How do clinical care and financial records stay connected across departments?

A shared patient and encounter link requests, specimens, reports, medication, procedures and stock activity. Authorized service evidence supports charge capture and the financial follow-up. The four hospital journeys show separate owners and records for care, charges, invoices, claims, payer advice and cash; a claim acceptance is not a payment.

THE MANSOQ PLATFORM

Every department, connected.

Specialist work, connected to the person and the next team.

Follow four complete hospital journeys

Operating Room

Connect preparation, intervention and recovery around the person.

Case booking
Preparation
Procedure
Consumables
Recovery handover

Explore this scope

01 / 06

FOUR CONNECTED HOSPITAL CASES

The care journey. The financial journey. Together.

Follow the person through the hospital—and the evidence from each department through billing and payment.

Illustrative hospital workflows · care and finance

CASE 01 / 04

One urgent admission. Every handover connected.

An emergency admission moves through investigations, an indicated procedure, critical care and recovery. The same encounter connects departmental evidence to financial follow-up.

Care setting: Emergency · theatre · ICU · ward
Financial route: Insured admission with unresolved eligibility at arrival
Connected stages: 8 · care + finance at every step

Select a department to see its role and highlight its connected stages. Every stage keeps care and finance side by side.

What must be configured before this case works?

Configure emergency, theatre, ICU and ward locations; name the receiving teams, permissions and local escalation procedures.
Prepare test and imaging catalogues, medication units, stock lots and performed-service mappings. Verify the chosen device and PACS interfaces separately.
Publish the applicable payer contracts, benefits, tariffs and coding mappings; assign an owner to missing insurance facts and external onboarding.

Setup instructions, CSV templates & acceptance checks

Patient & careFinancial activity

One patient and encounter connect both tracks. Care, charges and settlement keep their own review states.Download journey diagram

01
Receive & identify
The patient or family receives a named contact while urgent assessment starts.
CARE TEAM
Open the emergency encounter, review identity and record the clinical team. Follow the accepted temporary-identity procedure when demographics are incomplete.
Owner
Patient access team
Evidence passed forward
Patient identifier · encounter · location · responsible team
FINANCIAL ACTIVITY
Check coverage and record what is known, missing and time-stamped. Route unresolved eligibility to a reviewer alongside clinical assessment.
Owner
Revenue cycle team
Financial record / state
Coverage evidence · eligibility response or review task
The next team receives the encounter identity and unresolved responsibilities; financial uncertainty remains visible.
Emergency Care MANSOQ Core Patient Access
02
Investigate in parallel
The patient is told which investigations are requested and who will review them.
CARE TEAM
Link laboratory requests to collected specimens and imaging requests to accession and study identifiers. Return reviewed reports to the ordering encounter.
Owner
Clinician & nurse
Evidence passed forward
Request → specimen or study → report → reviewer
FINANCIAL ACTIVITY
Map completed activity to configured services and applicable coding. Keep requested, cancelled and performed work distinct; review authorization requirements.
Owner
Billing & coding team
Financial record / state
Performed-service evidence · charge candidate · approval status
Clinical review owns the next care decision. A report and a charge review remain separate states.
Laboratory Radiology Orders, Results & Medication
03
Prepare & perform the procedure
The patient receives the team’s explanation and the required consent process.
CARE TEAM
Record the team, theatre, preparation, consent references and safety checks. Document the performed procedure, medication and actual consumables for recovery.
Owner
Surgical, anesthesia & recovery teams
Evidence passed forward
Procedure record · checklist · medication · supply usage
FINANCIAL ACTIVITY
Review procedure and consumable evidence against tariff and contract rules. Remove unused planned items from charge consideration and track changes in authorized scope.
Owner
Billing & coding team
Financial record / state
Service and quantity evidence · charge review · authorization amendment
Recovery receives the current treatment, procedure record and outstanding actions with named owners.
Operating Room Inventory Pharmacy
04
Receive into ICU
The family knows the receiving unit and how updates will be communicated.
CARE TEAM
Record the receiving bed, assessments, observations and investigation responsibilities. Confirm device-to-encounter mapping where a tested feed is included.
Owner
ICU & receiving ward teams
Evidence passed forward
ICU location · observations · current plan · pending reports
FINANCIAL ACTIVITY
Review location and service dates against the accepted contract and coverage. Escalate missing or exceeded authorization rather than assuming approval.
Owner
Revenue cycle team
Financial record / state
Service dates · coverage review · payer follow-up task
A transfer or shift handover names the next team and the owner of every pending report and order.
Intensive Care Inpatient Care Laboratory Radiology
05
Deliver medication & supplies
The patient receives medication under the treating team’s plan; changes are explained.
CARE TEAM
Verify prescriptions, select usable lots and record quantities actually handed over. Nursing documents administration separately; inventory records departmental issues and returns.
Owner
Pharmacist & nursing team
Evidence passed forward
Request · dispense · administration · lot movement
FINANCIAL ACTIVITY
Apply approved unit and charge rules to actual dispensing or usage evidence. Reconcile returns and partial quantities without billing the same activity twice.
Owner
Billing & coding team
Financial record / state
Actual quantities · unit conversion · charge or correction reference
The ward receives current medication, remaining supply responsibility and traceable stock records.
Pharmacy Inventory Orders, Results & Medication Intensive Care
06
Recover, transfer & leave
The patient leaves with instructions, medication information and a named follow-up contact.
CARE TEAM
Document ward transfer and discharge decisions, reconcile medication and assign outstanding reports to a follow-up owner. Clinical staff decide readiness for discharge.
Owner
Clinician & nurse
Evidence passed forward
Discharge summary · medication list · follow-up · pending-result owner
FINANCIAL ACTIVITY
Reconcile departmental evidence, coding, charges and patient-liability assumptions. Explain the financial statement and leave unresolved items with a responsible team.
Owner
Billing & coding team
Financial record / state
Reviewed charge set · invoice evidence · open financial items
Clinical discharge and financial follow-up are tracked separately, with neither silently marked complete.
Inpatient Care Intensive Care Pharmacy Laboratory
07
Submit & follow the claim
The patient can ask the responsible team about documented liability and unresolved payer decisions.
CARE TEAM
Keep clinical evidence and authorship available to authorized reviewers. Respond to a documentation query through a traceable amendment.
Owner
Clinician & nurse
Evidence passed forward
Clinical evidence · coding query · amendment history
FINANCIAL ACTIVITY
Validate the claim and submit through the activated payer route. Distinguish transport failure, business rejection and adjudicated denial; assign the appropriate correction or appeal.
Owner
Revenue cycle team
Financial record / state
Claim identity · submission · response · denial or appeal task
The team tracks a payer response against the original claim and evidence, rather than treating transmission as payment.
Revenue Cycle Management Billing & Finance NPHIES
08
Reconcile & close responsibly
The patient receives an updated balance or approved refund explanation when applicable.
CARE TEAM
Keep the follow-up owner and unresolved clinical actions visible after the encounter ends. Preserve departmental and stock corrections in the audit trail.
Owner
Clinician & nurse
Evidence passed forward
Follow-up status · corrected records · stock reconciliation
FINANCIAL ACTIVITY
Match advice, actual cash and claim lines. Investigate unmatched or partial payments, approve adjustments and retain patient balances until reconciled.
Owner
Finance & reconciliation team
Financial record / state
Advice · payment · allocation · approved adjustment · remaining balance
Close only the reconciled financial items; outstanding clinical and financial work retains an owner.
Billing & Finance Revenue Cycle Management Inventory

When the journey changes.

The clinical response and financial consequence each keep an owner and their own evidence.

Incomplete identity or coverage

Responsible team · Patient access team

Care response

Use the approved identity review and local emergency care procedure; reconcile identifiers when evidence arrives.

Financial response

Keep unknown coverage in review; do not invent benefits or a patient-liability amount.

Rejected specimen or delayed report

Responsible team · Laboratory & ordering team

Care response

Retain the request, rejection reason and recollection or follow-up owner at every transfer.

Financial response

Review actual performed work and contract rules before retaining or correcting a charge.

Device or PACS interruption

Responsible team · ICU & receiving ward teams

Care response

Use the accepted downtime record, identify delayed data and reconcile source identities after recovery.

Financial response

Review service evidence independently of interface delivery; prevent duplicate posting on replay.

Denied or partially paid claim

Responsible team · Revenue cycle team

Care response

A documentation query has an authorized clinical owner and preserves original authorship.

Financial response

Classify the denial, pursue the accepted remedy and reconcile cash; a denial is not automatically a patient charge.

What completion looks like.

CareA traceable emergency-to-ward record, reviewed reports, medication reconciliation and a discharge plan with named follow-up.

FinanceEach reviewed charge has service evidence; every claim, correction, payment and open balance can be followed back to the encounter.

CASE 02 / 04

From the clinic decision to recovery and reconciliation.

A planned procedure connects pre-operative investigation, theatre preparation, stock usage, recovery and follow-up. Estimates and approvals are reviewed again when the actual scope changes.

Care setting: Clinic · day surgery or inpatient stay · recovery
Financial route: Insured procedure; self-pay branch included
Connected stages: 8 · care + finance at every step

Select a department to see its role and highlight its connected stages. Every stage keeps care and finance side by side.

What must be configured before this case works?

Set clinic and theatre sessions, practitioners, procedure services, receiving locations, consent references and checklist responsibilities.
Prepare investigation codes, medication units, consumable lots and return rules; distinguish patient-billable items from internal costs.
Agree the procedure tariff, payer coverage and authorization route. For self-pay, define estimate expiry, deposits and approved refund rules.

Setup instructions, CSV templates & acceptance checks

Patient & careFinancial activity

One patient and encounter connect both tracks. Care, charges and settlement keep their own review states.Download journey diagram

01
Agree the procedure plan
The patient understands the proposed procedure, preparation and next appointment.
CARE TEAM
Record the assessment and procedure request, then coordinate the intended theatre session, team and care setting.
Owner
Clinician & nurse
Evidence passed forward
Clinic encounter · request · planned session · responsible clinician
FINANCIAL ACTIVITY
Review eligibility, network, benefits and tariff. Share an estimate with assumptions, verification time and unresolved amounts clearly identified.
Owner
Revenue cycle team
Financial record / state
Estimate version · coverage evidence · authorization request
Confirm the next appointment and responsibility for outstanding preparation or approval.
Outpatient Care Operating Room Patient Access
02
Complete requested investigations
The patient completes the investigations requested by the treating team and receives preparation instructions.
CARE TEAM
Track specimens and imaging studies to their requests. Review reports, record outstanding findings and document any change to the plan.
Owner
Clinician & nurse
Evidence passed forward
Specimen or study · report · clinical review · revised plan
FINANCIAL ACTIVITY
Review performed investigation services and their authorization status. Recalculate the estimate when additional accepted scope changes the expected cost.
Owner
Billing & coding team
Financial record / state
Investigation evidence · service mapping · revised estimate
The procedure team receives reviewed results or a named owner for any unresolved preparation item.
Laboratory Radiology
03
Confirm people, theatre & supplies
The patient completes the approved identity, consent and preparation checks with the team.
CARE TEAM
Confirm the theatre slot, staffing, equipment, consent references and safety checks. Inventory issues appropriate lots; pharmacy verifies procedure medication.
Owner
Surgical, anesthesia & recovery teams
Evidence passed forward
Session · checklist · supply issue · medication preparation
FINANCIAL ACTIVITY
Confirm the approval scope and expiry or the agreed self-pay deposit. A booking or stock reservation alone is not evidence that a billable service occurred.
Owner
Revenue cycle team
Financial record / state
Authorization decision or deposit · planned versus performed status
Release to the procedure follows the team’s approved checks; unresolved financial facts stay assigned for review.
Operating Room Inventory Pharmacy
04
Document what actually happened
The procedure and immediate recovery are documented by the responsible clinical team.
CARE TEAM
Document the procedure, observations, medication and actual consumable usage. Retain the request, encounter and author links for recovery and later review.
Owner
Surgical, anesthesia & recovery teams
Evidence passed forward
Procedure notes · medication · consumed lots · author
FINANCIAL ACTIVITY
Review performed procedure codes and quantities against the applicable tariff. Reconcile supply issues with usage and returns before finalizing charge candidates.
Owner
Billing & coding team
Financial record / state
Procedure evidence · coding review · quantities · return references
Recovery receives the documented procedure, current treatment and outstanding actions.
Operating Room Inventory Pharmacy
05
Recover or transfer when indicated
Includes a conditional care branch
The patient and family know whether the next step is discharge, ward care or critical care.
CARE TEAM
Record recovery and the receiving team. If ICU is needed, carry observations, medication, procedure context and pending investigations into the handover.
Owner
Surgical, anesthesia & recovery teams
Evidence passed forward
Recovery note · destination · receiving team · pending actions
FINANCIAL ACTIVITY
Review any change from day case to admission or critical care, update estimated scope and pursue the applicable authorization amendment.
Owner
Revenue cycle team
Financial record / state
Care-setting change · estimate revision · approval amendment
ICU is a conditional branch, not a routine stage of every planned procedure.
Operating Room Intensive Care Inpatient Care
06
Prepare discharge & follow-up
The patient receives discharge instructions, prescribed medication and a follow-up appointment or contact.
CARE TEAM
Reconcile medication, record instructions and assign pending reports, including procedure specimens where applicable, to a follow-up owner.
Owner
Clinician & nurse
Evidence passed forward
Discharge record · actual dispense · follow-up · report responsibility
FINANCIAL ACTIVITY
Review the final service set against the estimate, authorizations and actual dispensing. Explain approved liability and unresolved items to the patient.
Owner
Billing & coding team
Financial record / state
Reviewed service set · invoice · liability explanation
Discharge instructions and financial explanations each have a named contact.
Pharmacy Outpatient Care Inpatient Care Laboratory
07
Invoice or claim the accepted activity
The patient has a clear statement of the agreed payment route and any outstanding balance.
CARE TEAM
Keep the procedure, investigation and medication evidence available for an authorized billing or clinical documentation query.
Owner
Clinician & nurse
Evidence passed forward
Supporting notes · reports · service evidence
FINANCIAL ACTIVITY
For insurance, validate and follow the claim response. For self-pay, review invoice and deposit allocation. Use national exchanges only within their activated scope.
Owner
Billing & coding team
Financial record / state
Claim and response or invoice · deposit allocation · submission evidence
A transmitted claim or issued invoice is distinct from receipt of money.
Billing & Finance Revenue Cycle Management NPHIES ZATCA E-invoicing
08
Resolve changes, returns & balances
The patient can trace an approved adjustment or refund and the final balance.
CARE TEAM
Reconcile unused supplies and corrected departmental records. Keep post-procedure follow-up and outstanding results assigned after the episode.
Owner
Inventory & department owners
Evidence passed forward
Returns · corrected records · follow-up evidence
FINANCIAL ACTIVITY
Match cash, deposits and payer advice to the reviewed items. Investigate variances and authorize refunds, credits or adjustments through the accepted finance process.
Owner
Finance & reconciliation team
Financial record / state
Payment allocation · variance · approved refund or adjustment
Closure records what is settled and what remains open, with no loss of the original history.
Billing & Finance Inventory Revenue Cycle Management

When the journey changes.

The clinical response and financial consequence each keep an owner and their own evidence.

Procedure cancelled after preparation

Responsible team · Surgical, anesthesia & recovery teams

Care response

Record the reason, notify the patient and receiving teams, release resources and reconcile unused supplies.

Financial response

Review work actually completed, approval expiry, deposits and the agreed cancellation rules before correcting charges or refunds.

Unexpected ICU transfer

Responsible team · ICU & receiving ward teams

Care response

Transfer the current record and pending responsibilities to the named ICU team under the local care procedure.

Financial response

Amend the service and coverage review; do not assume the original approval covers the changed stay.

Supply return or medication substitution

Responsible team · Pharmacist & nursing team

Care response

Keep approval, actual supplied quantity and lot identity; preserve the original request and issue history.

Financial response

Review the contractual charge effect separately from internal stock cost; avoid an automatic patient charge for every movement.

Coverage changes or estimate expires

Responsible team · Revenue cycle team

Care response

Explain the revised administrative plan while the clinical team retains responsibility for care decisions.

Financial response

Reverify missing facts, publish a revised estimate and record the patient communication and unresolved review items.

What completion looks like.

CareThe clinic plan, investigations, procedure, recovery and follow-up remain one traceable episode, including any ICU branch.

FinanceThe estimate can be compared with performed activity, reviewed charges, deposit allocation, payer decisions and approved adjustments.

CASE 03 / 04

Investigations, treatment and follow-up stay together.

A ward admission brings diagnostic reports, medication and supplies into daily care. The financial journey handles repeated services, partial quantities and payer review without losing the clinical context.

Care setting: Admission · ward · diagnostics · follow-up
Financial route: Insured stay with an additional-service review
Connected stages: 8 · care + finance at every step

Select a department to see its role and highlight its connected stages. Every stage keeps care and finance side by side.

What must be configured before this case works?

Configure ward locations, teams, shift responsibilities, clinical forms and the transfer and discharge procedures.
Prepare laboratory and radiology requests, report ownership, pharmacy units and stock sources with traceable patient and encounter identifiers.
Agree stay and service tariffs, benefits, approvals, duplicate-charge controls and the remedy for denied or partially paid items.

Setup instructions, CSV templates & acceptance checks

Patient & careFinancial activity

One patient and encounter connect both tracks. Care, charges and settlement keep their own review states.Download journey diagram

01
Admit with shared context
The patient knows the ward, responsible team and expected administrative steps.
CARE TEAM
Link admission, identity, location and responsible clinician; receive the referral, current medication and relevant history.
Owner
Patient access team
Evidence passed forward
Admission encounter · bed · referral · medication context
FINANCIAL ACTIVITY
Review policy, contract, admission approval and estimate assumptions. Mark missing benefits or remaining authorization as unresolved.
Owner
Revenue cycle team
Financial record / state
Policy evidence · approval · estimate · review responsibility
The ward receives both the clinical referral and the named administrative contact.
Inpatient Care Patient Access MANSOQ Core
02
Assess & request investigations
The patient understands the tests and imaging requested by the care team.
CARE TEAM
Document assessment, observations and requests. Link each laboratory specimen and imaging accession to the ordering encounter and priority.
Owner
Clinician & nurse
Evidence passed forward
Assessment · observations · requests · specimen and study identifiers
FINANCIAL ACTIVITY
Check whether requested services are covered or require additional authorization; assign unresolved decisions and communicate estimate changes.
Owner
Revenue cycle team
Financial record / state
Service-scope review · approval request · estimate amendment
Request status, authorization status and clinical priority remain separate.
Inpatient Care Laboratory Radiology Orders, Results & Medication
03
Review reports & update the plan
The treating team explains reviewed findings and the next care step.
CARE TEAM
Review released laboratory and imaging reports, record the plan and name owners for outstanding or amended results.
Owner
Clinician & nurse
Evidence passed forward
Released reports · review note · care plan · follow-up owner
FINANCIAL ACTIVITY
Review completed service evidence against mapped codes and tariffs. A corrected report does not by itself justify a second charge.
Owner
Billing & coding team
Financial record / state
Performed services · coding review · duplicate-charge check
The current plan and report version travel into the next shift with their authors and times.
Laboratory Radiology Inpatient Care
04
Supply & administer medication
Medication changes and any remaining dispensing responsibility are explained to the patient.
CARE TEAM
Verify the current prescription, lot and quantity; record actual dispensing. Nursing records administrations and missed or changed doses in the clinical workflow.
Owner
Pharmacist & nursing team
Evidence passed forward
Prescription · actual dispense · administration · remaining quantity
FINANCIAL ACTIVITY
Apply the accepted charge basis and unit conversions; reconcile partial dispensing, returns and corrections with the source records.
Owner
Billing & coding team
Financial record / state
Actual quantity · charge basis · return or correction reference
A dispense record is not proof that the medication was administered; both remain traceable.
Pharmacy Inventory Orders, Results & Medication Inpatient Care
05
Continue care & control supplies
Includes a conditional care branch
Each shift knows the current plan, outstanding tests and the person responsible for follow-up.
CARE TEAM
Review observations, repeat requests and outstanding actions at handover. Record departmental supply issues, returns and unit transfers with actual quantities.
Owner
Clinician & nurse
Evidence passed forward
Handover · new requests · supply movements · open actions
FINANCIAL ACTIVITY
Review new service dates and repeat-service evidence against coverage and approvals. Separate legitimate repeat work from duplicate records or interface replay.
Owner
Revenue cycle team
Financial record / state
Service dates · repeat-work evidence · approval review · reconciliation
If escalation to ICU is needed, a documented transfer carries the current treatment and pending responsibilities.
Inpatient Care Inventory Laboratory Radiology Intensive Care
06
Discharge with outstanding work assigned
The patient receives a medication list, instructions, follow-up plan and contact for pending reports.
CARE TEAM
Document the discharge decision and summary, reconcile medication and allocate follow-up for incomplete reports or requested appointments.
Owner
Clinician & nurse
Evidence passed forward
Summary · medication reconciliation · pending-results list · follow-up
FINANCIAL ACTIVITY
Reconcile ward, pharmacy and diagnostic service evidence; review coding and patient-liability facts before explaining the financial statement.
Owner
Billing & coding team
Financial record / state
Reviewed charges · coding evidence · liability review · statement
An outstanding result or payer response remains assigned after discharge rather than disappearing with the encounter.
Inpatient Care Outpatient Care Pharmacy Laboratory
07
Resolve the payer response
The patient is referred to the responsible team for questions about the reviewed balance.
CARE TEAM
Answer an authorized clinical query with encounter-linked evidence; preserve the original note and any approved amendment.
Owner
Clinician & nurse
Evidence passed forward
Evidence request · author response · approved amendment
FINANCIAL ACTIVITY
Submit through the activated route and classify responses. Resolve missing data, coverage disputes or clinical appeals through their distinct workflows.
Owner
Revenue cycle team
Financial record / state
Claim · response class · remedy · resubmission or appeal reference
A payer denial is a review responsibility; contractual adjustments and patient liability require separate decisions.
Revenue Cycle Management NPHIES Billing & Finance
08
Match payment & retain follow-up
The patient sees explained balance changes while the clinical follow-up remains available.
CARE TEAM
Keep follow-up responsibility active and reconcile corrected diagnostic, medication or inventory records with their original references.
Owner
Clinician & nurse
Evidence passed forward
Follow-up record · correction history · reconciled stock
FINANCIAL ACTIVITY
Allocate actual payment against reviewed claim or invoice lines, investigate partial settlements and retain approved adjustments and remaining balances.
Owner
Finance & reconciliation team
Financial record / state
Payment allocation · unmatched items · adjustment approval · open balance
Clinical completion and financial reconciliation each have their own evidence and owner.
Billing & Finance Revenue Cycle Management Inventory

When the journey changes.

The clinical response and financial consequence each keep an owner and their own evidence.

A repeat test or corrected report

Responsible team · Laboratory & ordering team

Care response

Preserve the reason, original request and reviewed report versions; notify the responsible clinician.

Financial response

A real repeat service needs its own evidence; a report correction alone does not create another charge.

Partial dispensing or unavailable item

Responsible team · Pharmacist & nursing team

Care response

Record supplied quantity, authorized substitution and responsibility for the remainder.

Financial response

Review the actual quantity and applicable unit rules, not the originally requested full quantity.

Clinical deterioration or unit transfer

Responsible team · ICU & receiving ward teams

Care response

Activate the local escalation process and transfer current observations, medication and unresolved actions.

Financial response

Review the changed care setting, dates and approval needs without treating the previous approval as unlimited.

Claim rejected or partial advice received

Responsible team · Revenue cycle team

Care response

Provide authorized evidence with traceable authorship when documentation is queried.

Financial response

Classify and remedy the response; reconcile advice separately from cash and keep disputed balances assigned.

What completion looks like.

CareReviewed diagnostic context, traceable medication and shift handovers, a discharge summary and ownership of every outstanding result.

FinanceRepeat work, partial quantities and adjustments are explained by source evidence; payer response and cash settlement remain independently traceable.

CASE 04 / 04

A specialist visit connects the hospital around the person.

A specialist consultation leads to requested diagnostics and, when indicated, a day procedure. The patient sees the next step and a clear self-pay estimate while services, stock and payments stay connected.

Care setting: Specialist clinic · diagnostics · optional day procedure
Financial route: Self-pay; insured and mixed-payment alternatives explained
Connected stages: 8 · care + finance at every step

Select a department to see its role and highlight its connected stages. Every stage keeps care and finance side by side.

What must be configured before this case works?

Configure clinic sessions, referral rules, diagnostic availability and day-procedure resources; name the result reviewer and patient contact.
Publish the relevant services, medication and supply catalogues, units, lots and locally approved patient preparation instructions.
Define estimate versions, agreed payment terms, deposit allocation, cancellations and refund approval. Mixed payment needs explicit allocation rules.

Setup instructions, CSV templates & acceptance checks

Patient & careFinancial activity

One patient and encounter connect both tracks. Care, charges and settlement keep their own review states.Download journey diagram

01
Book the specialist visit
The patient chooses an available appointment and receives preparation and contact information.
CARE TEAM
Link the person, clinic, practitioner and visit type; record referral details and communication needs in the encounter.
Owner
Patient access team
Evidence passed forward
Patient · booking · referral · encounter
FINANCIAL ACTIVITY
Confirm the payment route and consultation tariff; explain what the initial estimate includes and what still requires a clinical decision.
Owner
Billing & coding team
Financial record / state
Consultation estimate · payment route · stated assumptions
The patient arrives with an appointment, named team and clear initial administrative scope.
Outpatient Care Patient Access MANSOQ Core
02
Consult & agree the next step
The specialist explains requested investigations and how results will be discussed.
CARE TEAM
Document assessment and requested laboratory or imaging work with the clinical question, priority and result-review responsibility.
Owner
Clinician & nurse
Evidence passed forward
Consultation note · requests · result-review owner
FINANCIAL ACTIVITY
Update the estimate for the requested scope using configured services. If insurance is selected, begin eligibility and approval review instead of assuming self-pay.
Owner
Billing & coding team
Financial record / state
Updated estimate · selected payment route · coverage review if needed
The patient can distinguish a proposed investigation from a performed service and final charge.
Outpatient Care Clinical Documentation & Care Planning Laboratory Radiology
03
Complete diagnostic department visits
The patient visits the requested departments with linked requests and preparation information.
CARE TEAM
Collect and identify specimens, link imaging accessions and return reviewed reports. Record supplies used and responsibility for delayed or corrected reports.
Owner
Clinician & nurse
Evidence passed forward
Specimen · study · report · supply usage · communication
FINANCIAL ACTIVITY
Review actual diagnostic activity against the estimate and charge rules. Cancelled requests and repeat interface messages do not become additional performed services.
Owner
Billing & coding team
Financial record / state
Performed services · charge review · cancelled-request references
The specialist receives results linked to the original clinical question and reviewed version.
Laboratory Radiology Inventory
04
Add a day procedure only if indicated
Includes a conditional care branch
The patient receives an explanation of the additional procedure, preparation and revised financial scope.
CARE TEAM
If indicated, schedule resources, complete the accepted consent and checks, document the procedure and recovery, and track actual medication and supplies.
Owner
Surgical, anesthesia & recovery teams
Evidence passed forward
Procedure request · session · consent · procedure and recovery record
FINANCIAL ACTIVITY
Issue a revised estimate and record agreed terms or the applicable approval. After the procedure, review performed scope and unused supply returns.
Owner
Billing & coding team
Financial record / state
Revised estimate · agreement or approval · procedure charge evidence
If no procedure is indicated, this branch is skipped and the visit continues to the agreed care plan.
Operating Room Inventory Pharmacy
05
Review & dispense the prescription
The patient receives the actual supplied quantity, usage instructions and a contact for any remainder.
CARE TEAM
Verify medication and select the appropriate lot; record actual dispensing and authorized substitution with the prescribing request and encounter.
Owner
Pharmacist & nursing team
Evidence passed forward
Prescription · lot · quantity · handover time · substitution if approved
FINANCIAL ACTIVITY
Review supplied quantities and unit conversions; explain medication charges or the separately agreed external-dispensing route.
Owner
Billing & coding team
Financial record / state
Dispense evidence · applicable charge · payment-route allocation
The remaining prescription, stock movement and charge review have separate responsible owners.
Pharmacy Inventory Orders, Results & Medication
06
Close the visit with a follow-up plan
The patient knows when and with whom results, treatment or a pending procedure report will be reviewed.
CARE TEAM
Record the reviewed results and plan; name the contact for pending reports and book the follow-up where appropriate.
Owner
Clinician & nurse
Evidence passed forward
Visit summary · reviewed reports · pending items · follow-up booking
FINANCIAL ACTIVITY
Compare the final reviewed activity with the estimate and explain differences, cancellations and applicable patient-liability facts.
Owner
Billing & coding team
Financial record / state
Estimate comparison · reviewed charges · financial explanation
The patient has a clinical follow-up contact and a financial contact for the statement.
Outpatient Care Laboratory Radiology Clinical Documentation & Care Planning
07
Invoice, allocate & explain payment
The patient receives an explained invoice, payment reference and any outstanding balance.
CARE TEAM
Retain the consultation, diagnostic, procedure and dispensing evidence behind the accepted service set.
Owner
Clinician & nurse
Evidence passed forward
Encounter-linked notes · reports · procedure and dispense evidence
FINANCIAL ACTIVITY
Allocate actual cash and deposits to invoice items. For insured or mixed payment, split responsibility under accepted rules and track the claim independently.
Owner
Finance & reconciliation team
Financial record / state
Invoice · payment allocation · payer or patient responsibility · claim if selected
National e-invoice and payer exchanges use only the accepted, activated interface scope.
Billing & Finance Revenue Cycle Management ZATCA E-invoicing NPHIES
08
Handle returns, refunds & open work
The patient can ask about a pending report, remaining medication or approved refund using the same visit reference.
CARE TEAM
Keep pending-result responsibility and medication follow-up active; inventory and pharmacy reconcile approved returns without deleting the original history.
Owner
Clinician & nurse
Evidence passed forward
Open clinical work · supply return · original dispense reference
FINANCIAL ACTIVITY
Review the financial effect of returns, unused deposits or corrected services; authorize credits or refunds and match them to actual transactions.
Owner
Finance & reconciliation team
Financial record / state
Adjustment reason · approval · refund or credit · reconciled balance
The visit may be clinically complete while an identified report, claim or refund remains in follow-up.
Inventory Pharmacy Billing & Finance Outpatient Care

When the journey changes.

The clinical response and financial consequence each keep an owner and their own evidence.

Patient changes the requested scope

Responsible team · Clinician & nurse

Care response

Document the agreed next step and cancelled requests; explain any remaining clinical follow-up.

Financial response

Revise the estimate and deposit allocation; review completed activity under accepted cancellation terms.

Result arrives after the visit

Responsible team · Laboratory & ordering team

Care response

The named reviewer receives the report and documents patient communication and the next care action.

Financial response

Keep the completed service evidence linked; a late report does not mean a second billable encounter.

Insured, self-pay or mixed payment changes

Responsible team · Revenue cycle team

Care response

Retain the same clinical identities and avoid reopening duplicate care records solely for financial routing.

Financial response

Reverify coverage and allocate payer and patient responsibility using explicit rules; do not double collect.

Escalation beyond an ambulatory visit

Responsible team · ICU & receiving ward teams

Care response

Use a documented referral or admission and receiving-team handover; ICU is not silently added to the original visit.

Financial response

Review the new care-setting scope, estimate and approval requirements separately while preserving encounter links.

What completion looks like.

CareOne connected specialist episode with requested diagnostics, any indicated procedure, actual dispensing and a named follow-up for unfinished work.

FinanceA visible estimate-to-actual comparison, traceable invoice and payment allocation, and an approved record for each correction or refund.

Capabilities, interfaces & the assumptions behind these cases

These are illustrative operating cases, not reported customer outcomes or treatment protocols. Clinical teams decide which departments are needed. Confirm selected capabilities, release, role permissions, coding and tariff rules, device connections, payer exchange and e-invoice activation during implementation. A performed service, reviewed charge, invoice, claim decision and cash receipt are separate records and states.

Back to this case