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iEHR Fiscus: Financials & Coverage

As healthcare evolves toward precision and digital integration, financial data must keep pace. iEHR Fiscus emerges as a forward-thinking solution on the iEHR platform, delivering modular support for FHIR®-based financial workflows - from billing and coverage to patient cost estimation and remittance advice.

PatientRelatedPersonOrganizationAccountCoverageContractInvoice,Charge ItemPaymentNoticePaymentReconciliationClaim ResponseClaim

Fiscus bridges the gap between clinical and financial systems, ensuring transparency, standardization, and efficient revenue cycle management in healthcare IT environments.

Built on HL7 FHIR Financial Resources​

iEHR Fiscus is built entirely on HL7 FHIR R5 Financial modules, including:

  • Coverage, Claim, ClaimResponse
  • ExplanationOfBenefit, PaymentNotice, PaymentReconciliation
  • ChargeItem, ChargeItemDefinition
  • InsurancePlan, Account, Invoice

Core Value of FHIR-Based Finance:​

  • Interoperability: Aligns seamlessly with payer, provider, and clearinghouse systems.
  • Auditability: Structured traceability of financial events across encounters.
  • Real-Time Insights: Enables revenue cycle analytics from FHIR-native data.

Key Modules in iEHR Fiscus​

Claims Management Engine​

  • Submits FHIR Claims for procedures, medications, labs, etc.
  • Receives ClaimResponse objects with adjudication details from payers.
  • Supports batch and asynchronous claim processing with built-in retries.

Coverage & Eligibility Service​

  • Manages insurance Coverage data linked to patients.
  • Integrates with payers via CoverageEligibilityRequest and Response.
  • Real-time eligibility verification during appointment scheduling.

Payment & Reconciliation Hub​

  • Posts PaymentNotice and PaymentReconciliation from remittances.
  • Maps financial resources back to clinical encounters and services.
  • Supports reconciliation reporting and cross-walks to EOBs.

Pricing & Cost Estimation​

  • Uses ChargeItemDefinition to model service pricing.
  • Allows dynamic ChargeItem creation during encounters.
  • Generates pre-treatment cost estimates based on coverage rules and insurance plans.

Integration Capabilities​

FeatureDescription
RESTful & GraphQL APIsStandard endpoints for financial resource operations.
SMART-on-FHIR HooksTrigger billing events within clinical apps.
EHR Connector LibraryPre-built adapters for Cerner, Epic, and Meditech.

Use Cases​

  • Payer Claim Adjudication: Automate FHIR-native claims submission and response parsing.
  • Cost Estimation Tools: Deliver real-time out-of-pocket cost estimates for patients.
  • Hospital Billing Automation: Generate invoices and link charge items to orders.
  • Revenue Cycle Analytics: Feed normalized FHIR financial data into BI pipelines.

Conclusion​

By adopting FHIR for financial data exchange, iEHR Fiscus enables healthcare providers and payers to harmonize operations, reduce administrative overhead, and enhance patient transparency. It’s not just a financial engine - it’s a future-ready framework for digital reimbursement in health IT.

Interested in a demo or implementation guide? Let’s connect!

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