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13.9 Resource PaymentReconciliation - Content

Financial Management Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Practitioner

This resource provides payment the details and claim references supporting including amount of a bulk payment. payment and allocates the payment items being paid.

The PaymentReconciliation resource provides the bulk payment details associated with a payment by the payor for receivable amounts, such as for goods and services rendered by a provider to patients covered by insurance plans offered by that payor. These are the payment reconciliation details which may align to the individual payment amounts indicated on discrete ClaimResponses. ClaimResponses or Invoices for example.

Bulk payments need to provide a means to associate the amounts paid again against specific Claims, Invoices, and other financial exchanges and adjustments, to the bulk payment itself in order to reconcile provider accounts receivable.

The PaymentReconciliation resource is a "event" resource from a FHIR workflow perspective - see Workflow Event.

Additional information regarding electronic payment notice content and usage may be found at:

The PaymentReconciliation resource serves to correlate a payment amount to the adjudicated claim amounts appearing on one or more ClaimResponses . PaymentReconciliation provides the bulk payment details associated with a payment by the payor for goods and services rendered by a provider to patients covered by insurance plans offered by that payor.

The PaymentNotice resource is used to indicate that a payment has, or is about to occur. The resource is used commonly when tracking of payment occurences is required for regulatory or business purposes.

The ClaimResponse resource is an insurer's adjudication and/or authorization of a set of healthcare-related goods and services for a patient against the patient's insurance coverages and does not indicate that payment has occured.

For reporting out to patients or transferring data to patient centered applications, such as patient health Record (PHR) application, the ExplanationOfBenefit should be used instead.

The eClaim domain includes a number of related resources

PaymentReconciliation Provides the bulk payment details associated with a payment by the payor for goods and services rendered by a provider to patients covered by insurance plans offered by that payor.
ClaimResponse A payor's adjudication and/or authorization response to the suite of services provided in a Claim. Typically the ClaimResponse references the Claim but does not duplicate the clinical or financial information provided in the claim.
ExplanationOfBenefit This resource combines the information from the Claim and the ClaimResponse, stripping out any provider or payor proprietary information, into a unified information model suitable for use for: patient reporting; transferring information to a Patient Health Record system; and, supporting complete claim and adjudication information exchange with regulatory and analytics organizations and other parts of the provider's organization.
PaymentNotice An indication that a payment has occured, is about to occur, or has been cancelled.

This resource is referenced by PaymentNotice .

This resource implements the Event pattern.

Structure

total 0..1 Money Total amount of Payment
Name Flags Card. Type Description & Constraints doco
. . PaymentReconciliation TU DomainResource PaymentReconciliation resource
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier for a payment reconciliation
. . . status ?! ÎŁ Σ 0..1 1..1 code active | cancelled | draft | entered-in-error
Financial Resource Status Codes ( Required )
. . . period Σ 0..1 Period Period covered
. . . created Σ 0..1 1..1 dateTime Creation date
. . . organization paymentIssuer Σ 0..1 Reference ( Organization ) Insurer Party generating payment
. . . request 0..1 Reference ( ProcessRequest Task ) Claim reference Reference to requesting resource
. . . requestor 0..1 Reference ( Practitioner | PractitionerRole | Organization ) Responsible practitioner
... outcome 0..1 CodeableConcept code queued | complete | error | partial
RemittanceOutcome ( Required )
. . . disposition 0..1 string Disposition Message message
. . requestProvider . paymentDate Σ 0..1 1..1 Reference date ( Practitioner When payment issued
... paymentAmount ) Responsible practitioner Σ 1..1 Money Total amount of Payment
. . requestOrganization . paymentIdentifier 0..1 Reference ( Organization Identifier ) Responsible organization Business identifier for the payment
. . . detail 0..* BackboneElement List of settlements Settlement particulars
. . . . identifier 0..1 Identifier Business identifier of the payment detail
.... predecessor 0..1 Identifier Business identifier of the prior payment detail
.... type 1..1 CodeableConcept Type code Category of payment
Payment Type Codes ( Example )
. . . . request 0..1 Reference ( Any ) Claim Request giving rise to the payment
. . . . response submitter 0..1 Reference ( Any Practitioner | PractitionerRole | Organization ) Claim Response Submitter of the request
. . . . submitter response 0..1 Reference ( Organization Any ) Organization which submitted the claim Response committing to a payment
.... date 0..1 date Date of commitment to pay
. . . . payee responsible 0..1 Reference ( Organization PractitionerRole ) Organization which is receiving Contact for the payment response
. . . date . payee 0..1 date Reference ( Practitioner | PractitionerRole | Organization ) Invoice date Recipient of the payment
. . . . amount 0..1 Money Amount being paid allocated to this payable
. . . form formCode 0..1 CodeableConcept Printed Form Identifier form identifier
Form Codes Forms ( Example )
. . . processNote 0..* BackboneElement Processing comments Note concerning processing
. . . . type 0..1 CodeableConcept code display | print | printoper
NoteType ( Required )
. . . . text 0..1 string Comment on the processing Note explanatory text

doco Documentation for this format

UML Diagram ( Legend )

PaymentReconciliation ( DomainResource ) The Response business A unique identifier assigned to this payment reconciliation identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » The period of time for which payments have been gathered into this bulk payment for settlement period : Period [0..1] The date when the enclosed suite of services were performed or completed resource was created created : dateTime [0..1] [1..1] The Insurer party who produced this adjudicated response generated the payment organization paymentIssuer : Reference [0..1] « Organization » Original request resource reference request : Reference [0..1] ProcessRequest « Task » Transaction status: error, complete The practitioner who is responsible for the services rendered to the patient outcome requestor : CodeableConcept Reference [0..1] « Practitioner | PractitionerRole | Organization » The outcome of a request for a reconciliation outcome : code [0..1] « The outcome of the processing. (Strength=Required) RemittanceOutcome ! » A human readable description of the status of the adjudication request for the reconciliation disposition : string [0..1] The practitioner who is responsible for the services rendered to date of payment as indicated on the patient financial instrument requestProvider paymentDate : Reference date [0..1] Practitioner [1..1] Total payment amount as indicated on the financial instrument paymentAmount : Money [1..1] The organization which is responsible Issuer's unique identifier for the services rendered to the patient payment instrument requestOrganization paymentIdentifier : Reference Identifier [0..1] Organization The A code for the form to be used for printing the content form formCode : CodeableConcept [0..1] « The forms codes. (Strength=Example) Form ?? » Details Total Unique identifier for the current payment amount item for the referenced payable total identifier : Money Identifier [0..1] Details Unique identifier for the prior payment item for the referenced payable predecessor : Identifier [0..1] Code to indicate the nature of the payment, adjustment, funds advance, etc payment type : CodeableConcept [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example) Payment Type PaymentTypeCodes ?? » The claim or financial resource A resource, such as a Claim, the evaluation of which could lead to payment request : Reference [0..1] « Any » The party which submitted the claim response resource or financial transaction response submitter : Reference [0..1] Any « Practitioner | PractitionerRole | Organization » The Organization A resource, such as a ClaimResponse, which submitted the claim or financial transaction contains a commitment to payment submitter response : Reference [0..1] Organization « Any » The organization which date from the response resource containing a commitment to pay date : date [0..1] A reference to the individual who is receiving responsible for inquiries regarding the response and its payment payee responsible : Reference [0..1] Organization « PractitionerRole » The date of party which is receiving the invoice or financial resource payment date payee : date Reference [0..1] « Practitioner | PractitionerRole | Organization » Amount paid for this detail The monetary amount allocated from the total payment to the payable amount : Money [0..1] Notes The business purpose of the note purpose: Print/Display text type : CodeableConcept code [0..1] « The presentation types of notes. (Strength=Required) NoteType ! » The note text explanation or description associated with the processing text : string [0..1] List Distribution of individual settlement amounts and the corresponding transaction payment amount for a previously acknowledged payable detail [0..*] Suite of notes A note that describes or explains the processing in a human readable form processNote [0..*]

XML Template

<PaymentReconciliation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <

 <identifier><!-- 0..* Identifier Business Identifier for a payment reconciliation --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->

 <period><!-- 0..1 Period Period covered --></period>
 <
 <</organization>
 <</request>
 <</outcome>
 <
 <</requestProvider>
 <</requestOrganization>
 <
  <</type>
  <</request>
  <</response>
  <</submitter>
  <</payee>
  <
  <</amount>

 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <paymentIssuer><!-- 0..1 Reference(Organization) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <paymentDate value="[date]"/><!-- 1..1 When payment issued -->
 <paymentAmount><!-- 1..1 Money Total amount of Payment --></paymentAmount>
 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <detail>  <!-- 0..* Settlement particulars -->
  <identifier><!-- 0..1 Identifier Business identifier of the payment detail --></identifier>
  <predecessor><!-- 0..1 Identifier Business identifier of the prior payment detail --></predecessor>
  <type><!-- 1..1 CodeableConcept Category of payment --></type>
  <request><!-- 0..1 Reference(Any) Request giving rise to the payment --></request>
  <submitter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(Any) Response committing to a payment --></response>
  <date value="[date]"/><!-- 0..1 Date of commitment to pay -->
  <responsible><!-- 0..1 Reference(PractitionerRole) Contact for the response --></responsible>
  <payee><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>

 </detail>
 <</form>
 <</total>
 <
  <</type>
  <

 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->

 </processNote>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "",

  "resourceType" : "PaymentReconciliation",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "

  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error

  "period" : { Period }, // Period covered
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "
    "
    "
    "
    "

  "created" : "<dateTime>", // R!  Creation date
  "paymentIssuer" : { Reference(Organization) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "paymentDate" : "<date>", // R!  When payment issued
  "paymentAmount" : { Money }, // R!  Total amount of Payment
  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "detail" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "type" : { CodeableConcept }, // R!  Category of payment
    "request" : { Reference(Any) }, // Request giving rise to the payment
    "submitter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Submitter of the request
    "response" : { Reference(Any) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Recipient of the payment
    "amount" : { Money } // Amount allocated to this payable

  }],
  "
  "
  "
    "
    "

  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "type" : "<code>", // display | print | printoper
    "text" : "<string>" // Note explanatory text

  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:;

[ a fhir:PaymentReconciliation;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:
  fhir:

  fhir:PaymentReconciliation.identifier [ Identifier ], ... ; # 0..* Business Identifier for a payment reconciliation
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error

  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:

  fhir:PaymentReconciliation.created [ dateTime ]; # 1..1 Creation date
  fhir:PaymentReconciliation.paymentIssuer [ Reference(Organization) ]; # 0..1 Party generating payment
  fhir:PaymentReconciliation.request [ Reference(Task) ]; # 0..1 Reference to requesting resource
  fhir:PaymentReconciliation.requestor [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Responsible practitioner
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 queued | complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition message
  fhir:PaymentReconciliation.paymentDate [ date ]; # 1..1 When payment issued
  fhir:PaymentReconciliation.paymentAmount [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.paymentIdentifier [ Identifier ]; # 0..1 Business identifier for the payment
  fhir:PaymentReconciliation.detail [ # 0..* Settlement particulars
    fhir:PaymentReconciliation.detail.identifier [ Identifier ]; # 0..1 Business identifier of the payment detail
    fhir:PaymentReconciliation.detail.predecessor [ Identifier ]; # 0..1 Business identifier of the prior payment detail
    fhir:PaymentReconciliation.detail.type [ CodeableConcept ]; # 1..1 Category of payment
    fhir:PaymentReconciliation.detail.request [ Reference(Any) ]; # 0..1 Request giving rise to the payment
    fhir:PaymentReconciliation.detail.submitter [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Submitter of the request
    fhir:PaymentReconciliation.detail.response [ Reference(Any) ]; # 0..1 Response committing to a payment
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Date of commitment to pay
    fhir:PaymentReconciliation.detail.responsible [ Reference(PractitionerRole) ]; # 0..1 Contact for the response
    fhir:PaymentReconciliation.detail.payee [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Recipient of the payment
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Amount allocated to this payable

  ], ...;
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:

  fhir:PaymentReconciliation.formCode [ CodeableConcept ]; # 0..1 Printed form identifier
  fhir:PaymentReconciliation.processNote [ # 0..* Note concerning processing
    fhir:PaymentReconciliation.processNote.type [ code ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.processNote.text [ string ]; # 0..1 Note explanatory text

  ], ...;
]

Changes since DSTU2 R3

PaymentReconciliation PaymentReconciliation.status Added Element PaymentReconciliation.outcome Type changed from code to CodeableConcept PaymentReconciliation.detail.type Type changed from Coding to CodeableConcept PaymentReconciliation.detail.response Added Element
PaymentReconciliation.detail.amount PaymentReconciliation.status
  • Type changed Change value set from Quantity{http://hl7.org/fhir/StructureDefinition/Money} http://hl7.org/fhir/ValueSet/fm-status|4.0.0 to Money http://hl7.org/fhir/ValueSet/fm-status|4.1.0
PaymentReconciliation.form PaymentReconciliation.outcome
  • Type changed Change value set from Coding http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/forms (required) http://hl7.org/fhir/ValueSet/remittance-outcome|4.1.0
PaymentReconciliation.total PaymentReconciliation.processNote.type
  • Min Cardinality changed from 1 to 0 Type changed Change value set from Quantity{http://hl7.org/fhir/StructureDefinition/Money} http://hl7.org/fhir/ValueSet/note-type|4.0.0 to Money PaymentReconciliation.processNote Added Element PaymentReconciliation.processNote.type Added Element PaymentReconciliation.processNote.text Added Element PaymentReconciliation.ruleset deleted PaymentReconciliation.originalRuleset deleted PaymentReconciliation.detail.responce deleted PaymentReconciliation.note deleted http://hl7.org/fhir/ValueSet/note-type|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors). )

Structure

total 0..1 Money Total amount of Payment
Name Flags Card. Type Description & Constraints doco
. . PaymentReconciliation TU DomainResource PaymentReconciliation resource
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier for a payment reconciliation
. . . status ?! ÎŁ Σ 0..1 1..1 code active | cancelled | draft | entered-in-error
Financial Resource Status Codes ( Required )
. . . period Σ 0..1 Period Period covered
. . . created Σ 0..1 1..1 dateTime Creation date
. . . organization paymentIssuer Σ 0..1 Reference ( Organization ) Insurer Party generating payment
. . . request 0..1 Reference ( ProcessRequest Task ) Claim reference Reference to requesting resource
. . . requestor 0..1 Reference ( Practitioner | PractitionerRole | Organization ) Responsible practitioner
... outcome 0..1 CodeableConcept code queued | complete | error | partial
RemittanceOutcome ( Required )
. . . disposition 0..1 string Disposition Message message
. . requestProvider . paymentDate Σ 0..1 1..1 Reference date ( Practitioner When payment issued
... paymentAmount ) Responsible practitioner Σ 1..1 Money Total amount of Payment
. . requestOrganization . paymentIdentifier 0..1 Reference ( Organization Identifier ) Responsible organization Business identifier for the payment
. . . detail 0..* BackboneElement List of settlements Settlement particulars
. . . . identifier 0..1 Identifier Business identifier of the payment detail
.... predecessor 0..1 Identifier Business identifier of the prior payment detail
.... type 1..1 CodeableConcept Type code Category of payment
Payment Type Codes ( Example )
. . . . request 0..1 Reference ( Any ) Claim Request giving rise to the payment
. . . . response submitter 0..1 Reference ( Any Practitioner | PractitionerRole | Organization ) Claim Response Submitter of the request
. . . . submitter response 0..1 Reference ( Organization Any ) Organization which submitted the claim Response committing to a payment
.... date 0..1 date Date of commitment to pay
. . . . payee responsible 0..1 Reference ( Organization PractitionerRole ) Organization which is receiving Contact for the payment response
. . . date . payee 0..1 date Reference ( Practitioner | PractitionerRole | Organization ) Invoice date Recipient of the payment
. . . . amount 0..1 Money Amount being paid allocated to this payable
. . . form formCode 0..1 CodeableConcept Printed Form Identifier form identifier
Form Codes Forms ( Example )
. . . processNote 0..* BackboneElement Processing comments Note concerning processing
. . . . type 0..1 CodeableConcept code display | print | printoper
NoteType ( Required )
. . . . text 0..1 string Comment on the processing Note explanatory text

doco Documentation for this format

UML Diagram ( Legend )

PaymentReconciliation ( DomainResource ) The Response business A unique identifier assigned to this payment reconciliation identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » The period of time for which payments have been gathered into this bulk payment for settlement period : Period [0..1] The date when the enclosed suite of services were performed or completed resource was created created : dateTime [0..1] [1..1] The Insurer party who produced this adjudicated response generated the payment organization paymentIssuer : Reference [0..1] « Organization » Original request resource reference request : Reference [0..1] ProcessRequest « Task » Transaction status: error, complete The practitioner who is responsible for the services rendered to the patient outcome requestor : CodeableConcept Reference [0..1] « Practitioner | PractitionerRole | Organization » The outcome of a request for a reconciliation outcome : code [0..1] « The outcome of the processing. (Strength=Required) RemittanceOutcome ! » A human readable description of the status of the adjudication request for the reconciliation disposition : string [0..1] The practitioner who is responsible for the services rendered to date of payment as indicated on the patient financial instrument requestProvider paymentDate : Reference date [0..1] Practitioner [1..1] Total payment amount as indicated on the financial instrument paymentAmount : Money [1..1] The organization which is responsible Issuer's unique identifier for the services rendered to the patient payment instrument requestOrganization paymentIdentifier : Reference Identifier [0..1] Organization The A code for the form to be used for printing the content form formCode : CodeableConcept [0..1] « The forms codes. (Strength=Example) Form ?? » Details Total Unique identifier for the current payment amount item for the referenced payable total identifier : Money Identifier [0..1] Details Unique identifier for the prior payment item for the referenced payable predecessor : Identifier [0..1] Code to indicate the nature of the payment, adjustment, funds advance, etc payment type : CodeableConcept [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example) Payment Type PaymentTypeCodes ?? » The claim or financial resource A resource, such as a Claim, the evaluation of which could lead to payment request : Reference [0..1] « Any » The party which submitted the claim response resource or financial transaction response submitter : Reference [0..1] Any « Practitioner | PractitionerRole | Organization » The Organization A resource, such as a ClaimResponse, which submitted the claim or financial transaction contains a commitment to payment submitter response : Reference [0..1] Organization « Any » The organization which date from the response resource containing a commitment to pay date : date [0..1] A reference to the individual who is receiving responsible for inquiries regarding the response and its payment payee responsible : Reference [0..1] Organization « PractitionerRole » The date of party which is receiving the invoice or financial resource payment date payee : date Reference [0..1] « Practitioner | PractitionerRole | Organization » Amount paid for this detail The monetary amount allocated from the total payment to the payable amount : Money [0..1] Notes The business purpose of the note purpose: Print/Display text type : CodeableConcept code [0..1] « The presentation types of notes. (Strength=Required) NoteType ! » The note text explanation or description associated with the processing text : string [0..1] List Distribution of individual settlement amounts and the corresponding transaction payment amount for a previously acknowledged payable detail [0..*] Suite of notes A note that describes or explains the processing in a human readable form processNote [0..*]

XML Template

<PaymentReconciliation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <

 <identifier><!-- 0..* Identifier Business Identifier for a payment reconciliation --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->

 <period><!-- 0..1 Period Period covered --></period>
 <
 <</organization>
 <</request>
 <</outcome>
 <
 <</requestProvider>
 <</requestOrganization>
 <
  <</type>
  <</request>
  <</response>
  <</submitter>
  <</payee>
  <
  <</amount>

 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <paymentIssuer><!-- 0..1 Reference(Organization) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <paymentDate value="[date]"/><!-- 1..1 When payment issued -->
 <paymentAmount><!-- 1..1 Money Total amount of Payment --></paymentAmount>
 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <detail>  <!-- 0..* Settlement particulars -->
  <identifier><!-- 0..1 Identifier Business identifier of the payment detail --></identifier>
  <predecessor><!-- 0..1 Identifier Business identifier of the prior payment detail --></predecessor>
  <type><!-- 1..1 CodeableConcept Category of payment --></type>
  <request><!-- 0..1 Reference(Any) Request giving rise to the payment --></request>
  <submitter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(Any) Response committing to a payment --></response>
  <date value="[date]"/><!-- 0..1 Date of commitment to pay -->
  <responsible><!-- 0..1 Reference(PractitionerRole) Contact for the response --></responsible>
  <payee><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>

 </detail>
 <</form>
 <</total>
 <
  <</type>
  <

 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->

 </processNote>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "",

  "resourceType" : "PaymentReconciliation",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "

  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error

  "period" : { Period }, // Period covered
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "
    "
    "
    "
    "

  "created" : "<dateTime>", // R!  Creation date
  "paymentIssuer" : { Reference(Organization) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "paymentDate" : "<date>", // R!  When payment issued
  "paymentAmount" : { Money }, // R!  Total amount of Payment
  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "detail" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "type" : { CodeableConcept }, // R!  Category of payment
    "request" : { Reference(Any) }, // Request giving rise to the payment
    "submitter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Submitter of the request
    "response" : { Reference(Any) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Recipient of the payment
    "amount" : { Money } // Amount allocated to this payable

  }],
  "
  "
  "
    "
    "

  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "type" : "<code>", // display | print | printoper
    "text" : "<string>" // Note explanatory text

  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:;

[ a fhir:PaymentReconciliation;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:
  fhir:

  fhir:PaymentReconciliation.identifier [ Identifier ], ... ; # 0..* Business Identifier for a payment reconciliation
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error

  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:

  fhir:PaymentReconciliation.created [ dateTime ]; # 1..1 Creation date
  fhir:PaymentReconciliation.paymentIssuer [ Reference(Organization) ]; # 0..1 Party generating payment
  fhir:PaymentReconciliation.request [ Reference(Task) ]; # 0..1 Reference to requesting resource
  fhir:PaymentReconciliation.requestor [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Responsible practitioner
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 queued | complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition message
  fhir:PaymentReconciliation.paymentDate [ date ]; # 1..1 When payment issued
  fhir:PaymentReconciliation.paymentAmount [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.paymentIdentifier [ Identifier ]; # 0..1 Business identifier for the payment
  fhir:PaymentReconciliation.detail [ # 0..* Settlement particulars
    fhir:PaymentReconciliation.detail.identifier [ Identifier ]; # 0..1 Business identifier of the payment detail
    fhir:PaymentReconciliation.detail.predecessor [ Identifier ]; # 0..1 Business identifier of the prior payment detail
    fhir:PaymentReconciliation.detail.type [ CodeableConcept ]; # 1..1 Category of payment
    fhir:PaymentReconciliation.detail.request [ Reference(Any) ]; # 0..1 Request giving rise to the payment
    fhir:PaymentReconciliation.detail.submitter [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Submitter of the request
    fhir:PaymentReconciliation.detail.response [ Reference(Any) ]; # 0..1 Response committing to a payment
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Date of commitment to pay
    fhir:PaymentReconciliation.detail.responsible [ Reference(PractitionerRole) ]; # 0..1 Contact for the response
    fhir:PaymentReconciliation.detail.payee [ Reference(Organization|Practitioner|PractitionerRole) ]; # 0..1 Recipient of the payment
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Amount allocated to this payable

  ], ...;
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:

  fhir:PaymentReconciliation.formCode [ CodeableConcept ]; # 0..1 Printed form identifier
  fhir:PaymentReconciliation.processNote [ # 0..* Note concerning processing
    fhir:PaymentReconciliation.processNote.type [ code ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.processNote.text [ string ]; # 0..1 Note explanatory text

  ], ...;
]

Changes since DSTU2 Release 3

PaymentReconciliation PaymentReconciliation.status Added Element PaymentReconciliation.outcome Type changed from code to CodeableConcept PaymentReconciliation.detail.type Type changed from Coding to CodeableConcept PaymentReconciliation.detail.response Added Element
PaymentReconciliation.detail.amount PaymentReconciliation.status
  • Type changed Change value set from Quantity{http://hl7.org/fhir/StructureDefinition/Money} http://hl7.org/fhir/ValueSet/fm-status|4.0.0 to Money http://hl7.org/fhir/ValueSet/fm-status|4.1.0
PaymentReconciliation.form PaymentReconciliation.outcome
  • Type changed Change value set from Coding http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/forms (required) http://hl7.org/fhir/ValueSet/remittance-outcome|4.1.0
PaymentReconciliation.total PaymentReconciliation.processNote.type
  • Min Cardinality changed from 1 to 0 Type changed Change value set from Quantity{http://hl7.org/fhir/StructureDefinition/Money} http://hl7.org/fhir/ValueSet/note-type|4.0.0 to Money PaymentReconciliation.processNote Added Element PaymentReconciliation.processNote.type Added Element PaymentReconciliation.processNote.text Added Element PaymentReconciliation.ruleset deleted PaymentReconciliation.originalRuleset deleted PaymentReconciliation.detail.responce deleted PaymentReconciliation.note deleted http://hl7.org/fhir/ValueSet/note-type|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors). )

 

Alternate See the Profiles & Extensions and the alternate definitions: Master Definition ( XML , + JSON ), , XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis a

PaymentReconciliation.form
Path Definition Type Reference
PaymentReconciliation.status A code specifying the state of the resource instance. Required Financial Resource Status Codes FinancialResourceStatusCodes
PaymentReconciliation.outcome The outcome of the processing. Required RemittanceOutcome
PaymentReconciliation.detail.type The reason for the amount: payment, adjustment, advance. Example Payment Type Codes PaymentTypeCodes
PaymentReconciliation.formCode The forms codes. Example Form Codes
PaymentReconciliation.processNote.type The presentation types of notes. Required NoteType

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
created date The creation date PaymentReconciliation.created
disposition string The contents of the disposition message PaymentReconciliation.disposition
identifier token The business identifier of the Explanation of Benefit ExplanationOfBenefit PaymentReconciliation.identifier
organization outcome reference token The organization who generated this resource processing outcome PaymentReconciliation.organization ( Organization ) PaymentReconciliation.outcome
outcome payment-issuer token reference The processing outcome organization which generated this resource PaymentReconciliation.outcome PaymentReconciliation.paymentIssuer
( Organization )
request reference The reference to the claim PaymentReconciliation.request
( ProcessRequest Task )
request-organization requestor reference The organization reference to the provider who generated this resource submitted the claim PaymentReconciliation.requestOrganization PaymentReconciliation.requestor
( Practitioner , Organization , PractitionerRole )
request-provider status reference token The reference to the provider who sumbitted status of the claim payment reconciliation PaymentReconciliation.requestProvider ( Practitioner ) PaymentReconciliation.status