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

13.9 Resource PaymentReconciliation - Content

Financial Management Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Practitioner

This resource provides the details including amount of a payment and allocates the payment items being paid.

13.9.1 Scope and Usage

The PaymentReconciliation resource provides the bulk payment details associated with a payment by the payor for receivable amounts, such as for goods and services rendered by a provider to patients covered by insurance plans offered by that payor. These are the payment reconciliation details which may align to the individual payment amounts indicated on discrete ClaimResponses or Invoices for example.

Bulk payments need to provide a means to associate the amounts paid against specific Claims, Invoices, and other financial exchanges and adjustments, to the bulk payment itself in order to reconcile accounts receivable.

The PaymentReconciliation resource is a "event" resource from a FHIR workflow perspective - see Workflow Event.

13.9.1.1 Additional Information

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

13.9.2 Boundaries and Relationships

The PaymentReconciliation resource serves to correlate a payment amount to the adjudicated claim amounts appearing on one or more ClaimResponses. 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.

The PaymentNotice resource is used to indicate that a payment has, or is about to occur. The resource is used commonly when tracking of payment occurences is required for regulatory or business purposes.

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.

For reporting out to patients or transferring data to patient centered applications, such as patient health Record (PHR) application, the ExplanationOfBenefit should be used instead.

The eClaim domain includes a number of related resources

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.
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.
ExplanationOfBenefit This resource combines the information from the Claim and the ClaimResponse, stripping out any provider or payor proprietary information, into a unified information model suitable for use for: patient reporting; transferring information to a Patient Health Record system; and, supporting complete claim and adjudication information exchange with regulatory and analytics organizations and other parts of the provider's organization.
PaymentNotice An indication that a payment has occured, is about to occur, or has been cancelled.

This resource is referenced by PaymentNotice

13.9.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentReconciliation TUDomainResourcePaymentReconciliation resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for a payment reconciliation
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... period Σ0..1PeriodPeriod covered
... created Σ1..1dateTimeCreation date
... paymentIssuer Σ0..1Reference(Organization)Party generating payment
... request 0..1Reference(Task)Reference to requesting resource
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Responsible practitioner
... outcome 0..1codequeued | complete | error | partial
RemittanceOutcome (Required)
... disposition 0..1stringDisposition message
... paymentDate Σ1..1dateWhen payment issued
... paymentAmount Σ1..1MoneyTotal amount of Payment
... paymentIdentifier 0..1IdentifierBusiness identifier for the payment
... detail 0..*BackboneElementSettlement particulars
.... identifier 0..1IdentifierBusiness identifier of the payment detail
.... predecessor 0..1IdentifierBusiness identifier of the prior payment detail
.... type 1..1CodeableConceptCategory of payment
Payment Type Codes (Example)
.... request 0..1Reference(Any)Request giving rise to the payment
.... submitter 0..1Reference(Practitioner | PractitionerRole | Organization)Submitter of the request
.... response 0..1Reference(Any)Response committing to a payment
.... date 0..1dateDate of commitment to pay
.... responsible 0..1Reference(PractitionerRole)Contact for the response
.... payee 0..1Reference(Practitioner | PractitionerRole | Organization)Recipient of the payment
.... amount 0..1MoneyAmount allocated to this payable
... formCode 0..1CodeableConceptPrinted form identifier
Forms (Example)
... processNote 0..*BackboneElementNote concerning processing
.... type 0..1codedisplay | print | printoper
NoteType (Required)
.... text 0..1stringNote explanatory text

doco Documentation for this format

UML Diagram (Legend)

PaymentReconciliation (DomainResource)A unique identifier assigned to this payment reconciliationidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)FinancialResourceStatusCodes! »The period of time for which payments have been gathered into this bulk payment for settlementperiod : Period [0..1]The date when the resource was createdcreated : dateTime [1..1]The party who generated the paymentpaymentIssuer : Reference [0..1] « Organization »Original request resource referencerequest : Reference [0..1] « Task »The practitioner who is responsible for the services rendered to the patientrequestor : Reference [0..1] « Practitioner|PractitionerRole| Organization »The outcome of a request for a reconciliationoutcome : code [0..1] « The outcome of the processing. (Strength=Required)RemittanceOutcome! »A human readable description of the status of the request for the reconciliationdisposition : string [0..1]The date of payment as indicated on the financial instrumentpaymentDate : date [1..1]Total payment amount as indicated on the financial instrumentpaymentAmount : Money [1..1]Issuer's unique identifier for the payment instrumentpaymentIdentifier : Identifier [0..1]A code for the form to be used for printing the contentformCode : CodeableConcept [0..1] « The forms codes. (Strength=Example)Form ?? »DetailsUnique identifier for the current payment item for the referenced payableidentifier : Identifier [0..1]Unique identifier for the prior payment item for the referenced payablepredecessor : Identifier [0..1]Code to indicate the nature of the paymenttype : CodeableConcept [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example)PaymentTypeCodes?? »A resource, such as a Claim, the evaluation of which could lead to paymentrequest : Reference [0..1] « Any »The party which submitted the claim or financial transactionsubmitter : Reference [0..1] « Practitioner|PractitionerRole| Organization »A resource, such as a ClaimResponse, which contains a commitment to paymentresponse : Reference [0..1] « Any »The date from the response resource containing a commitment to paydate : date [0..1]A reference to the individual who is responsible for inquiries regarding the response and its paymentresponsible : Reference [0..1] « PractitionerRole »The party which is receiving the paymentpayee : Reference [0..1] « Practitioner|PractitionerRole| Organization »The monetary amount allocated from the total payment to the payableamount : Money [0..1]NotesThe business purpose of the note texttype : code [0..1] « The presentation types of notes. (Strength=Required)NoteType! »The explanation or description associated with the processingtext : string [0..1]Distribution of the payment amount for a previously acknowledged payabledetail[0..*]A note that describes or explains the processing in a human readable formprocessNote[0..*]

XML Template

<PaymentReconciliation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for a payment reconciliation --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <period><!-- 0..1 Period Period covered --></period>
 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <paymentIssuer><!-- 0..1 Reference(Organization) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <paymentDate value="[date]"/><!-- 1..1 When payment issued -->
 <paymentAmount><!-- 1..1 Money Total amount of Payment --></paymentAmount>
 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <detail>  <!-- 0..* Settlement particulars -->
  <identifier><!-- 0..1 Identifier Business identifier of the payment detail --></identifier>
  <predecessor><!-- 0..1 Identifier Business identifier of the prior payment detail --></predecessor>
  <type><!-- 1..1 CodeableConcept Category of payment --></type>
  <request><!-- 0..1 Reference(Any) Request giving rise to the payment --></request>
  <submitter><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(Any) Response committing to a payment --></response>
  <date value="[date]"/><!-- 0..1 Date of commitment to pay -->
  <responsible><!-- 0..1 Reference(PractitionerRole) Contact for the response --></responsible>
  <payee><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>
 </detail>
 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->
 </processNote>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // R!  Creation date
  "paymentIssuer" : { Reference(Organization) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Practitioner|PractitionerRole|Organization) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "paymentDate" : "<date>", // R!  When payment issued
  "paymentAmount" : { Money }, // R!  Total amount of Payment
  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "detail" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "type" : { CodeableConcept }, // R!  Category of payment
    "request" : { Reference(Any) }, // Request giving rise to the payment
    "submitter" : { Reference(Practitioner|PractitionerRole|Organization) }, // Submitter of the request
    "response" : { Reference(Any) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Practitioner|PractitionerRole|Organization) }, // Recipient of the payment
    "amount" : { Money } // Amount allocated to this payable
  }],
  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "type" : "<code>", // display | print | printoper
    "text" : "<string>" // Note explanatory text
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:PaymentReconciliation;
  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:PaymentReconciliation.identifier [ Identifier ], ... ; # 0..* Business Identifier for a payment reconciliation
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  fhir:PaymentReconciliation.created [ dateTime ]; # 1..1 Creation date
  fhir:PaymentReconciliation.paymentIssuer [ Reference(Organization) ]; # 0..1 Party generating payment
  fhir:PaymentReconciliation.request [ Reference(Task) ]; # 0..1 Reference to requesting resource
  fhir:PaymentReconciliation.requestor [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 queued | complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition message
  fhir:PaymentReconciliation.paymentDate [ date ]; # 1..1 When payment issued
  fhir:PaymentReconciliation.paymentAmount [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.paymentIdentifier [ Identifier ]; # 0..1 Business identifier for the payment
  fhir:PaymentReconciliation.detail [ # 0..* Settlement particulars
    fhir:PaymentReconciliation.detail.identifier [ Identifier ]; # 0..1 Business identifier of the payment detail
    fhir:PaymentReconciliation.detail.predecessor [ Identifier ]; # 0..1 Business identifier of the prior payment detail
    fhir:PaymentReconciliation.detail.type [ CodeableConcept ]; # 1..1 Category of payment
    fhir:PaymentReconciliation.detail.request [ Reference(Any) ]; # 0..1 Request giving rise to the payment
    fhir:PaymentReconciliation.detail.submitter [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Submitter of the request
    fhir:PaymentReconciliation.detail.response [ Reference(Any) ]; # 0..1 Response committing to a payment
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Date of commitment to pay
    fhir:PaymentReconciliation.detail.responsible [ Reference(PractitionerRole) ]; # 0..1 Contact for the response
    fhir:PaymentReconciliation.detail.payee [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Recipient of the payment
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Amount allocated to this payable
  ], ...;
  fhir:PaymentReconciliation.formCode [ CodeableConcept ]; # 0..1 Printed form identifier
  fhir:PaymentReconciliation.processNote [ # 0..* Note concerning processing
    fhir:PaymentReconciliation.processNote.type [ code ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.processNote.text [ string ]; # 0..1 Note explanatory text
  ], ...;
]

Changes since R3

PaymentReconciliation
PaymentReconciliation.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
PaymentReconciliation.created
  • Min Cardinality changed from 0 to 1
PaymentReconciliation.paymentIssuer
  • Renamed from organization to paymentIssuer
PaymentReconciliation.request
  • Type Reference: Added Target Type Task
  • Type Reference: Removed Target Type ProcessRequest
PaymentReconciliation.requestor
  • Renamed from requestOrganization to requestor
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentReconciliation.outcome
  • Type changed from CodeableConcept to code
  • Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
PaymentReconciliation.paymentDate
  • Added Mandatory Element
PaymentReconciliation.paymentAmount
  • Renamed from total to paymentAmount
  • Min Cardinality changed from 0 to 1
PaymentReconciliation.paymentIdentifier
  • Added Element
PaymentReconciliation.detail.identifier
  • Added Element
PaymentReconciliation.detail.predecessor
  • Added Element
PaymentReconciliation.detail.submitter
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentReconciliation.detail.responsible
  • Added Element
PaymentReconciliation.detail.payee
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentReconciliation.formCode
  • Renamed from form to formCode
PaymentReconciliation.processNote.type
  • Type changed from CodeableConcept to code
  • Change value set from http://hl7.org/fhir/ValueSet/note-type to http://hl7.org/fhir/ValueSet/note-type|4.0.1
PaymentReconciliation.requestProvider
  • 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

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentReconciliation TUDomainResourcePaymentReconciliation resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for a payment reconciliation
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... period Σ0..1PeriodPeriod covered
... created Σ1..1dateTimeCreation date
... paymentIssuer Σ0..1Reference(Organization)Party generating payment
... request 0..1Reference(Task)Reference to requesting resource
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Responsible practitioner
... outcome 0..1codequeued | complete | error | partial
RemittanceOutcome (Required)
... disposition 0..1stringDisposition message
... paymentDate Σ1..1dateWhen payment issued
... paymentAmount Σ1..1MoneyTotal amount of Payment
... paymentIdentifier 0..1IdentifierBusiness identifier for the payment
... detail 0..*BackboneElementSettlement particulars
.... identifier 0..1IdentifierBusiness identifier of the payment detail
.... predecessor 0..1IdentifierBusiness identifier of the prior payment detail
.... type 1..1CodeableConceptCategory of payment
Payment Type Codes (Example)
.... request 0..1Reference(Any)Request giving rise to the payment
.... submitter 0..1Reference(Practitioner | PractitionerRole | Organization)Submitter of the request
.... response 0..1Reference(Any)Response committing to a payment
.... date 0..1dateDate of commitment to pay
.... responsible 0..1Reference(PractitionerRole)Contact for the response
.... payee 0..1Reference(Practitioner | PractitionerRole | Organization)Recipient of the payment
.... amount 0..1MoneyAmount allocated to this payable
... formCode 0..1CodeableConceptPrinted form identifier
Forms (Example)
... processNote 0..*BackboneElementNote concerning processing
.... type 0..1codedisplay | print | printoper
NoteType (Required)
.... text 0..1stringNote explanatory text

doco Documentation for this format

UML Diagram (Legend)

PaymentReconciliation (DomainResource)A unique identifier assigned to this payment reconciliationidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)FinancialResourceStatusCodes! »The period of time for which payments have been gathered into this bulk payment for settlementperiod : Period [0..1]The date when the resource was createdcreated : dateTime [1..1]The party who generated the paymentpaymentIssuer : Reference [0..1] « Organization »Original request resource referencerequest : Reference [0..1] « Task »The practitioner who is responsible for the services rendered to the patientrequestor : Reference [0..1] « Practitioner|PractitionerRole| Organization »The outcome of a request for a reconciliationoutcome : code [0..1] « The outcome of the processing. (Strength=Required)RemittanceOutcome! »A human readable description of the status of the request for the reconciliationdisposition : string [0..1]The date of payment as indicated on the financial instrumentpaymentDate : date [1..1]Total payment amount as indicated on the financial instrumentpaymentAmount : Money [1..1]Issuer's unique identifier for the payment instrumentpaymentIdentifier : Identifier [0..1]A code for the form to be used for printing the contentformCode : CodeableConcept [0..1] « The forms codes. (Strength=Example)Form ?? »DetailsUnique identifier for the current payment item for the referenced payableidentifier : Identifier [0..1]Unique identifier for the prior payment item for the referenced payablepredecessor : Identifier [0..1]Code to indicate the nature of the paymenttype : CodeableConcept [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example)PaymentTypeCodes?? »A resource, such as a Claim, the evaluation of which could lead to paymentrequest : Reference [0..1] « Any »The party which submitted the claim or financial transactionsubmitter : Reference [0..1] « Practitioner|PractitionerRole| Organization »A resource, such as a ClaimResponse, which contains a commitment to paymentresponse : Reference [0..1] « Any »The date from the response resource containing a commitment to paydate : date [0..1]A reference to the individual who is responsible for inquiries regarding the response and its paymentresponsible : Reference [0..1] « PractitionerRole »The party which is receiving the paymentpayee : Reference [0..1] « Practitioner|PractitionerRole| Organization »The monetary amount allocated from the total payment to the payableamount : Money [0..1]NotesThe business purpose of the note texttype : code [0..1] « The presentation types of notes. (Strength=Required)NoteType! »The explanation or description associated with the processingtext : string [0..1]Distribution of the payment amount for a previously acknowledged payabledetail[0..*]A note that describes or explains the processing in a human readable formprocessNote[0..*]

XML Template

<PaymentReconciliation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for a payment reconciliation --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <period><!-- 0..1 Period Period covered --></period>
 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <paymentIssuer><!-- 0..1 Reference(Organization) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <paymentDate value="[date]"/><!-- 1..1 When payment issued -->
 <paymentAmount><!-- 1..1 Money Total amount of Payment --></paymentAmount>
 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <detail>  <!-- 0..* Settlement particulars -->
  <identifier><!-- 0..1 Identifier Business identifier of the payment detail --></identifier>
  <predecessor><!-- 0..1 Identifier Business identifier of the prior payment detail --></predecessor>
  <type><!-- 1..1 CodeableConcept Category of payment --></type>
  <request><!-- 0..1 Reference(Any) Request giving rise to the payment --></request>
  <submitter><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(Any) Response committing to a payment --></response>
  <date value="[date]"/><!-- 0..1 Date of commitment to pay -->
  <responsible><!-- 0..1 Reference(PractitionerRole) Contact for the response --></responsible>
  <payee><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>
 </detail>
 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->
 </processNote>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // R!  Creation date
  "paymentIssuer" : { Reference(Organization) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Practitioner|PractitionerRole|Organization) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "paymentDate" : "<date>", // R!  When payment issued
  "paymentAmount" : { Money }, // R!  Total amount of Payment
  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "detail" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "type" : { CodeableConcept }, // R!  Category of payment
    "request" : { Reference(Any) }, // Request giving rise to the payment
    "submitter" : { Reference(Practitioner|PractitionerRole|Organization) }, // Submitter of the request
    "response" : { Reference(Any) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Practitioner|PractitionerRole|Organization) }, // Recipient of the payment
    "amount" : { Money } // Amount allocated to this payable
  }],
  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "type" : "<code>", // display | print | printoper
    "text" : "<string>" // Note explanatory text
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:PaymentReconciliation;
  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:PaymentReconciliation.identifier [ Identifier ], ... ; # 0..* Business Identifier for a payment reconciliation
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  fhir:PaymentReconciliation.created [ dateTime ]; # 1..1 Creation date
  fhir:PaymentReconciliation.paymentIssuer [ Reference(Organization) ]; # 0..1 Party generating payment
  fhir:PaymentReconciliation.request [ Reference(Task) ]; # 0..1 Reference to requesting resource
  fhir:PaymentReconciliation.requestor [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 queued | complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition message
  fhir:PaymentReconciliation.paymentDate [ date ]; # 1..1 When payment issued
  fhir:PaymentReconciliation.paymentAmount [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.paymentIdentifier [ Identifier ]; # 0..1 Business identifier for the payment
  fhir:PaymentReconciliation.detail [ # 0..* Settlement particulars
    fhir:PaymentReconciliation.detail.identifier [ Identifier ]; # 0..1 Business identifier of the payment detail
    fhir:PaymentReconciliation.detail.predecessor [ Identifier ]; # 0..1 Business identifier of the prior payment detail
    fhir:PaymentReconciliation.detail.type [ CodeableConcept ]; # 1..1 Category of payment
    fhir:PaymentReconciliation.detail.request [ Reference(Any) ]; # 0..1 Request giving rise to the payment
    fhir:PaymentReconciliation.detail.submitter [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Submitter of the request
    fhir:PaymentReconciliation.detail.response [ Reference(Any) ]; # 0..1 Response committing to a payment
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Date of commitment to pay
    fhir:PaymentReconciliation.detail.responsible [ Reference(PractitionerRole) ]; # 0..1 Contact for the response
    fhir:PaymentReconciliation.detail.payee [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Recipient of the payment
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Amount allocated to this payable
  ], ...;
  fhir:PaymentReconciliation.formCode [ CodeableConcept ]; # 0..1 Printed form identifier
  fhir:PaymentReconciliation.processNote [ # 0..* Note concerning processing
    fhir:PaymentReconciliation.processNote.type [ code ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.processNote.text [ string ]; # 0..1 Note explanatory text
  ], ...;
]

Changes since Release 3

PaymentReconciliation
PaymentReconciliation.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
PaymentReconciliation.created
  • Min Cardinality changed from 0 to 1
PaymentReconciliation.paymentIssuer
  • Renamed from organization to paymentIssuer
PaymentReconciliation.request
  • Type Reference: Added Target Type Task
  • Type Reference: Removed Target Type ProcessRequest
PaymentReconciliation.requestor
  • Renamed from requestOrganization to requestor
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentReconciliation.outcome
  • Type changed from CodeableConcept to code
  • Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
PaymentReconciliation.paymentDate
  • Added Mandatory Element
PaymentReconciliation.paymentAmount
  • Renamed from total to paymentAmount
  • Min Cardinality changed from 0 to 1
PaymentReconciliation.paymentIdentifier
  • Added Element
PaymentReconciliation.detail.identifier
  • Added Element
PaymentReconciliation.detail.predecessor
  • Added Element
PaymentReconciliation.detail.submitter
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentReconciliation.detail.responsible
  • Added Element
PaymentReconciliation.detail.payee
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentReconciliation.formCode
  • Renamed from form to formCode
PaymentReconciliation.processNote.type
  • Type changed from CodeableConcept to code
  • Change value set from http://hl7.org/fhir/ValueSet/note-type to http://hl7.org/fhir/ValueSet/note-type|4.0.1
PaymentReconciliation.requestProvider
  • 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

13.9.3.1 Terminology Bindings

PathDefinitionTypeReference
PaymentReconciliation.status A code specifying the state of the resource instance.RequiredFinancialResourceStatusCodes
PaymentReconciliation.outcome The outcome of the processing.RequiredRemittanceOutcome
PaymentReconciliation.detail.type The reason for the amount: payment, adjustment, advance.ExamplePaymentTypeCodes
PaymentReconciliation.formCode The forms codes.ExampleForm Codes
PaymentReconciliation.processNote.type The presentation types of notes.RequiredNoteType

13.9.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
createddateThe creation datePaymentReconciliation.created
dispositionstringThe contents of the disposition messagePaymentReconciliation.disposition
identifiertokenThe business identifier of the ExplanationOfBenefitPaymentReconciliation.identifier
outcometokenThe processing outcomePaymentReconciliation.outcome
payment-issuerreferenceThe organization which generated this resourcePaymentReconciliation.paymentIssuer
(Organization)
requestreferenceThe reference to the claimPaymentReconciliation.request
(Task)
requestorreferenceThe reference to the provider who submitted the claimPaymentReconciliation.requestor
(Practitioner, Organization, PractitionerRole)
statustokenThe status of the payment reconciliationPaymentReconciliation.status