2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

7.11.5 Resource PaymentReconciliation - Examples

Example Index:

General Payment Reconciliation ExampleXMLJSON

7.11.5.1 General-Primary

XML

General Payment Reconciliation Example (id = "ER2500")

Raw XML

<PaymentReconciliation xmlns="http://hl7.org/fhir">
  <id value="ER2500"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <identifier>
    <system value="http://www.BenefitsInc.com/fhir/enrollmentresponse"/>
    <value value="781234"/>
  </identifier>
  <request>
    <reference value="http://www.BenefitsInc.com/fhir/eligibility/225476332402"/>
  </request>
  <outcome value="complete"/>
  <disposition value="2014 August mid-month settlement."/>
  <created value="2014-08-16"/>
  <organization>
    <reference value="Organization/2"/>
  </organization>
  <requestOrganization>
    <reference value="Organization/1"/>
  </requestOrganization>
  <detail>
    <type>
      <system value="http://hl7.org/fhir/paymenttype"/>
      <code value="payment"/>
    </type>
    <request>
      <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332402"/>
    </request>
    <date value="2014-08-16"/>
    <amount>
      <value value="1000.00"/>
      <system value="urn:std:iso:4217"/>
      <code value="USD"/>
    </amount>
  </detail>
  <detail>
    <type>
      <system value="http://hl7.org/fhir/paymenttype"/>
      <code value="payment"/>
    </type>
    <request>
      <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699"/>
    </request>
    <date value="2014-08-12"/>
    <amount>
      <value value="4000.00"/>
      <system value="urn:std:iso:4217"/>
      <code value="USD"/>
    </amount>
  </detail>
  <detail>
    <type>
      <system value="http://hl7.org/fhir/paymenttype"/>
      <code value="advance"/>
    </type>
    <date value="2014-08-16"/>
    <amount>
      <value value="-1500.00"/>
      <system value="urn:std:iso:4217"/>
      <code value="USD"/>
    </amount>
  </detail>
  <total>
    <value value="3500.00"/>
    <system value="urn:std:iso:4217"/>
    <code value="USD"/>
  </total>
</PaymentReconciliation>

JSON

General Payment Reconciliation Example

Raw JSON (Canonical)

{
  "resourceType": "PaymentReconciliation",
  "id": "ER2500",
  "text": {
    "status": "generated",
    "div": "<div>!-- Snipped for Brevity --></div>"
  },
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/enrollmentresponse",
      "value": "781234"
    }
  ],
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/eligibility/225476332402"
  },
  "outcome": "complete",
  "disposition": "2014 August mid-month settlement.",
  "created": "2014-08-16",
  "organization": {
    "reference": "Organization/2"
  },
  "requestOrganization": {
    "reference": "Organization/1"
  },
  "detail": [
    {
      "type": {
        "system": "http://hl7.org/fhir/paymenttype",
        "code": "payment"
      },
      "request": {
        "reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332402"
      },
      "date": "2014-08-16",
      "amount": {
        "value": 1000.00,
        "system": "urn:std:iso:4217",
        "code": "USD"
      }
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/paymenttype",
        "code": "payment"
      },
      "request": {
        "reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699"
      },
      "date": "2014-08-12",
      "amount": {
        "value": 4000.00,
        "system": "urn:std:iso:4217",
        "code": "USD"
      }
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/paymenttype",
        "code": "advance"
      },
      "date": "2014-08-16",
      "amount": {
        "value": -1500.00,
        "system": "urn:std:iso:4217",
        "code": "USD"
      }
    }
  ],
  "total": {
    "value": 3500.00,
    "system": "urn:std:iso:4217",
    "code": "USD"
  }
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.