R6 Ballot (1st Draft)

This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

13.8 Resource PaymentNotice - Content

Financial Management icon

Work Group

Maturity Level: 4

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.

13.8.1 Scope and Usage

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.

13.8.1.1 Additional Information

Additional information regarding electronic payment notice content and usage may be found at:

Financial Resource Status Lifecycle: how .status is used in the financial resources.
Batches: how eClaims may handle batches of eligibility, claims, payments and responses.

13.8.2 Boundaries and Relationships

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.

13.8.3 References to this Resource

Implements: Event

Structure

Name	Flags	Card.	Type	Description & Constraints
PaymentNotice	TU		DomainResource	PaymentNotice request Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	Business Identifier for the payment notice
status	?!Σ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: Financial Resource Status Codes (Required)
request		0..1	Reference(Any)	Request reference
response		0..1	Reference(Any)	Response reference
created	Σ	1..1	dateTime	Creation date
reporter		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
payment	Σ	0..1	Reference(PaymentReconciliation)	Payment reference
paymentDate		0..1	date	Payment or clearing date
payee		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Party being paid
recipient	Σ	1..1	Reference(Organization)	Party being notified
amount	Σ	1..1	Money	Monetary amount of the payment
paymentStatus		0..1	CodeableConcept	Issued or cleared Status of the payment Binding: Payment Status Codes (Example)
Documentation for this format

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/> .


[ a fhir:PaymentNotice;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for the payment notice
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:request [ Reference(Any) ] ; # 0..1 Request reference
  fhir:response [ Reference(Any) ] ; # 0..1 Response reference
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:reporter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:payment [ Reference(PaymentReconciliation) ] ; # 0..1 Payment reference
  fhir:paymentDate [ date ] ; # 0..1 Payment or clearing date
  fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Party being paid
  fhir:recipient [ Reference(Organization) ] ; # 1..1 Party being notified
  fhir:amount [ Money ] ; # 1..1 Monetary amount of the payment
  fhir:paymentStatus [ CodeableConcept ] ; # 0..1 Issued or cleared Status of the payment
]

Changes from both R4 and R4B

PaymentNotice

PaymentNotice.reporter

Added Element

PaymentNotice.payment

Min Cardinality changed from 1 to 0

PaymentNotice.provider

Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

Name	Flags	Card.	Type	Description & Constraints
PaymentNotice	TU		DomainResource	PaymentNotice request Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	Business Identifier for the payment notice
status	?!Σ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: Financial Resource Status Codes (Required)
request		0..1	Reference(Any)	Request reference
response		0..1	Reference(Any)	Response reference
created	Σ	1..1	dateTime	Creation date
reporter		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
payment	Σ	0..1	Reference(PaymentReconciliation)	Payment reference
paymentDate		0..1	date	Payment or clearing date
payee		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Party being paid
recipient	Σ	1..1	Reference(Organization)	Party being notified
amount	Σ	1..1	Money	Monetary amount of the payment
paymentStatus		0..1	CodeableConcept	Issued or cleared Status of the payment Binding: Payment Status Codes (Example)
Documentation for this format

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/> .


[ a fhir:PaymentNotice;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for the payment notice
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:request [ Reference(Any) ] ; # 0..1 Request reference
  fhir:response [ Reference(Any) ] ; # 0..1 Response reference
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:reporter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:payment [ Reference(PaymentReconciliation) ] ; # 0..1 Payment reference
  fhir:paymentDate [ date ] ; # 0..1 Payment or clearing date
  fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Party being paid
  fhir:recipient [ Reference(Organization) ] ; # 1..1 Party being notified
  fhir:amount [ Money ] ; # 1..1 Monetary amount of the payment
  fhir:paymentStatus [ CodeableConcept ] ; # 0..1 Issued or cleared Status of the payment
]

Changes from both R4 and R4B

PaymentNotice

PaymentNotice.reporter

Added Element

PaymentNotice.payment

Min Cardinality changed from 1 to 0

PaymentNotice.provider

Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

13.8.4.1 Terminology Bindings

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.

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.

13.8.5 Search Parameters

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