BAR^P03 — Update Patient Account

The message that notifies an update to an existing patient account: insurance change, guarantor addition, diagnosis update, coverage cap change.

Purpose

BAR^P03 updates the financial data of an already-created patient account (by BAR^P01 or ADT^A01). Typical cases:

• The patient changes primary insurance mid-stay.
• An additional guarantor is added (employer, parent).
• A primary diagnosis is requalified (ICD-10 updated).
• A coverage is cancelled (insurer denies).
• A supplemental file is opened (Medicaid, charity care...).

Whereas BAR^P01 creates an account from scratch, BAR^P03 updates it. ADT^A08 is the demographic counterpart on the patient side.

Segment structure

The abstract structure BAR_P02 (shared with BAR^P01):

BAR_P02
  MSH                    Message Header (mandatory)
  [ SFT ]                Software Segment (optional)
  EVN                    Event Type (mandatory)
  { PID                  Patient Identification (mandatory)
    [ PD1 ]              Patient Additional Demographics
    [ { ROL } ]          Role
    PV1                  Patient Visit (mandatory)
    [ PV2 ]
    [ { ROL } ]
    [ { DB1 } ]
    [ { OBX } ]
    [ { AL1 } ]
    [ { DG1 } ]
    [ DRG ]
    [ { GT1 } ]          Guarantor
    [ { NK1 } ]
    { [ { IN1 [IN2] [{IN3}] } ] }  Insurance
    [ { ACC } ]
    [ { UB1 | UB2 } ]
  }

MSH — Message Header

• MSH-9: BAR^P03^BAR_P02.
• MSH-12: 2.5.1.
• MSH-15/16: AL + NE typical in real-time push.

EVN — Event Type

• EVN-1: P03.
• EVN-2: HIS timestamp (CCYYMMDDHHMMSS).
• EVN-5: operator that triggered the update.

PID — Patient Identification

Identifies the patient owning the account. PID-3 (CX), PID-5 (XPN), PID-18 (patient account number).

PV1 — Patient Visit

Encounter context. PV1-19 (visit number, CX) must match the existing visit.

Financial segments (GT1, IN1, IN2)

• GT1 — Guarantor: financial guarantor.
  • GT1-2: guarantor number (CX).
  • GT1-3: guarantor name (XPN).
  • GT1-11: relationship to patient (table 0063: SLF=Self, SPO=Spouse, EMR=Employer...).
• IN1 — Insurance: insurance information.
  • IN1-2: plan identifier (table 0072).
  • IN1-3: insurance company identifier.
  • IN1-17: insured's relationship to patient.
  • IN1-22: coordination of benefits code (1=Primary, 2=Secondary).
  • IN1-36: policy number.
• IN2 — Insurance Additional Information: subscriber SSN, employer, extra options.

Real-world example

Update of account ACCT123456 for John Doe during an ICU stay: add a secondary dental coverage via spouse, requalify primary diagnosis as ICD-10 E11.9 (type 2 diabetes):

MSH|^~\&|HIS|HOSP01|SAP|FIN|20260514103000||BAR^P03^BAR_P02|MSG00000020|P|2.5.1|||AL|NE
EVN|P03|20260514103000|||DRJONES^Jones^Sarah^^^DR.
PID|1||MRN567890^^^HOSP^MR||DOE^JOHN^A^^MR.||19720515|M|||100 MAIN ST^^ANYTOWN^CA^90210^USA||(555)555-1234|||S||ACCT123456|123-45-6789
PV1|1|I|ICU^101^A^HOSP01|||||||CAR|||||||||VISIT00789||||||||||||||||||HOSP01|||||20260514102530
GT1|1|GUAR98765|DOE^JOHN^A^^MR.||100 MAIN ST^^ANYTOWN^CA^90210^USA|(555)555-1234||19720515|M||SLF^Self|123-45-6789
IN1|1|PRIM|ACME-HMO|Acme HMO Insurance|PO BOX 100^^CITY^CA^90000|||GROUP01||||||||DOE^JOHN^A|SELF|19720515|100 MAIN ST^^ANYTOWN^CA^90210^USA|||1|||||||Y|20260101|||||||||MEM987654321
IN2|1||||||||EMP123|Acme Corp
IN1|2|SEC|ACME-DENTAL|Acme Dental|PO BOX 200^^CITY^CA^90000|||GROUP-D02||||||||DOE^JOHN^A|SPOUSE|19750810|100 MAIN ST^^ANYTOWN^CA^90210^USA|||2|||||||Y|20260101|||||||||DEN456789012
DG1|1|I10|E11.9|Type 2 diabetes mellitus without complications|20260514|F

• MSH: HIS HOSP01 to SAP FIN, P03, 2.5.1.
• EVN: P03 recorded at 10:30 by DRJONES.
• PV1-19 = VISIT00789: same visit number as the originating A01 admission, guaranteed correlation.
• GT1: patient is his own guarantor (SLF).
• IN1 #1 PRIM: Acme HMO, primary plan, policy number MEM987654321.
• IN1 #2 SEC: Acme Dental, secondary via spouse.
• DG1: final primary diagnosis E11.9 (type 2 diabetes without complications), ICD-10.

Common errors

• BAR^P03 with no existing account: the receiver looks up PV1-19 and rejects if no BAR^P01 or A01 came before.
• Inconsistent IN1-22: two IN1 with 1 (Primary) without transition: COB ambiguity.
• Missing GT1-11: without relationship, the biller cannot tell self-pay from third-party.
• DG1-6 missing: diagnosis type (A=Admitting, F=Final) — an F diagnosis before discharge is ambiguous.
• IN1/IN2 ordering off: IN2 describes the IN1 subscriber; order must be strict (IN1 #n followed by IN2 #n).

Related BAR events

See also: BAR^P01 — Add Patient Account for initial creation, and ADT^A08 for demographic patient updates.