[3] Identify individuals as "Do not Dunn"

[4] how is this used?

[5] it is linked to the patient