Da Vinci Postable Remittance
1.0.0-ballot - STU 1 Ballot United States of America flag

This page is part of the DaVinci Postable Remittance FHIR Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

: ExampleSearchResult - XML Representation

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<Parameters xmlns="http://hl7.org/fhir">
  <id value="ExampleSearchResult"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchResultParameters"/>
  </meta>
  <parameter>
    <name value="TIN"/>
    <valueString value="123456"/>
  </parameter>
  <parameter>
    <name value="Payer"/>
    <part>
      <name value="PayerID"/>
      <valueString value="54321"/>
    </part>
    <part>
      <name value="PayerName"/>
      <valueString value="Acme Payment Inc"/>
    </part>
  </parameter>
  <parameter>
    <name value="Claim"/>
    <part>
      <name value="ProviderClaimID"/>
      <valueString value="12345"/>
    </part>
    <part>
      <name value="ClaimReceivedDate"/>
      <valueDate value="2024-06-01"/>
    </part>
    <part>
      <name value="ProviderID"/>
      <valueString value="23456"/>
    </part>
    <part>
      <name value="PayerClaimID"/>
      <valueString value="34567"/>
    </part>
    <part>
      <name value="PaymentInfo"/>
      <part>
        <name value="PaymentDate"/>
        <valueDate value="2024-06-07"/>
      </part>
      <part>
        <name value="PaymentNumber"/>
        <valueString value="11111"/>
      </part>
      <part>
        <name value="PaymentAmount"/>
        <valueMoney>
          <value value="123.45"/>
          <currency value="CAD"/>
        </valueMoney>
      </part>
      <part>
        <name value="Remittance"/>
        <part>
          <name value="RemittanceAdviceIdentifier"/>
          <valueString value="99999"/>
        </part>
        <part>
          <name value="RemittanceAdviceType"/>
          <valueCode value="835"/>
        </part>
        <part>
          <name value="RemittanceAdviceDate"/>
          <valueDate value="2024-06-07"/>
        </part>
        <part>
          <name value="RemittanceAdviceFileSize"/>
          <valueInteger value="123456"/>
        </part>
      </part>
    </part>
  </parameter>
  <parameter>
    <name value="Patient"/>
    <part>
      <name value="DateOfBirth"/>
      <valueDate value="1970-11-27"/>
    </part>
    <part>
      <name value="PatientID"/>
      <valueString value="23456"/>
    </part>
    <part>
      <name value="PatientFirstName"/>
      <valueString value="Adam"/>
    </part>
    <part>
      <name value="PatientLastName"/>
      <valueString value="Patient"/>
    </part>
  </parameter>
</Parameters>