STU 3 Ballot

This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). 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

13.10.5 Resource PaymentReconciliation - Detailed Descriptions

Detailed Descriptions for the elements in the PaymentReconciliation resource.

PaymentReconciliation
Definition

This resource provides payment details and claim references supporting a bulk payment.

Control1..1
PaymentReconciliation.identifier
Definition

The Response business identifier.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
PaymentReconciliation.status
Definition

The status of the resource instance.

Control1..1
BindingPaymentReconciliationStatus: A code specifying the state of the resource instance. (Required)
Typecode
Is Modifiertrue
Summarytrue
To DoThe category of claim this is.
PaymentReconciliation.request[x]
Definition

Original request resource reference.

Control0..1
TypeIdentifier|Reference(ProcessRequest)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.outcome
Definition

Transaction status: error, complete.

Control0..1
BindingRemittanceOutcome: The outcome of the processing. (Required)
Typecode
PaymentReconciliation.disposition
Definition

A description of the status of the adjudication.

Control0..1
Typestring
PaymentReconciliation.ruleset
Definition

The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources.

Control0..1
BindingRuleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example)
TypeCoding
PaymentReconciliation.originalRuleset
Definition

The style (standard) and version of the original material which was converted into this resource.

Control0..1
BindingRuleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example)
TypeCoding
Requirements

Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.

PaymentReconciliation.created
Definition

The date when the enclosed suite of services were performed or completed.

Control0..1
TypedateTime
PaymentReconciliation.period
Definition

The period of time for which payments have been gathered into this bulk payment for settlement.

Control0..1
TypePeriod
PaymentReconciliation.organization[x]
Definition

The Insurer who produced this adjudicated response.

Control0..1
TypeIdentifier|Reference(Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.requestProvider[x]
Definition

The practitioner who is responsible for the services rendered to the patient.

Control0..1
TypeIdentifier|Reference(Practitioner)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.requestOrganization[x]
Definition

The organization which is responsible for the services rendered to the patient.

Control0..1
TypeIdentifier|Reference(Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.detail
Definition

List of individual settlement amounts and the corresponding transaction.

Control0..*
PaymentReconciliation.detail.type
Definition

Code to indicate the nature of the payment, adjustment, funds advance, etc.

Control1..1
BindingPayment Type Codes: The reason for the amount: payment, adjustment, advance. (Example)
TypeCoding
PaymentReconciliation.detail.request[x]
Definition

The claim or financial resource.

Control0..1
TypeIdentifier|Reference(Any)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.detail.response[x]
Definition

The claim response resource.

Control0..1
TypeIdentifier|Reference(Any)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.detail.submitter[x]
Definition

The Organization which submitted the invoice or financial transaction.

Control0..1
TypeIdentifier|Reference(Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.detail.payee[x]
Definition

The organization which is receiving the payment.

Control0..1
TypeIdentifier|Reference(Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
PaymentReconciliation.detail.date
Definition

The date of the invoice or financial resource.

Control0..1
Typedate
PaymentReconciliation.detail.amount
Definition

Amount paid for this detail.

Control0..1
TypeMoney
PaymentReconciliation.form
Definition

The form to be used for printing the content.

Control0..1
BindingForm Codes: The forms codes. (Required)
TypeCoding
PaymentReconciliation.total
Definition

Total payment amount.

Control1..1
TypeMoney
PaymentReconciliation.note
Definition

Suite of notes.

Control0..*
PaymentReconciliation.note.type
Definition

The note purpose: Print/Display.

Control0..1
BindingNoteType: The presentation types of notes. (Required)
TypeCoding
PaymentReconciliation.note.text
Definition

The note text.

Control0..1
Typestring