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Invoice Profile

Canonical../StructureDefinition/nexus-emr-core-invoice
Statusdraft · 1.26.0
BaseInvoice (constraint)
CQL primary code pathtype — what this means
SourceFSH · JSON

Nexus EMR profile for Invoice representing Canadian provider-side billing records. Aligned with Oscar Pro's billing model: one invoice per claim header, with its line items inline. Phase 1 scope: Ontario OHIP billing via Oscar Pro.

Overview

Handbook: Oscar Billing

The narrative treatment -- what this is for, why it is shaped this way, and how it is used.

Nexus EMR Core Invoice Profile

Overview

The Nexus EMR Core Invoice profile represents Canadian provider-side billing records — the header and line items a physician submits or records for services provided. Aligned with Oscar Pro's existing InvoiceConverter emission so that source tables (billing_on_cheader1 + billing_on_item) map cleanly to Invoice + inline Invoice.lineItem[].

Key Features

  • Header + inline line items — one Invoice per billing_on_cheader1 header, with Invoice.lineItem[] components per billing_on_item row; no separate ChargeItem resource
  • Canonical FHIR status + rich Oscar extension — Invoice.status uses FHIR's required binding (draft|issued|balanced|cancelled|entered-in-error); the 10-code Oscar enum (H|O|P|N|W|B|S|X|D|I) is preserved via the oscarBillingStatus extension
  • Shadow-bill indicator — shadowBill boolean extension on Invoice flags FHO/FHN capitated submissions (Oscar status H)
  • Pay program extension — payProgram extension carries Oscar's pay_program code
  • OHIP fee codes — lineItem.chargeItemCodeableConcept.coding sliced for OHIP Schedule of Benefits codes
  • Per-line diagnostic codes — up to 3 dx codes per line via DIAGNOSTIC_1/2/3 extensions (Oscar product feature)

Mapping to Source

See the Oscar Billing feature section under Guide → Features for the full field-by-field mapping between billing_on_cheader1 + billing_on_item and this profile (Oscar → FHIR and FHIR → Oscar directions), and the Write-Back Design page for the Jarvis → Oscar round-trip state machine.

Terminology bindings

Path Strength Value set
Invoice.type.coding.code extensible Oscar Pay Program Value Set