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 Resource PaymentReconciliation - Content

Financial Management Work GroupMaturity Level: 1Compartments: Not linked to any defined compartments

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

13.10.1 Scope and Usage

The PaymentReconciliation resource 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. These are the payment reconciliation details which align to the individual payment amounts indicated on discrete ClaimResponses.

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

13.10.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentReconciliation DomainResourcePaymentReconciliation resource
... identifier 0..*IdentifierBusiness Identifier
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
PaymentReconciliationStatus (Required)
... request[x] 0..1Claim reference
.... requestIdentifierIdentifier
.... requestReferenceReference(ProcessRequest)
... outcome 0..1codecomplete | error | partial
RemittanceOutcome (Required)
... disposition 0..1stringDisposition Message
... ruleset 0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset Codes (Example)
... created 0..1dateTimeCreation date
... period 0..1PeriodPeriod covered
... organization[x] 0..1Insurer
.... organizationIdentifierIdentifier
.... organizationReferenceReference(Organization)
... requestProvider[x] 0..1Responsible practitioner
.... requestProviderIdentifierIdentifier
.... requestProviderReferenceReference(Practitioner)
... requestOrganization[x] 0..1Responsible organization
.... requestOrganizationIdentifierIdentifier
.... requestOrganizationReferenceReference(Organization)
... detail 0..*BackboneElementDetails
.... type 1..1CodingType code
Payment Type Codes (Example)
.... request[x] 0..1Claim
..... requestIdentifierIdentifier
..... requestReferenceReference(Any)
.... response[x] 0..1Claim Response
..... responseIdentifierIdentifier
..... responseReferenceReference(Any)
.... submitter[x] 0..1Submitter
..... submitterIdentifierIdentifier
..... submitterReferenceReference(Organization)
.... payee[x] 0..1Payee
..... payeeIdentifierIdentifier
..... payeeReferenceReference(Organization)
.... date 0..1dateInvoice date
.... amount 0..1MoneyDetail amount
... form 0..1CodingPrinted Form Identifier
Form Codes (Required)
... total 1..1MoneyTotal amount of Payment
... note 0..*BackboneElementNote text
.... type 0..1Codingdisplay | print | printoper
NoteType (Required)
.... text 0..1stringNotes text

doco Documentation for this format

UML Diagram (Legend)

PaymentReconciliation (DomainResource)The Response business identifieridentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)PaymentReconciliationStatus! »Original request resource referencerequest[x] : Type [0..1] « Identifier|Reference(ProcessRequest) »Transaction status: error, completeoutcome : code [0..1] « The outcome of the processing. (Strength=Required)RemittanceOutcome! »A description of the status of the adjudicationdisposition : string [0..1]The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resourcesruleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The style (standard) and version of the original material which was converted into this resourceoriginalRuleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The date when the enclosed suite of services were performed or completedcreated : dateTime [0..1]The period of time for which payments have been gathered into this bulk payment for settlementperiod : Period [0..1]The Insurer who produced this adjudicated responseorganization[x] : Type [0..1] « Identifier|Reference(Organization) »The practitioner who is responsible for the services rendered to the patientrequestProvider[x] : Type [0..1] « Identifier|Reference(Practitioner) »The organization which is responsible for the services rendered to the patientrequestOrganization[x] : Type [0..1] « Identifier|Reference( Organization) »The form to be used for printing the contentform : Coding [0..1] « The forms codes. (Strength=Required)Form ! »Total payment amounttotal : Money [1..1]DetailsCode to indicate the nature of the payment, adjustment, funds advance, etctype : Coding [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example)Payment Type ?? »The claim or financial resourcerequest[x] : Type [0..1] « Identifier|Reference(Any) »The claim response resourceresponse[x] : Type [0..1] « Identifier|Reference(Any) »The Organization which submitted the invoice or financial transactionsubmitter[x] : Type [0..1] « Identifier|Reference(Organization) »The organization which is receiving the paymentpayee[x] : Type [0..1] « Identifier|Reference(Organization) »The date of the invoice or financial resourcedate : date [0..1]Amount paid for this detailamount : Money [0..1]NotesThe note purpose: Print/Displaytype : Coding [0..1] « The presentation types of notes. (Strength=Required)NoteType! »The note texttext : string [0..1]List of individual settlement amounts and the corresponding transactiondetail[0..*]Suite of notesnote[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><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <request[x]><!-- 0..1 Identifier|Reference(ProcessRequest) Claim reference --></request[x]>
 <outcome value="[code]"/><!-- 0..1 complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <period><!-- 0..1 Period Period covered --></period>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>
 <detail>  <!-- 0..* Details -->
  <type><!-- 1..1 Coding Type code --></type>
  <request[x]><!-- 0..1 Identifier|Reference(Any) Claim --></request[x]>
  <response[x]><!-- 0..1 Identifier|Reference(Any) Claim Response --></response[x]>
  <submitter[x]><!-- 0..1 Identifier|Reference(Organization) Submitter --></submitter[x]>
  <payee[x]><!-- 0..1 Identifier|Reference(Organization) Payee --></payee[x]>
  <date value="[date]"/><!-- 0..1 Invoice date -->
  <amount><!-- 0..1 Money Detail amount --></amount>
 </detail>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <total><!-- 1..1 Money Total amount of Payment --></total>
 <note>  <!-- 0..* Note text -->
  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Notes text -->
 </note>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  // request[x]: Claim reference. One of these 2:
  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(ProcessRequest) },
  "outcome" : "<code>", // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "period" : { Period }, // Period covered
  // organization[x]: Insurer. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:
  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:
  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },
  "detail" : [{ // Details
    "type" : { Coding }, // R!  Type code
    // request[x]: Claim. One of these 2:
    "requestIdentifier" : { Identifier },
    "requestReference" : { Reference(Any) },
    // response[x]: Claim Response. One of these 2:
    "responseIdentifier" : { Identifier },
    "responseReference" : { Reference(Any) },
    // submitter[x]: Submitter. One of these 2:
    "submitterIdentifier" : { Identifier },
    "submitterReference" : { Reference(Organization) },
    // payee[x]: Payee. One of these 2:
    "payeeIdentifier" : { Identifier },
    "payeeReference" : { Reference(Organization) },
    "date" : "<date>", // Invoice date
    "amount" : { Money } // Detail amount
  }],
  "form" : { Coding }, // Printed Form Identifier
  "total" : { Money }, // R!  Total amount of Payment
  "note" : [{ // Note text
    "type" : { Coding }, // display | print | printoper
    "text" : "<string>" // Notes text
  }]
}

Turtle Template

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


[ 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:PaymentReconciliation.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  # PaymentReconciliation.request[x] : 0..1 Claim reference. One of these 2
    fhir:PaymentReconciliation.requestIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestReference [ Reference(ProcessRequest) ]
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition Message
  fhir:PaymentReconciliation.ruleset [ Coding ]; # 0..1 Resource version
  fhir:PaymentReconciliation.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:PaymentReconciliation.created [ dateTime ]; # 0..1 Creation date
  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  # PaymentReconciliation.organization[x] : 0..1 Insurer. One of these 2
    fhir:PaymentReconciliation.organizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.organizationReference [ Reference(Organization) ]
  # PaymentReconciliation.requestProvider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:PaymentReconciliation.requestProviderIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestProviderReference [ Reference(Practitioner) ]
  # PaymentReconciliation.requestOrganization[x] : 0..1 Responsible organization. One of these 2
    fhir:PaymentReconciliation.requestOrganizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestOrganizationReference [ Reference(Organization) ]
  fhir:PaymentReconciliation.detail [ # 0..* Details
    fhir:PaymentReconciliation.detail.type [ Coding ]; # 1..1 Type code
    # PaymentReconciliation.detail.request[x] : 0..1 Claim. One of these 2
      fhir:PaymentReconciliation.detail.requestIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.requestReference [ Reference(Any) ]
    # PaymentReconciliation.detail.response[x] : 0..1 Claim Response. One of these 2
      fhir:PaymentReconciliation.detail.responseIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.responseReference [ Reference(Any) ]
    # PaymentReconciliation.detail.submitter[x] : 0..1 Submitter. One of these 2
      fhir:PaymentReconciliation.detail.submitterIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.submitterReference [ Reference(Organization) ]
    # PaymentReconciliation.detail.payee[x] : 0..1 Payee. One of these 2
      fhir:PaymentReconciliation.detail.payeeIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.payeeReference [ Reference(Organization) ]
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Invoice date
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Detail amount
  ], ...;
  fhir:PaymentReconciliation.form [ Coding ]; # 0..1 Printed Form Identifier
  fhir:PaymentReconciliation.total [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.note [ # 0..* Note text
    fhir:PaymentReconciliation.note.type [ Coding ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.note.text [ string ]; # 0..1 Notes text
  ], ...;
]

Changes since DSTU2

PaymentReconciliation
PaymentReconciliation.status added
PaymentReconciliation.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.organization[x] Renamed from organization to organization[x]
Add Identifier
PaymentReconciliation.requestProvider[x] Renamed from requestProvider to requestProvider[x]
Add Identifier
PaymentReconciliation.requestOrganization[x] Renamed from requestOrganization to requestOrganization[x]
Add Identifier
PaymentReconciliation.detail.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.detail.response[x] added
PaymentReconciliation.detail.submitter[x] Renamed from submitter to submitter[x]
Add Identifier
PaymentReconciliation.detail.payee[x] Renamed from payee to payee[x]
Add Identifier
PaymentReconciliation.detail.amount Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.total Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.detail.responce deleted

See the Full Difference for further information

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentReconciliation DomainResourcePaymentReconciliation resource
... identifier 0..*IdentifierBusiness Identifier
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
PaymentReconciliationStatus (Required)
... request[x] 0..1Claim reference
.... requestIdentifierIdentifier
.... requestReferenceReference(ProcessRequest)
... outcome 0..1codecomplete | error | partial
RemittanceOutcome (Required)
... disposition 0..1stringDisposition Message
... ruleset 0..1CodingResource version
Ruleset Codes (Example)
... originalRuleset 0..1CodingOriginal version
Ruleset Codes (Example)
... created 0..1dateTimeCreation date
... period 0..1PeriodPeriod covered
... organization[x] 0..1Insurer
.... organizationIdentifierIdentifier
.... organizationReferenceReference(Organization)
... requestProvider[x] 0..1Responsible practitioner
.... requestProviderIdentifierIdentifier
.... requestProviderReferenceReference(Practitioner)
... requestOrganization[x] 0..1Responsible organization
.... requestOrganizationIdentifierIdentifier
.... requestOrganizationReferenceReference(Organization)
... detail 0..*BackboneElementDetails
.... type 1..1CodingType code
Payment Type Codes (Example)
.... request[x] 0..1Claim
..... requestIdentifierIdentifier
..... requestReferenceReference(Any)
.... response[x] 0..1Claim Response
..... responseIdentifierIdentifier
..... responseReferenceReference(Any)
.... submitter[x] 0..1Submitter
..... submitterIdentifierIdentifier
..... submitterReferenceReference(Organization)
.... payee[x] 0..1Payee
..... payeeIdentifierIdentifier
..... payeeReferenceReference(Organization)
.... date 0..1dateInvoice date
.... amount 0..1MoneyDetail amount
... form 0..1CodingPrinted Form Identifier
Form Codes (Required)
... total 1..1MoneyTotal amount of Payment
... note 0..*BackboneElementNote text
.... type 0..1Codingdisplay | print | printoper
NoteType (Required)
.... text 0..1stringNotes text

doco Documentation for this format

UML Diagram (Legend)

PaymentReconciliation (DomainResource)The Response business identifieridentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)PaymentReconciliationStatus! »Original request resource referencerequest[x] : Type [0..1] « Identifier|Reference(ProcessRequest) »Transaction status: error, completeoutcome : code [0..1] « The outcome of the processing. (Strength=Required)RemittanceOutcome! »A description of the status of the adjudicationdisposition : string [0..1]The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resourcesruleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The style (standard) and version of the original material which was converted into this resourceoriginalRuleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example)Ruleset ?? »The date when the enclosed suite of services were performed or completedcreated : dateTime [0..1]The period of time for which payments have been gathered into this bulk payment for settlementperiod : Period [0..1]The Insurer who produced this adjudicated responseorganization[x] : Type [0..1] « Identifier|Reference(Organization) »The practitioner who is responsible for the services rendered to the patientrequestProvider[x] : Type [0..1] « Identifier|Reference(Practitioner) »The organization which is responsible for the services rendered to the patientrequestOrganization[x] : Type [0..1] « Identifier|Reference( Organization) »The form to be used for printing the contentform : Coding [0..1] « The forms codes. (Strength=Required)Form ! »Total payment amounttotal : Money [1..1]DetailsCode to indicate the nature of the payment, adjustment, funds advance, etctype : Coding [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example)Payment Type ?? »The claim or financial resourcerequest[x] : Type [0..1] « Identifier|Reference(Any) »The claim response resourceresponse[x] : Type [0..1] « Identifier|Reference(Any) »The Organization which submitted the invoice or financial transactionsubmitter[x] : Type [0..1] « Identifier|Reference(Organization) »The organization which is receiving the paymentpayee[x] : Type [0..1] « Identifier|Reference(Organization) »The date of the invoice or financial resourcedate : date [0..1]Amount paid for this detailamount : Money [0..1]NotesThe note purpose: Print/Displaytype : Coding [0..1] « The presentation types of notes. (Strength=Required)NoteType! »The note texttext : string [0..1]List of individual settlement amounts and the corresponding transactiondetail[0..*]Suite of notesnote[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><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <request[x]><!-- 0..1 Identifier|Reference(ProcessRequest) Claim reference --></request[x]>
 <outcome value="[code]"/><!-- 0..1 complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <period><!-- 0..1 Period Period covered --></period>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>
 <detail>  <!-- 0..* Details -->
  <type><!-- 1..1 Coding Type code --></type>
  <request[x]><!-- 0..1 Identifier|Reference(Any) Claim --></request[x]>
  <response[x]><!-- 0..1 Identifier|Reference(Any) Claim Response --></response[x]>
  <submitter[x]><!-- 0..1 Identifier|Reference(Organization) Submitter --></submitter[x]>
  <payee[x]><!-- 0..1 Identifier|Reference(Organization) Payee --></payee[x]>
  <date value="[date]"/><!-- 0..1 Invoice date -->
  <amount><!-- 0..1 Money Detail amount --></amount>
 </detail>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <total><!-- 1..1 Money Total amount of Payment --></total>
 <note>  <!-- 0..* Note text -->
  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Notes text -->
 </note>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  // request[x]: Claim reference. One of these 2:
  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(ProcessRequest) },
  "outcome" : "<code>", // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "period" : { Period }, // Period covered
  // organization[x]: Insurer. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:
  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:
  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },
  "detail" : [{ // Details
    "type" : { Coding }, // R!  Type code
    // request[x]: Claim. One of these 2:
    "requestIdentifier" : { Identifier },
    "requestReference" : { Reference(Any) },
    // response[x]: Claim Response. One of these 2:
    "responseIdentifier" : { Identifier },
    "responseReference" : { Reference(Any) },
    // submitter[x]: Submitter. One of these 2:
    "submitterIdentifier" : { Identifier },
    "submitterReference" : { Reference(Organization) },
    // payee[x]: Payee. One of these 2:
    "payeeIdentifier" : { Identifier },
    "payeeReference" : { Reference(Organization) },
    "date" : "<date>", // Invoice date
    "amount" : { Money } // Detail amount
  }],
  "form" : { Coding }, // Printed Form Identifier
  "total" : { Money }, // R!  Total amount of Payment
  "note" : [{ // Note text
    "type" : { Coding }, // display | print | printoper
    "text" : "<string>" // Notes text
  }]
}

Turtle Template

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


[ 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:PaymentReconciliation.identifier [ Identifier ], ... ; # 0..* Business Identifier
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  # PaymentReconciliation.request[x] : 0..1 Claim reference. One of these 2
    fhir:PaymentReconciliation.requestIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestReference [ Reference(ProcessRequest) ]
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition Message
  fhir:PaymentReconciliation.ruleset [ Coding ]; # 0..1 Resource version
  fhir:PaymentReconciliation.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:PaymentReconciliation.created [ dateTime ]; # 0..1 Creation date
  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  # PaymentReconciliation.organization[x] : 0..1 Insurer. One of these 2
    fhir:PaymentReconciliation.organizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.organizationReference [ Reference(Organization) ]
  # PaymentReconciliation.requestProvider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:PaymentReconciliation.requestProviderIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestProviderReference [ Reference(Practitioner) ]
  # PaymentReconciliation.requestOrganization[x] : 0..1 Responsible organization. One of these 2
    fhir:PaymentReconciliation.requestOrganizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestOrganizationReference [ Reference(Organization) ]
  fhir:PaymentReconciliation.detail [ # 0..* Details
    fhir:PaymentReconciliation.detail.type [ Coding ]; # 1..1 Type code
    # PaymentReconciliation.detail.request[x] : 0..1 Claim. One of these 2
      fhir:PaymentReconciliation.detail.requestIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.requestReference [ Reference(Any) ]
    # PaymentReconciliation.detail.response[x] : 0..1 Claim Response. One of these 2
      fhir:PaymentReconciliation.detail.responseIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.responseReference [ Reference(Any) ]
    # PaymentReconciliation.detail.submitter[x] : 0..1 Submitter. One of these 2
      fhir:PaymentReconciliation.detail.submitterIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.submitterReference [ Reference(Organization) ]
    # PaymentReconciliation.detail.payee[x] : 0..1 Payee. One of these 2
      fhir:PaymentReconciliation.detail.payeeIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.payeeReference [ Reference(Organization) ]
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Invoice date
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Detail amount
  ], ...;
  fhir:PaymentReconciliation.form [ Coding ]; # 0..1 Printed Form Identifier
  fhir:PaymentReconciliation.total [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.note [ # 0..* Note text
    fhir:PaymentReconciliation.note.type [ Coding ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.note.text [ string ]; # 0..1 Notes text
  ], ...;
]

Changes since DSTU2

PaymentReconciliation
PaymentReconciliation.status added
PaymentReconciliation.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.organization[x] Renamed from organization to organization[x]
Add Identifier
PaymentReconciliation.requestProvider[x] Renamed from requestProvider to requestProvider[x]
Add Identifier
PaymentReconciliation.requestOrganization[x] Renamed from requestOrganization to requestOrganization[x]
Add Identifier
PaymentReconciliation.detail.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.detail.response[x] added
PaymentReconciliation.detail.submitter[x] Renamed from submitter to submitter[x]
Add Identifier
PaymentReconciliation.detail.payee[x] Renamed from payee to payee[x]
Add Identifier
PaymentReconciliation.detail.amount Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.total Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.detail.responce deleted

See the Full Difference for further information

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

13.10.2.1 Terminology Bindings

PathDefinitionTypeReference
PaymentReconciliation.status A code specifying the state of the resource instance.RequiredPaymentReconciliationStatus
PaymentReconciliation.outcome The outcome of the processing.RequiredRemittanceOutcome
PaymentReconciliation.ruleset
PaymentReconciliation.originalRuleset
The static and dynamic model to which contents conform, which may be business version or standard/version.ExampleRuleset Codes
PaymentReconciliation.detail.type The reason for the amount: payment, adjustment, advance.ExamplePayment Type Codes
PaymentReconciliation.form The forms codes.RequiredForm Codes
PaymentReconciliation.note.type The presentation types of notes.RequiredNoteType

13.10.3 Search Parameters

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

NameTypeDescriptionPaths
createddateThe creation datePaymentReconciliation.created
dispositionstringThe contents of the disposition messagePaymentReconciliation.disposition
identifiertokenThe business identifier of the Explanation of BenefitPaymentReconciliation.identifier
organization-identifiertokenThe organization who generated this resourcePaymentReconciliation.organizationIdentifier
organization-referencereferenceThe organization who generated this resourcePaymentReconciliation.organizationReference
(Organization)
outcometokenThe processing outcomePaymentReconciliation.outcome
request-identifiertokenThe reference to the claimPaymentReconciliation.requestIdentifier
request-organization-identifiertokenThe organization who generated this resourcePaymentReconciliation.requestOrganizationIdentifier
request-organization-referencereferenceThe organization who generated this resourcePaymentReconciliation.requestOrganizationReference
(Organization)
request-provider-identifiertokenThe reference to the provider who sumbitted the claimPaymentReconciliation.requestProviderIdentifier
request-provider-referencereferenceThe reference to the provider who sumbitted the claimPaymentReconciliation.requestProviderReference
(Practitioner)
request-referencereferenceThe reference to the claimPaymentReconciliation.requestReference
(ProcessRequest)