DFT^P10 — Detailed Financial Transaction (Insurance)

DFT variant that explicitly adds the insurance context via IN1/IN2/IN3, allowing the transaction to carry both the billable procedure and the applicable insurance contract.

Purpose

DFT (Detailed Financial Transaction) is the HL7 family of financial messages used to transmit a charge, a credit, a refund or an adjustment. P10 is the insurance variant: it structures the financial transaction by explicitly including the insurance context (IN1 for the contract, IN2 for additional details, IN3 for authorisations).

Typical cases: billing of a consultation with primary + secondary insurance coordination, transmission of a covered procedure for pre-authorisation, post-receipt adjustment of a payer response.

Segment structure

DFT_P10
  MSH                    Message Header
  EVN                    Event Type
  PID                    Patient Identification
  [ PD1 ]                Patient Additional Demographics
  [ ROL ]                Role
  [ PV1 ]                Patient Visit
  [ PV2 ]                Visit - Additional
  [ DB1 ]                Disability
  [ { OBX } ]            Observation/Result
  { IN1                  Insurance (1..*)
    [ IN2 ]              Insurance — Additional
    [ IN3 ]              Insurance — Certification
    [ { ROL } ]          Role
  }
  { FT1                  Financial Transaction (1..*)
    [ { PR1 } ]          Procedures
    [ { ROL } ]
    [ { GT1 } ]          Guarantor
    [ { DG1 } ]          Diagnosis
  }

Real-world example

Cardiology visit billed to Blue Cross Blue Shield (BCBS), group 78912, CPT 99213, 150 USD:

MSH|^~\&|HIS|HOSP01|BILLING|HOSP01|20260516183000||DFT^P10^DFT_P10|MSG-DFT-P10-007|P|2.5.1|||AL|NE
EVN|P10|20260516183000
PID|1||MRN567890^^^HOSP^MR||DOE^JOHN^A^^MR.||19720515|M
PV1|1|I|CARDIO^302^A^HOSP01|EL|||DRSMITH^Smith^James^A^^DR.|||CAR
IN1|1|BCBS-001^Blue Cross|BCBS|Blue Cross Blue Shield|PO BOX 12345^^CHICAGO^IL^60606^USA||(800)555-0123||GROUP-78912|HOME-PPO|||20260101|20261231|||SELF|||||||F||1.00|GRP|F
IN2|||SSN-123-45-6789|||M||F
IN3||||||PROFESSIONAL^Professional Authorization
FT1|1|FT-P10-001|FT1-EXT-001|20260516|20260516|CG^Charge|99213^Office visit, established patient^CPT|||1|150.00|||PROFESSIONAL

• IN1-1 = BCBS company, IN1-2 = internal code BCBS-001, IN1-8 = group 78912.
• IN1-12 / IN1-13 = coverage period 01/01-31/12/2026.
• IN3 = Professional Authorization certification type.
• FT1-7 = CPT 99213 (Office visit, established patient).
• FT1-10 / FT1-11 = quantity and amount 150 USD.

Acknowledgment (ACK)

MSH|^~\&|BILLING|HOSP01|HIS|HOSP01|20260516183001||ACK^P10^ACK|ACK-DFT-P10-007|P|2.5.1
MSA|AA|MSG-DFT-P10-007

Common errors

• IN1 missing: P10 = insurance variant, IN1 mandatory at least once.
• Several IN1 without priority: for a patient with primary + secondary insurance, order IN1 by expected payment order.
• Obsolete CPT: CPT codes are yearly (AMA publishes each October).
• Inconsistent FT1-6: CG charge, CD credit, AJ adjustment. Pick the right type to avoid account discrepancies.
• Expired IN1 effective date: if IN1-13 (Plan Effective Date To) is past, the coverage is not active at the procedure date.

Related messages

See also: DFT^P03 — standard DFT and DFT^P11 — Statement Period.