Shadow Bill Extension¶
| Canonical | ../StructureDefinition/oscar-billing-shadow-bill-extension |
|---|---|
| Status | draft · 1.26.0 |
| Base | Extension (constraint) |
| Context | Invoice (element) |
| Source | FSH · JSON |
True when the Invoice represents a shadow bill (capitated FHO/FHN submission) rather than a regular FFS claim. Derived from Oscar billing status H (Capitated).
FSH
The authored source of truth: extensions/ShadowBillExtension.fsh (edit on GitHub). One FSH file may define several related artifacts.
// ShadowBillExtension.fsh
// Boolean flag on Invoice indicating whether the invoice represents a shadow bill
// (capitated FHO/FHN submission) rather than a regular FFS claim.
Extension: ShadowBillExtension
Id: oscar-billing-shadow-bill-extension
Title: "Shadow Bill Extension"
Description: "True when the Invoice represents a shadow bill (capitated FHO/FHN submission) rather than a regular FFS claim. Derived from Oscar billing status `H` (Capitated)."
* ^url = "../StructureDefinition/oscar-billing-shadow-bill-extension"
* ^status = #draft
* ^date = "2026-04-21"
* ^publisher = "WELLSTAR Technologies Corp."
* ^contact.name = "Nexus EMR FHIR Implementation Guide"
* ^contact.telecom.system = #url
* ^contact.telecom.value = ".."
* ^jurisdiction = urn:iso:std:iso:3166#CA "Canada"
* ^context[0].type = #element
* ^context[0].expression = "Invoice"
* . ^short = "Shadow bill indicator"
* . ^definition = """
True when the Invoice represents a shadow bill — a capitated submission under Ontario's
FHO/FHN models where payment is via capitation and the bill is submitted for tracking and
utilization-reporting purposes only. Derived from Oscar Pro's `billing_on_cheader1.status = 'H'`
(Capitated).
When true, `Invoice.totalGross` reflects the shadow bill value (typically a fraction of the FFS
rate under FHO/FHN capitation; exact percentages are set by Ontario MoH policy and not encoded
in Oscar source — consult the OHIP Schedule of Benefits + the relevant MoH contract). Consumers
should not expect a payment remittance for shadow bills.
"""
* extension 0..0
* url 1..1
* value[x] 1..1 MS
* value[x] only boolean
* valueBoolean ^short = "Whether this invoice is a shadow bill"
* valueBoolean ^definition = "True if this invoice represents a shadow bill (capitated submission), false otherwise."