Paymentnotice-example.json - FHIR v5.0.0-ballot

Release 5 Ballot

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

Financial Management Work Group

Maturity Level: N/A

Standards Status: Informative

Compartments: Practitioner

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

Claim PaymentNotice Example

{
  "resourceType": "PaymentNotice",
  "id": "77654",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentNotice</div>"
  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/paymentnotice",
      "value": "776543"
    }
  ],
  "status": "active",
  "request": {
    "reference": "http://benefitsinc.com/fhir/claim/12345"
  },
  "response": {
    "reference": "http://benefitsinc.com/fhir/claimresponse/CR12345"
  },
  "created": "2014-08-16",
  "provider": {
    "reference": "Organization/1"
  },
  "payment": {
    "reference": "PaymentReconciliation/ER2500"
  },
  "paymentDate": "2014-08-15",
  "payee": {
    "reference": "Organization/1"
  },
  "recipient": {
    "identifier": {
      "system": "http://regulators.gov",
      "value": "AB123"
    }
  },
  "amount": {
    "value": 12500.00,
    "currency": "USD"
  },
  "paymentStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/paymentstatus",
        "code": "paid"
      }
    ]
  }
}

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.