BAR^P05 — Update Account

The patient financial account evolves mid-stay: secondary coverage added, diagnosis corrected, guarantor changed. P05 propagates the update to billing.

Purpose

P05 updates a patient account already created by a P01 (or a prior P03). Use it to propagate any change to the financial record:

• insurance coverage add / change / remove (IN1/IN2/IN3);
• guarantor change (GT1);
• admission diagnosis correction or comorbidity addition (DG1);
• performed procedure addition (PR1);
• billing-relevant demographic update (PID-11 address).

Segment structure

BAR_P05
  MSH                    Message Header (mandatory)
  [ SFT ]                Software Segment (optional)
  EVN                    Event Type (mandatory)
  {                      Account loop (1..n)
    PID                  Patient Identification
    [ PD1 ]              Patient Additional Demographics
    [ { ROL } ]          Role (repeatable)
    [ PV1 ]              Patient Visit
    [ PV2 ]              Patient Visit - Additional Info
    [ { DB1 } ]          Disability (repeatable)
    [ { OBX } ]          Observation (repeatable)
    [ { AL1 } ]          Allergy (repeatable)
    [ { DG1 } ]          Diagnosis (repeatable)
    [ DRG ]              Diagnosis Related Group
    [ { PR1 [ { ROL } ] } ] Procedure (repeatable)
    [ { GT1 } ]          Guarantor (repeatable)
    [ { NK1 } ]          Next of Kin (repeatable)
    [ { IN1 [IN2] [IN3] } ] Insurance (repeatable)
    [ ACC ]              Accident
    [ UB1 ]              UB82 Data
    [ UB2 ]              UB92 Data
  }

Real-world example

Add Medigap coverage to patient John A. Doe's account, plus a secondary diagnosis (acute kidney injury N17.9) discovered during the stay:

MSH|^~\&|HIS|HOSP01|BILLING|HOSP01|20260516120000||BAR^P05^BAR_P05|MSG00013001|P|2.5.1
EVN|P05|20260516120000|||USER001^Smith^John^^^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|MED^205^B^HOSP01|EM|||DRSMITH^Smith^James^A^^DR.|||MED|||1|||DRSMITH^Smith^James^A^^DR.|ADM|||||||||||||||||||HOSP01|||||20260514102530
DG1|1||I21.0^Acute transmural MI of anterior wall^I10|||F
DG1|2||N17.9^Acute kidney failure, unspecified^I10|||F
IN1|2|MEDIGAP^Medigap Plan F^HL70072|MGAP9876|MEDIGAP|^^^Medigap Insurance^Boston^MA^02101||||||20260601|20271231||SE^Self^HL70063|DOE^JOHN^A^^MR.|18^Self^HL70063|19720515

Acknowledgment (ACK)

MSH|^~\&|BILLING|HOSP01|HIS|HOSP01|20260516120001||ACK^P05^ACK|ACK00013001|P|2.5.1
MSA|AA|MSG00013001

P05 vs P01 / P03

Common errors

• P05 sent before P01: invalid; the receiver has no account to update.
• Snapshot vs delta: some senders ship the full snapshot in P05, others only the delta. Agree on a convention with the receiver.
• IN1 set ID (IN1-1) changed: trap when multiple coverages exist — IN1-1 must stay consistent to identify which coverage to update.

Related BAR events

See also: BAR^P01, BAR^P06, and FHIR Account.