Release 5 Preview #3

This page is part of the FHIR Specification (v4.5.0: R5 Preview #3). 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

Financial Management Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Practitioner

Detailed Descriptions for the elements in the PaymentReconciliation resource.

PaymentReconciliation
Element IdPaymentReconciliation
Definition

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

Cardinality0..*
TypeDomainResource
PaymentReconciliation.identifier
Element IdPaymentReconciliation.identifier
Definition

A unique identifier assigned to this payment reconciliation.

NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Requirements

Allows payment reconciliations to be distinguished and referenced.

PaymentReconciliation.status
Element IdPaymentReconciliation.status
Definition

The status of the resource instance.

Cardinality1..1
Terminology BindingFinancial Resource Status Codes (Required)
Typecode
Is Modifiertrue (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Requirements

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

Summarytrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

PaymentReconciliation.period
Element IdPaymentReconciliation.period
Definition

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

Cardinality0..1
TypePeriod
Requirements

Needed to allow receivers to monitor and reconcile payment issuer schedules.

Summarytrue
PaymentReconciliation.created
Element IdPaymentReconciliation.created
Definition

The date when the resource was created.

Cardinality1..1
TypedateTime
Requirements

Need to record a timestamp for use by both the recipient and the issuer.

Summarytrue
PaymentReconciliation.paymentIssuer
Element IdPaymentReconciliation.paymentIssuer
Definition

The party who generated the payment.

Cardinality0..1
TypeReference(Organization)
Requirements

Need to identify the party resonsible for the payment and this resource.

Summarytrue
Comments

This party is also responsible for the reconciliation.

PaymentReconciliation.request
Element IdPaymentReconciliation.request
Definition

Original request resource reference.

Cardinality0..1
TypeReference(Task)
Requirements

Needed to allow the response to be linked to the request.

PaymentReconciliation.requestor
Element IdPaymentReconciliation.requestor
Definition

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

Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization)
PatternsReference(Practitioner,PractitionerRole,Organization): Common patterns = Participant
Requirements

Need to identify the party responsible for the request.

PaymentReconciliation.outcome
Element IdPaymentReconciliation.outcome
Definition

The outcome of a request for a reconciliation.

Cardinality0..1
Terminology BindingRemittanceOutcome (Required)
Typecode
Requirements

To advise the requestor of an overall processing outcome.

Comments

The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

PaymentReconciliation.disposition
Element IdPaymentReconciliation.disposition
Definition

A human readable description of the status of the request for the reconciliation.

Cardinality0..1
Typestring
Requirements

Provided for user display.

PaymentReconciliation.paymentDate
Element IdPaymentReconciliation.paymentDate
Definition

The date of payment as indicated on the financial instrument.

Cardinality1..1
Typedate
Requirements

To advise the payee when payment can be expected.

Summarytrue
PaymentReconciliation.paymentAmount
Element IdPaymentReconciliation.paymentAmount
Definition

Total payment amount as indicated on the financial instrument.

Cardinality1..1
TypeMoney
Requirements

Needed to provide the actual payment amount.

Summarytrue
PaymentReconciliation.paymentIdentifier
Element IdPaymentReconciliation.paymentIdentifier
Definition

Issuer's unique identifier for the payment instrument.

Cardinality0..1
TypeIdentifier
Requirements

Enable the receiver to reconcile when payment is received.

Comments

For example: EFT number or check number.

PaymentReconciliation.detail
Element IdPaymentReconciliation.detail
Definition

Distribution of the payment amount for a previously acknowledged payable.

Cardinality0..*
Requirements

Needed to show how the payment amount is distributed across the payables.

PaymentReconciliation.detail.identifier
Element IdPaymentReconciliation.detail.identifier
Definition

Unique identifier for the current payment item for the referenced payable.

NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..1
TypeIdentifier
Requirements

Needed for reconciliation of payments.

PaymentReconciliation.detail.predecessor
Element IdPaymentReconciliation.detail.predecessor
Definition

Unique identifier for the prior payment item for the referenced payable.

Cardinality0..1
TypeIdentifier
Requirements

Needed for reconciliation of payments.

PaymentReconciliation.detail.type
Element IdPaymentReconciliation.detail.type
Definition

Code to indicate the nature of the payment.

Cardinality1..1
Terminology BindingPayment Type Codes (Example)
TypeCodeableConcept
Requirements

Needed to provide context for the amount.

Comments

For example: payment, adjustment, funds advance, etc.

PaymentReconciliation.detail.request
Element IdPaymentReconciliation.detail.request
Definition

A resource, such as a Claim, the evaluation of which could lead to payment.

Cardinality0..1
TypeReference(Any)
Requirements

Needed to provide a linkage to the original request.

PaymentReconciliation.detail.submitter
Element IdPaymentReconciliation.detail.submitter
Definition

The party which submitted the claim or financial transaction.

Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization)
PatternsReference(Practitioner,PractitionerRole,Organization): Common patterns = Participant
Requirements

Needed for audit and validation.

PaymentReconciliation.detail.response
Element IdPaymentReconciliation.detail.response
Definition

A resource, such as a ClaimResponse, which contains a commitment to payment.

Cardinality0..1
TypeReference(Any)
Requirements

Needed to provide a linkage to the payment commitment.

PaymentReconciliation.detail.date
Element IdPaymentReconciliation.detail.date
Definition

The date from the response resource containing a commitment to pay.

Cardinality0..1
Typedate
Requirements

Needed for audit and validation.

PaymentReconciliation.detail.responsible
Element IdPaymentReconciliation.detail.responsible
Definition

A reference to the individual who is responsible for inquiries regarding the response and its payment.

Cardinality0..1
TypeReference(PractitionerRole)
Requirements

To provide contact information.

PaymentReconciliation.detail.payee
Element IdPaymentReconciliation.detail.payee
Definition

The party which is receiving the payment.

Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization)
PatternsReference(Practitioner,PractitionerRole,Organization): Common patterns = Participant
Requirements

Needed for audit and validation.

PaymentReconciliation.detail.amount
Element IdPaymentReconciliation.detail.amount
Definition

The monetary amount allocated from the total payment to the payable.

Cardinality0..1
TypeMoney
Requirements

Needed to explain the distribution of the payment to the payables.

PaymentReconciliation.formCode
Element IdPaymentReconciliation.formCode
Definition

A code for the form to be used for printing the content.

Cardinality0..1
Terminology BindingForms (Example)
TypeCodeableConcept
Requirements

Needed to specify the specific form used for producing output for this response.

Comments

May be needed to identify specific jurisdictional forms.

PaymentReconciliation.processNote
Element IdPaymentReconciliation.processNote
Definition

A note that describes or explains the processing in a human readable form.

Cardinality0..*
Requirements

Provides the specific textual explanations associated with the processing.

PaymentReconciliation.processNote.type
Element IdPaymentReconciliation.processNote.type
Definition

The business purpose of the note text.

Cardinality0..1
Terminology BindingNoteType (Required)
Typecode
Requirements

To convey the expectation for when the text is used.

PaymentReconciliation.processNote.text
Element IdPaymentReconciliation.processNote.text
Definition

The explanation or description associated with the processing.

Cardinality0..1
Typestring
Requirements

Required to provide human readable explanation.