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

Technical

General Technical Information

Search Parameter Formats

For all of the use cases, the incoming parameters are specified as a FHIR Parameters resource. The outgoing information for the three Search operations are also specified as a FHIR Parameters resource. The Download Remittance outgoing information is a FHIR Binary instance with the remittance specified in the Binary.content element as encoded binary data.

Search Timeframes

The time from when a remittance was returned to when you can retrieve it via a search using this API is payer-specific. Payers SHALL provide the timeframe of searches.

The list of input and output search parameters has been reviewed by multiple providers and payers. It will undergo validation at Connectathons and via balloting.

No Match Results

If the set of input parameters results in no results found, then the output Parameters will be empty.

Search for Remittance by Claim

This search is used to find remittances associated with a previous claim submission. This API does not provide any means to return a claim status. As well, only remittances for adjudicated claims will be returned. The payer will search for the claim given the passed-in search parameters and find remittances associated with that claim. The remittance information is returned along with claim and payment information that can be used by the provider to verify the proper claim was retrieved. Any of the returned remittance identifiers can then be used in the Download Remittance operation.

Input

• Provider TIN (mandatory)
• Date Of Service Period (optional)
• Patient ID (optional)
• Payer ID (optional)
• Payer Name (optional)
• Claim Information (mandatory)
  • Provider Claim ID (mandatory) - also known as Patient Account Number
  • Provider ID (optional)
  • Payer Claim ID (optional)
  • Claim Charge Amount (optional)

Output

• Provider TIN (optional, mandatory if Remittance information found)
• Payer Information (optional, mandatory if Remittance information found)
  • Payer ID (mandatory)
  • Payer Name (mandatory)
• Patient Information (optional, mandatory if Remittance information found)
  • Patient ID (mandatory)
  • Patient Date of Birth (mandatory)
  • Patient First Name (mandatory)
  • Patient Last Name (mandatory)
• Claim Information (optional, mandatory if Remittance information found, repeats)
  • Payer Claim ID (mandatory) - the primary key of the claim information
  • Provider Claim ID (mandatory)
  • Claim Received Date (mandatory)
  • Provider ID (mandatory)
  • Payment Information (optional, repeats)
    • Payment Issue Date (mandatory)
    • Payment Number (mandatory)
    • Payment Amount (mandatory)
    • Remittance Information (mandatory)
      • Remittance Advice Identifier (mandatory)
      • Remittance Advice Type (mandatory)
      • Remittance Advice Date (mandatory)
      • Remittance Advice File Size (mandatory)

Search for Remittance by Patient

This search is used to find remittances associated with a patient. The payer will search for the patient given the passed-in search parameters and find remittances associated with that patient. The remittance information is returned along with patient and claim information that can be used by the provider to verify the proper patient was retrieved. Any of the returned remittance identifiers can then be used in the Download Remittance operation.

Input

• Provider TIN (mandatory)
• Date of Service Period (optional)
• Payer ID (optional)
• Payer Name (optional)
• Patient Information (mandatory)
  • Patient ID (mandatory)
  • Patient Date of Birth (mandatory)
  • Patient First Name (optional)
  • Patient Last Name (optional)

Output

• Provider TIN (optional, mandatory if Remittance information found)
• Payer Information (optional, mandatory if Remittance information found)
  • Payer ID (mandatory)
  • Payer Name (mandatory)
• Patient Information (optional, mandatory if Remittance information found)
  • Patient ID (mandatory)
  • Patient Date of Birth (mandatory)
  • Patient First Name (mandatory)
  • Patient Last Name (mandatory)
• Claim Information (optional, mandatory if Remittance information found, repeats)
  • Payer Claim ID (mandatory) - the primary key of the claim information
  • Provider Claim ID (mandatory)
  • Claim Received Date (mandatory)
  • Provider ID (mandatory)
  • Payment Information (optional, repeats)
    • Payment Issue Date (mandatory)
    • Payment Number (mandatory)
    • Payment Amount (mandatory)
    • Remittance Information (mandatory)
      • Remittance Advice Identifier (mandatory)
      • Remittance Advice Type (mandatory)
      • Remittance Advice Date (mandatory)
      • Remittance Advice File Size (mandatory)

Search for Remittance by Payment

This search is used to find remittances associated with a received payment. The payer will search for the payment given the passed-in search parameters and find remittances associated with that payment. The remittance information is returned along the payment information that can be used by the provider to verify the proper payment was retrieved. Any of the returned remittance identifiers can then be used in the Download Remittance operation.

Input

• Provider TIN (mandatory)
• Date of Service Period (optional)
• Payer ID (optional)
• Payer Name (optional)
• Payment Information (mandatory)
  • Payment Issue Date Period (mandatory)
  • Payment Amount (optional)
    • Payment Amount Low
    • Payment Amount High
  • Payment Number (mandatory)

NOTE: Due to the format of payment numbers, specifically cheques where they may be many leading zeroes, only the significant numbers need to be specified and payers SHALL search for these using a wild card search. eg. 0000000123 can be specified as 123.

Output

• Provider TIN (optional, mandatory if Remittance information found)
• Payer Information (optional, mandatory if Remittance information found)
  • Payer ID (mandatory)
  • Payer Name (mandatory)
• Payment Information (optional, mandatory if Remittance information found)
  • Payment Issue Date (mandatory)
  • Payment Number (mandatory)
  • Payment Amount (mandatory)
  • Remittance Information (optional)
    • Remittance Advice Identifier (mandatory)
    • Remittance Advice Type (mandatory)
    • Remittance Advice Date (mandatory)
    • Remittance Advice File Size (mandatory)

Download Remittance

The remittance identifier is provided along with an optional hint as to the type of document to return - either 835 or PDF. This is only a hint as a payer may only have one format and thus will return what they have.

Input

• Remittance Advice Identifier (mandatory)
• Remittance Advice Type Hint (optional)

Output

The copy of the remittance advice is returned in a FHIR Binary resource with the Binary.data element containing the data. Whether the remittance is returned as a 835 document or a PDF file, it is gzipped and base64 encoded and returned in the data element. The Binary.contentType element is used to indicate whether the returned remittance is a PDF file ('application/pdf+gzip') or an 835 document ('application/txt+gzip'). The remittance identifier is also returned as an extension on the Binary.data element.