Release 4

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU) in it's permanent home (it will always be available at this URL). 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

13.8 Resource PaymentNotice - Content

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.

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.

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 noctice
status	?!Σ	1..1	code	active \| cancelled \| draft \| entered-in-error 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
provider		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
payment	Σ	1..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 Payment Status Codes (Example)
Documentation for this format

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

Changes since R3

PaymentNotice

PaymentNotice.status

Min Cardinality changed from 0 to 1
Change value set from http://hl7.org/fhir/ValueSet/fm-status to http://hl7.org/fhir/ValueSet/fm-status|4.0.1

PaymentNotice.created

Min Cardinality changed from 0 to 1

PaymentNotice.provider

Renamed from organization to provider
Type Reference: Added Target Types Practitioner, PractitionerRole

PaymentNotice.payment

Added Mandatory Element

PaymentNotice.paymentDate

Renamed from statusDate to paymentDate

PaymentNotice.payee

Added Element

PaymentNotice.recipient

Renamed from target to recipient
Min Cardinality changed from 0 to 1

PaymentNotice.amount

Added Mandatory Element

PaymentNotice.provider

deleted

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

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 noctice
status	?!Σ	1..1	code	active \| cancelled \| draft \| entered-in-error 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
provider		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Responsible practitioner
payment	Σ	1..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 Payment Status Codes (Example)
Documentation for this format

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

Changes since Release 3

PaymentNotice

PaymentNotice.status

Min Cardinality changed from 0 to 1
Change value set from http://hl7.org/fhir/ValueSet/fm-status to http://hl7.org/fhir/ValueSet/fm-status|4.0.1

PaymentNotice.created

Min Cardinality changed from 0 to 1

PaymentNotice.provider

Renamed from organization to provider
Type Reference: Added Target Types Practitioner, PractitionerRole

PaymentNotice.payment

Added Mandatory Element

PaymentNotice.paymentDate

Renamed from statusDate to paymentDate

PaymentNotice.payee

Added Element

PaymentNotice.recipient

Renamed from target to recipient
Min Cardinality changed from 0 to 1

PaymentNotice.amount

Added Mandatory Element

PaymentNotice.provider

deleted

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).)

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

13.8.3.1 Terminology Bindings

Path	Definition	Type	Reference
PaymentNotice.status	A code specifying the state of the resource instance.	Required	FinancialResourceStatusCodes
PaymentNotice.paymentStatus	The payment conveyance status codes.	Example	PaymentStatusCodes

Path

Definition

Type

Reference

PaymentNotice.status

A code specifying the state of the resource instance.

Required

FinancialResourceStatusCodes

PaymentNotice.paymentStatus

The payment conveyance status codes.

Example

PaymentStatusCodes

13.8.4 Search Parameters

Search parameters for 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 fro the notice	PaymentNotice.created
identifier	token	The business identifier of the notice	PaymentNotice.identifier
payment-status	token	The type of payment notice	PaymentNotice.paymentStatus
provider	reference	The reference to the provider	PaymentNotice.provider (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