R5 Final QA
FinancialThis page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - 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
| Financial Management Work Group | Maturity Level: 2 | Trial Use | Security Category: Patient | Compartments: Practitioner |
This resource provides the status of the payment for goods and services rendered, and the request and response resource references.
The PaymentNotice resource indicates the resource for which the payment has been indicated and reports the current status information of that payment. The payment notice may be used by providers and payers to advise the provider or regulatory bodies of the state of a payment (check in the mail/EFT sent, payment cashed, payment canceled). Employers or Insurance Exchanges may use this to advise payers of premium payment.
Payers and/or providers may have the need to advise providers and/or regulators of the status of claim settlement and payment completion. This same resource may be used by employers and insurance exchanges to advise payers that premium payments have been issued and settled.
The PaymentNotice resource is a "event" resource from a FHIR workflow perspective - see Workflow Event.
Additional information regarding electronic payment notice content and usage may be found at:
The PaymentNotice resource is used to indicate that a payment is, or is about to occur. The resource is used commonly when tracking of payment occurences is required for regulatory or business purposes, such as ensuring that payment of claim adjudications occurs within a specific timeframe. The PaymentNotice is not used to report adjudicated amounts (see ClaimResponse) or to reconcile adjudicated amounts against actual payment (see PaymentReconciliation)
The ClaimResponse resource is an insurer's adjudication and/or authorization of a set of healthcare-related goods and services for a patient against the patient's insurance coverages and does not indicate that payment has occured.
The PaymentReconciliation resource serves to correlate payment amounts to the adjudicated claim amounts appearing on one or more ClaimResponses.
The eClaim domain includes a number of related resources
| PaymentNotice | An indication that a payment has occured, is about to occur, or has been cancelled. |
| ClaimResponse | A payor's adjudication and/or authorization response to the suite of services provided in a Claim. Typically the ClaimResponse references the Claim but does not duplicate the clinical or financial information provided in the claim. |
| PaymentReconciliation | 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. |
Structure
See the Extensions for this resource
UML Diagram (Legend)
XML Template
<PaymentNotice xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business Identifier for the payment notice --></identifier> <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error --> <request><!-- 0..1 Reference(Any) Request reference --></request> <response><!-- 0..1 Reference(Any) Response reference --></response> <created value="[dateTime]"/><!-- 1..1 Creation date --> <reporter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></reporter> <payment><!-- 0..1 Reference(PaymentReconciliation) Payment reference --></payment> <paymentDate value="[date]"/><!-- 0..1 Payment or clearing date --> <payee><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Party being paid --></payee> <recipient><!-- 1..1 Reference(Organization) Party being notified --></recipient> <amount><!-- 1..1 Money Monetary amount of the payment --></amount> <paymentStatus><!-- 0..1 CodeableConcept Issued or cleared Status of the payment --></paymentStatus> </PaymentNotice>
JSON Template
{
"resourceType" : "PaymentNotice",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Business Identifier for the payment notice
"status" : "<code>", // R! active | cancelled | draft | entered-in-error
"request" : { Reference(Any) }, // Request reference
"response" : { Reference(Any) }, // Response reference
"created" : "<dateTime>", // R! Creation date
"reporter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
"payment" : { Reference(PaymentReconciliation) }, // Payment reference
"paymentDate" : "<date>", // Payment or clearing date
"payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Party being paid
"recipient" : { Reference(Organization) }, // R! Party being notified
"amount" : { Money }, // R! Monetary amount of the payment
"paymentStatus" : { CodeableConcept } // Issued or cleared Status of the payment
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since R4
| PaymentNotice | |
| PaymentNotice.reporter |
|
| PaymentNotice.payment |
|
| PaymentNotice.provider |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors).)
Structure
See the Extensions for this resource
XML Template
<PaymentNotice xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "PaymentNotice",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Business Identifier for the payment notice
"status" : "<code>", // R! active | cancelled | draft | entered-in-error
"request" : { Reference(Any) }, // Request reference
"response" : { Reference(Any) }, // Response reference
"created" : "<dateTime>", // R! Creation date
"reporter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
"payment" : { Reference(PaymentReconciliation) }, // Payment reference
"paymentDate" : "<date>", // Payment or clearing date
"payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Party being paid
"recipient" : { Reference(Organization) }, // R! Party being notified
"amount" : { Money }, // R! Monetary amount of the payment
"paymentStatus" : { CodeableConcept } // Issued or cleared Status of the payment
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since Release 4
| PaymentNotice | |
| PaymentNotice.reporter |
|
| PaymentNotice.payment |
|
| PaymentNotice.provider |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors).)
Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis
| Path | ValueSet | Type | Documentation |
|---|---|---|---|
| PaymentNotice.status | FinancialResourceStatusCodes | Required | This value set includes Status codes. |
| PaymentNotice.paymentStatus | PaymentStatusCodes | Example | This value set includes a sample set of Payment Status codes. |
Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| created | date | Creation date for the notice | PaymentNotice.created | |
| identifier | token | The business identifier of the notice | PaymentNotice.identifier | |
| payment-status | token | The type of payment notice | PaymentNotice.paymentStatus | |
| reporter | reference | The reference to the reporter | PaymentNotice.reporter (Practitioner, Organization, PractitionerRole) | |
| request | reference | The Claim | PaymentNotice.request (Any) | |
| response | reference | The ClaimResponse | PaymentNotice.response (Any) | |
| status | token | The status of the payment notice | PaymentNotice.status |
FHIR ®© HL7.org 2011+. FHIR R5 hl7.fhir.core#5.0.0-draft-final generated on Wed, Mar 1, 2023 23:07+1100.
Links: Search |
Version History |
Contents |
Glossary |
QA |
Compare to R4B |
Compare to R5 Draft |
|
Propose a change