Billing Use Cases (BILL)¶
UC-BILL-001: Fetch Tariff From HIS¶
Purpose: Query hospital tariff master for pricing.
| Property | Value |
|---|---|
| Actor | Billing Integration Service |
| Trigger | Billable item identified |
| Priority | P1 |
Main Success Scenario:
1. Extract procedure/consultation code from encounter
2. Query HIS tariff API with code
3. Receive price, tax, insurance coverage
4. Cache tariff for session
Acceptance Criteria: 1. [ ] Supports multiple tariff schemes 2. [ ] Cache TTL: 24 hours 3. [ ] Falls back to default pricing if API unavailable
UC-BILL-002: Generate Billable Item From Encounter¶
Purpose: Extract billable procedures/consultations from note.
| Property | Value |
|---|---|
| Actor | Billing Extraction Service |
| Trigger | Encounter note approved |
| Priority | P1 |
Main Success Scenario:
1. Parse approved encounter note
2. Extract billable items:
- Consultation type (OPD/IPD)
- Procedures performed
- Medications prescribed
3. Map items to billing codes
4. Create billing line items
5. Enqueue to billing queue
Acceptance Criteria: 1. [ ] Captures all billable events 2. [ ] Supports custom billing rules 3. [ ] Audit trail for billing changes
UC-BILL-003: Publish Billing Event to HIS¶
Purpose: Push charges to billing system.
| Property | Value |
|---|---|
| Actor | HIS Integration Service |
| Trigger | Billing items ready |
| Priority | P1 |
Main Success Scenario:
1. Build billing payload (HL7 DFT or API format)
2. POST to HIS billing endpoint
3. Receive acknowledgment
4. Update billing status to "POSTED"
5. Handle errors with retry logic
Acceptance Criteria: 1. [ ] Supports HL7 DFT and REST APIs 2. [ ] Retry logic: 3 attempts 3. [ ] Billing reconciliation report available