FHIR Release 3 (STU) CI-Build

This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0 . For a full list Continuous Integration Build of available versions, see FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions icon . Page versions: R5 R4B R4 R3 R2

13.8 Resource PaymentNotice - Content

Responsible Owner: Financial Management icon Work Group   Normative 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 payors payers to advise the Provider provider or regulatory bodies of the state of a payment (cheque (check in the mail/EFT sent, payment cashed, payment cancelled). canceled)for example to provide payment status information or to document the forwarding or receipt of payment to support regulatory requirements. Employers or Insurance Exchanges may also use this to advise payors payers of premium payment.

Payors and /or 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 payors 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:

13.8.2 Boundaries and Relationships

The PaymentNotice resource is used to indicate that a payment has been initiated. 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 been initiated 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

13.8.2 13.8.4 Resource Content

Structure

0..1 Payment or clearing Whether payment has been sent
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . PaymentNotice N 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 . statusReason Σ 0..1 string Reason for status change
. . . response 0..1 Reference ( Any ) Response reference
. . . statusDate created Σ 0..1 1..1 date dateTime Creation date
. . created . reporter 0..1 dateTime Reference ( Practitioner | PractitionerRole | Organization ) Responsible practitioner
Creation date
. . . target payment Σ 0..1 Reference ( Organization PaymentReconciliation ) Payment reference
Insurer
. . . paymentDate 0..1 date Payment or Regulatory body clearing date
. . . provider payee 0..1 Reference ( Practitioner | PractitionerRole | Organization ) Party being paid
Responsible practitioner
. . organization . recipient Σ 0..1 1..1 Reference ( Organization ) Party being notified
Responsible organization
. . . paymentStatus amount Σ 0..1 1..1 Money Monetary amount of the payment
... paymentStatus 0..1 CodeableConcept Issued or cleared Status of the payment
Binding: Payment Status Codes ( Example Preferred )

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

PaymentNotice ( DomainResource ) The notice business A unique identifier assigned to this payment notice identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. null (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » Used to indicate why the status has changed statusReason : string [0..1] Reference of resource for which payment is being made request : Reference [0..1] « Any » Reference of response to resource for which payment is being made response : Reference [0..1] « Any » The date when this resource was created created : dateTime [1..1] The party who reports the above payment action occurrred notice statusDate reporter : date Reference [0..1] « Practitioner | PractitionerRole | Organization » A reference to the payment which is the subject of this notice payment : Reference [0..1] « PaymentReconciliation » The date when this resource was created the above payment action occurred created paymentDate : dateTime date [0..1] The Insurer party who will receive or has received payment that is target of the request subject of this notification target payee : Reference [0..1] « Practitioner | PractitionerRole | Organization » The practitioner party who is responsible for the services rendered to notified of the patient payment status provider recipient : Reference [0..1] Practitioner [1..1] « Organization » The organization which is responsible for the services rendered amount sent to the patient payee organization amount : Reference [0..1] Organization Money [1..1] The payment status, typically paid: payment sent, cleared: A code indicating whether payment received has been sent or cleared paymentStatus : CodeableConcept [0..1] « The payment conveyance status codes (Strength=Example) null (Strength=Preferred) Payment Status PaymentStatusCodes ?? ? »

XML Template 

<

<PaymentNotice xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <

 <identifier><!-- 0..* Identifier Business Identifier for the payment notice --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <statusReason value="[string]"/><!-- 0..1 Reason for status change -->

 <request><!-- 0..1 Reference(Any) Request reference --></request>
 <response><!-- 0..1 Reference(Any) Response reference --></response>
 <
 <
 <</target>
 <</provider>
 <</organization>
 <</paymentStatus>

 <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>

Turtle Template 

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


[ a fhir:PaymentNotice;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for the payment notice
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:statusReason [ string ] ; # 0..1 Reason for status change
  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 since DSTU2 from both R4 and R4B

PaymentNotice
PaymentNotice.status PaymentNotice.statusReason
  • Added Element
PaymentNotice.statusDate PaymentNotice.reporter
  • Added Element
PaymentNotice.paymentStatus PaymentNotice.payment
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept PaymentNotice.ruleset deleted
PaymentNotice.originalRuleset PaymentNotice.provider
  • deleted 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 .

Structure

0..1 Payment or clearing Whether payment has been sent
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . PaymentNotice N 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 . statusReason Σ 0..1 string Reason for status change
. . . response 0..1 Reference ( Any ) Response reference
. . . statusDate created Σ 0..1 1..1 date dateTime Creation date
. . created . reporter 0..1 dateTime Reference ( Practitioner | PractitionerRole | Organization ) Responsible practitioner
Creation date
. . . target payment Σ 0..1 Reference ( Organization PaymentReconciliation ) Payment reference
Insurer
. . . paymentDate 0..1 date Payment or Regulatory body clearing date
. . . provider payee 0..1 Reference ( Practitioner | PractitionerRole | Organization ) Party being paid
Responsible practitioner
. . organization . recipient Σ 0..1 1..1 Reference ( Organization ) Party being notified
Responsible organization
. . . paymentStatus amount Σ 0..1 1..1 Money Monetary amount of the payment
... paymentStatus 0..1 CodeableConcept Issued or cleared Status of the payment
Binding: Payment Status Codes ( Example Preferred )

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

PaymentNotice ( DomainResource ) The notice business A unique identifier assigned to this payment notice identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. null (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » Used to indicate why the status has changed statusReason : string [0..1] Reference of resource for which payment is being made request : Reference [0..1] « Any » Reference of response to resource for which payment is being made response : Reference [0..1] « Any » The date when this resource was created created : dateTime [1..1] The party who reports the above payment action occurrred notice statusDate reporter : date Reference [0..1] « Practitioner | PractitionerRole | Organization » A reference to the payment which is the subject of this notice payment : Reference [0..1] « PaymentReconciliation » The date when this resource was created the above payment action occurred created paymentDate : dateTime date [0..1] The Insurer party who will receive or has received payment that is target of the request subject of this notification target payee : Reference [0..1] « Practitioner | PractitionerRole | Organization » The practitioner party who is responsible for the services rendered to notified of the patient payment status provider recipient : Reference [0..1] Practitioner [1..1] « Organization » The organization which is responsible for the services rendered amount sent to the patient payee organization amount : Reference [0..1] Organization Money [1..1] The payment status, typically paid: payment sent, cleared: A code indicating whether payment received has been sent or cleared paymentStatus : CodeableConcept [0..1] « The payment conveyance status codes (Strength=Example) null (Strength=Preferred) Payment Status PaymentStatusCodes ?? ? »

XML Template 

<

<PaymentNotice xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <

 <identifier><!-- 0..* Identifier Business Identifier for the payment notice --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <statusReason value="[string]"/><!-- 0..1 Reason for status change -->

 <request><!-- 0..1 Reference(Any) Request reference --></request>
 <response><!-- 0..1 Reference(Any) Response reference --></response>
 <
 <
 <</target>
 <</provider>
 <</organization>
 <</paymentStatus>

 <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>

Turtle Template 

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


[ a fhir:PaymentNotice;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for the payment notice
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:statusReason [ string ] ; # 0..1 Reason for status change
  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 since DSTU2 from both R4 and R4B

PaymentNotice
PaymentNotice.status PaymentNotice.statusReason
  • Added Element
PaymentNotice.statusDate PaymentNotice.reporter
  • Added Element
PaymentNotice.paymentStatus PaymentNotice.payment
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept PaymentNotice.ruleset deleted
PaymentNotice.originalRuleset PaymentNotice.provider
  • deleted 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 .

 

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

13.8.2.1 13.8.4.1 Terminology Bindings

Path Definition ValueSet Type Reference Documentation
PaymentNotice.status A code specifying the state of the resource instance. FinancialResourceStatusCodes Required Financial Resource

This value set includes Status Codes codes.

PaymentNotice.paymentStatus The payment conveyance status codes PaymentStatusCodes Example Preferred

This value set includes a sample set of Payment Status Codes codes.



13.8.3 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.

reference The organization who generated this resource PaymentNotice.organization ( Organization )
Name Type Description Expression In Common
created date Creation date fro for the notice PaymentNotice.created
identifier token The business identifier of the notice PaymentNotice.identifier organization
payment-status token The type of payment notice PaymentNotice.paymentStatus
provider reporter reference The reference to the provider reporter PaymentNotice.provider PaymentNotice.reporter
( Practitioner , Organization , PractitionerRole )
request reference The Claim PaymentNotice.request
(Any)
response reference The ClaimResponse PaymentNotice.response
(Any)
status statusdate date token The date status of the payment action notice PaymentNotice.statusDate PaymentNotice.status