Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: R5 Ballot - see ballot notes). 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

Example PaymentNotice/77654 (XML)

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Practitioner

Raw XML (canonical form + also see XML Format Specification)

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Claim PaymentNotice Example (id = "77654")

<?xml version="1.0" encoding="UTF-8"?>

<PaymentNotice xmlns="http://hl7.org/fhir">
  <id value="77654"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the PaymentNotice</div> 
  </text> 

  <identifier> 
    <system value="http://benefitsinc.com/paymentnotice"/> 
    <value value="776543"/> 
  </identifier> 

  <status value="active"/> 

  <request> 
    <reference value="http://benefitsinc.com/fhir/claim/12345"/> 
  </request> 

  <response> 
    <reference value="http://benefitsinc.com/fhir/claimresponse/CR12345"/> 
  </response> 

  <created value="2014-08-16"/> 

  <provider> 
    <reference value="Organization/1"/> 
  </provider> 

  <payment> 
    <reference value="PaymentReconciliation/ER2500"/> 
  </payment> 

  <paymentDate value="2014-08-15"/> 

  <payee> 
    <reference value="Organization/1"/> 
  </payee> 

  <recipient> 
    <identifier> 
      <system value="http://regulators.gov"/> 
      <value value="AB123"/> 
    </identifier> 
  </recipient> 

  <amount> 
    <value value="12500.00"/> 
    <currency value="USD"/>  
  </amount> 

  <paymentStatus> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/paymentstatus"/> 
      <code value="paid"/> 
    </coding> 
  </paymentStatus> 

</PaymentNotice>

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.