~~R6 Ballot (3rd Draft)~~ FHIR CI-Build

This ~~page~~ is ~~part of~~ the ~~FHIR Specification v6.0.0-ballot3: Release 6 Ballot (3rd Draft) (see Ballot Notes ). The current version is 5.0.0 . For a full list~~ Continuous Integration Build of ~~available versions, see~~ FHIR (will be incorrect/inconsistent at times).
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13.9 Resource PaymentReconciliation - Content

Responsible Owner: Financial Management icon

Work Group

~~Maturity Level : 4~~ Trial Use

Security 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:

Financial Resource Status Lifecycle : how .status is used in the financial resources.

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.

13.9.3 References to this Resource

Implements: Event
Resource References: PaymentNotice

Structure

~~1..1~~

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
PaymentReconciliation	TU		DomainResource	PaymentReconciliation resource Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
identifier		0..*	Identifier	Business Identifier for a payment reconciliation
type	Σ	1..1	CodeableConcept	Category of payment Binding: Payment Type Codes ( Extensible )
status	?! Σ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: Financial Resource Status Codes ( Required )
statusReason	Σ	0..1	string	Reason for status change
kind		0..1	CodeableConcept	Workflow originating payment Binding: Payment Kind ( Extensible )
period	Σ	0..1	Period	Period covered
created	Σ	1..1	dateTime	Creation date
enterer		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Who entered the payment
issuerType		0..1	CodeableConcept	Nature of the source Binding: Payment Issuer Type ( Extensible )
paymentIssuer	Σ	0..1	Reference ( Organization \| Patient \| RelatedPerson )	Party generating payment
request		0..1	Reference ( Task )	Reference to requesting resource
requestor		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Responsible practitioner
outcome		0..1	code	queued \| complete \| error \| partial Binding: Payment Outcome ( Required )
disposition		0..1	string	Disposition message
date	Σ	1..1	date	When payment issued
location		0..1	Reference ( Location )	Where payment collected
method		0..1	CodeableConcept	Payment instrument Binding: hl7VS-paymentMethodCode ( Extensible )
cardBrand		0..1	string	Type of card
accountNumber		0..1	string	Digits for verification
expirationDate		0..1	date	Expiration year-month
processor		0..1	string	Processor name
referenceNumber		0..1	string	Check number or payment reference
authorization		0..1	string	Authorization number
tenderedAmount		0..1	Money	Amount offered by the issuer
returnedAmount		0..1	Money	Amount returned by the receiver
amount	Σ	0..1	Money	Total amount of Payment
paymentIdentifier		0..1	Identifier	Business identifier for the payment
allocation		0..*	BackboneElement	Settlement particulars
identifier		0..1	Identifier	Business identifier of the payment detail
predecessor		0..1	Identifier	Business identifier of the prior payment detail
target		0..1	Reference ( Claim \| Account \| Invoice \| ~~ChargeItem \|~~ Encounter \| Contract )	Subject of the payment
targetItem[x]		0..1		Sub-element of the subject
targetItemString			string
targetItemIdentifier			Identifier
targetItemPositiveInt			positiveInt
encounter		0..1	Reference ( Encounter )	Applied-to encounter
account		0..1	Reference ( Account )	Applied-to account
type		0..1	CodeableConcept	Category of payment Binding: Payment Type Codes ( Extensible )
submitter		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Submitter of the request
response		0..1	Reference ( ClaimResponse )	Response committing to a payment
date		0..1	date	Date of commitment to pay
responsible		0..1	Reference ( PractitionerRole )	Contact for the response
payee		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Recipient of the payment
amount		0..1	Money	Amount allocated to this payable
noteNumber		0..*	positiveInt	Applicable note numbers
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes ( Example )
processNote		0..*	BackboneElement	Note concerning processing
class		0..1	CodeableConcept	Business kind of note Binding: ProcessNoteClass ( Example )
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display \| print \| printoper Binding: NoteType ( Required )
text		0..1	~~string~~ markdown	Note explanatory text
Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

XML Template

<PaymentReconciliation 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 a payment reconciliation --></identifier>
 <type><!-- 1..1 CodeableConcept Category of payment --></type>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <statusReason value="[string]"/><!-- 0..1 Reason for status change -->

 <kind><!-- 0..1 CodeableConcept Workflow originating payment --></kind>
 <period><!-- 0..1 Period Period covered --></period>
 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <enterer><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Who entered the payment --></enterer>
 <issuerType><!-- 0..1 CodeableConcept Nature of the source --></issuerType>
 <paymentIssuer><!-- 0..1 Reference(Organization|Patient|RelatedPerson) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <date value="[date]"/><!-- 1..1 When payment issued -->
 <location><!-- 0..1 Reference(Location) Where payment collected --></location>
 <</method>

 <method><!-- 0..1 CodeableConcept Payment instrument  --></method>

 <cardBrand value="[string]"/><!-- 0..1 Type of card -->
 <accountNumber value="[string]"/><!-- 0..1 Digits for verification -->
 <expirationDate value="[date]"/><!-- 0..1 Expiration year-month -->
 <processor value="[string]"/><!-- 0..1 Processor name -->
 <referenceNumber value="[string]"/><!-- 0..1 Check number or payment reference -->
 <authorization value="[string]"/><!-- 0..1 Authorization number -->
 <tenderedAmount><!-- 0..1 Money Amount offered by the issuer --></tenderedAmount>
 <returnedAmount><!-- 0..1 Money Amount returned by the receiver --></returnedAmount>
 <</amount>

 <amount><!-- 0..1 Money Total amount of Payment --></amount>

 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <allocation>  <!-- 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>
  <</target>

  <target><!-- 0..1 Reference(Account|Claim|Contract|Encounter|Invoice) Subject of the payment --></target>

  <targetItem[x]><!-- 0..1 string|Identifier|positiveInt Sub-element of the subject --></targetItem[x]>
  <encounter><!-- 0..1 Reference(Encounter) Applied-to encounter --></encounter>
  <account><!-- 0..1 Reference(Account) Applied-to account --></account>
  <type><!-- 0..1 CodeableConcept Category of payment --></type>
  <submitter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(ClaimResponse) 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(Organization|Practitioner|PractitionerRole) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>
  <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->

 </allocation>
 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <class><!-- 0..1 CodeableConcept Business kind of note --></class>
  <number value="[positiveInt]"/><!-- 0..1 Note instance identifier -->

  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <

  <text value="[markdown]"/><!-- 0..1 Note explanatory text -->

 </processNote>
</PaymentReconciliation>

JSON Template

{
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "type" : { CodeableConcept }, // R!  Category of payment
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "statusReason" : "<string>", // Reason for status change

  "kind" : { CodeableConcept }, // Workflow originating payment
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // R!  Creation date
  "enterer" : { Reference(Organization|Practitioner|PractitionerRole) }, // Who entered the payment
  "issuerType" : { CodeableConcept }, // Nature of the source
  "paymentIssuer" : { Reference(Organization|Patient|RelatedPerson) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "date" : "<date>", // R!  When payment issued
  "location" : { Reference(Location) }, // Where payment collected
  "

  "method" : { CodeableConcept }, // Payment instrument 

  "cardBrand" : "<string>", // Type of card
  "accountNumber" : "<string>", // Digits for verification
  "expirationDate" : "<date>", // Expiration year-month
  "processor" : "<string>", // Processor name
  "referenceNumber" : "<string>", // Check number or payment reference
  "authorization" : "<string>", // Authorization number
  "tenderedAmount" : { Money }, // Amount offered by the issuer
  "returnedAmount" : { Money }, // Amount returned by the receiver
  "

  "amount" : { Money }, // Total amount of Payment

  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "allocation" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "

    "target" : { Reference(Account|Claim|Contract|Encounter|Invoice) }, // Subject of the payment

    // targetItem[x]: Sub-element of the subject. One of these 3:
    "targetItemString" : "<string>",
    "targetItemIdentifier" : { Identifier },
    "targetItemPositiveInt" : "<positiveInt>",
    "encounter" : { Reference(Encounter) }, // Applied-to encounter
    "account" : { Reference(Account) }, // Applied-to account
    "type" : { CodeableConcept }, // Category of payment
    "submitter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Submitter of the request
    "response" : { Reference(ClaimResponse) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Recipient of the payment
    "

    "amount" : { Money }, // Amount allocated to this payable
    "noteNumber" : ["<positiveInt>"] // Applicable note numbers

  }],
  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "class" : { CodeableConcept }, // Business kind of note
    "number" : "<positiveInt>", // Note instance identifier

    "type" : "<code>", // display | print | printoper
    "

    "text" : "<markdown>" // Note explanatory text

  }]
}

Turtle Template

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


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

  # from 
  # from 

  # 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 a payment reconciliation
  fhir:type [ CodeableConcept ] ; # 1..1 Category of payment
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:statusReason [ string ] ; # 0..1 Reason for status change

  fhir:kind [ CodeableConcept ] ; # 0..1 Workflow originating payment
  fhir:period [ Period ] ; # 0..1 Period covered
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:enterer [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Who entered the payment
  fhir:issuerType [ CodeableConcept ] ; # 0..1 Nature of the source
  fhir:paymentIssuer [ Reference(Organization|Patient|RelatedPerson) ] ; # 0..1 Party generating payment
  fhir:request [ Reference(Task) ] ; # 0..1 Reference to requesting resource
  fhir:requestor [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:outcome [ code ] ; # 0..1 queued | complete | error | partial
  fhir:disposition [ string ] ; # 0..1 Disposition message
  fhir:date [ date ] ; # 1..1 When payment issued
  fhir:location [ Reference(Location) ] ; # 0..1 Where payment collected
  fhir:method [ CodeableConcept ] ; # 0..1 Payment instrument
  fhir:cardBrand [ string ] ; # 0..1 Type of card
  fhir:accountNumber [ string ] ; # 0..1 Digits for verification
  fhir:expirationDate [ date ] ; # 0..1 Expiration year-month
  fhir:processor [ string ] ; # 0..1 Processor name
  fhir:referenceNumber [ string ] ; # 0..1 Check number or payment reference
  fhir:authorization [ string ] ; # 0..1 Authorization number
  fhir:tenderedAmount [ Money ] ; # 0..1 Amount offered by the issuer
  fhir:returnedAmount [ Money ] ; # 0..1 Amount returned by the receiver
  fhir:

  fhir:amount [ Money ] ; # 0..1 Total amount of Payment

  fhir:paymentIdentifier [ Identifier ] ; # 0..1 Business identifier for the payment
  fhir:allocation ( [ # 0..* Settlement particulars
    fhir:identifier [ Identifier ] ; # 0..1 Business identifier of the payment detail
    fhir:predecessor [ Identifier ] ; # 0..1 Business identifier of the prior payment detail
    fhir:

    fhir:target [ Reference(Account|Claim|Contract|Encounter|Invoice) ] ; # 0..1 Subject of the payment

    # targetItem[x] : 0..1 Sub-element of the subject. One of these 3
      fhir: ]

      fhir:targetItem [  a fhir:String ; string ]

      fhir:targetItem [  a fhir:Identifier ; Identifier ]
      fhir: ]

      fhir:targetItem [  a fhir:PositiveInt ; positiveInt ]

    fhir:encounter [ Reference(Encounter) ] ; # 0..1 Applied-to encounter
    fhir:account [ Reference(Account) ] ; # 0..1 Applied-to account
    fhir:type [ CodeableConcept ] ; # 0..1 Category of payment
    fhir:submitter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Submitter of the request
    fhir:response [ Reference(ClaimResponse) ] ; # 0..1 Response committing to a payment
    fhir:date [ date ] ; # 0..1 Date of commitment to pay
    fhir:responsible [ Reference(PractitionerRole) ] ; # 0..1 Contact for the response
    fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Recipient of the payment
    fhir:amount [ Money ] ; # 0..1 Amount allocated to this payable
    fhir:noteNumber  ( [ positiveInt ] ... ) ; # 0..* Applicable note numbers

  ] ... ) ;
  fhir:formCode [ CodeableConcept ] ; # 0..1 Printed form identifier
  fhir:processNote ( [ # 0..* Note concerning processing
    fhir:class [ CodeableConcept ] ; # 0..1 Business kind of note
    fhir:number [ positiveInt ] ; # 0..1 Note instance identifier

    fhir:type [ code ] ; # 0..1 display | print | printoper
    fhir:

    fhir:text [ markdown ] ; # 0..1 Note explanatory text

  ] ... ) ;
]

Changes from both R4 and R4B

PaymentReconciliation

PaymentReconciliation.type

Added Mandatory Element

PaymentReconciliation.statusReason

Added Element

PaymentReconciliation.kind

Added Element

PaymentReconciliation.enterer

Added Element

PaymentReconciliation.issuerType

Added Element

PaymentReconciliation.paymentIssuer

Type Reference: Added Target Types Patient, RelatedPerson

PaymentReconciliation.outcome

Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to Payment Outcome

PaymentReconciliation.date

Added Mandatory Element

PaymentReconciliation.location

Added Element

PaymentReconciliation.method

Added Element

PaymentReconciliation.cardBrand

Added Element

PaymentReconciliation.accountNumber

Added Element

PaymentReconciliation.expirationDate

Added Element

PaymentReconciliation.processor

Added Element

PaymentReconciliation.referenceNumber

Added Element

PaymentReconciliation.authorization

Added Element

PaymentReconciliation.tenderedAmount

Added Element

PaymentReconciliation.returnedAmount

Added Element

PaymentReconciliation.amount

Added ~~Mandatory~~ Element

PaymentReconciliation.allocation

Added Element

PaymentReconciliation.allocation.identifier

Added Element

PaymentReconciliation.allocation.predecessor

Added Element

PaymentReconciliation.allocation.target

Added Element

PaymentReconciliation.allocation.targetItem[x]

Added Element

PaymentReconciliation.allocation.encounter

Added Element

PaymentReconciliation.allocation.account

Added Element

PaymentReconciliation.allocation.type

Added Element

PaymentReconciliation.allocation.submitter

Added Element

PaymentReconciliation.allocation.response

Added Element

PaymentReconciliation.allocation.date

Added Element

PaymentReconciliation.allocation.responsible

Added Element

PaymentReconciliation.allocation.payee

Added Element

PaymentReconciliation.allocation.amount

Added Element

PaymentReconciliation.allocation.noteNumber

Added Element

PaymentReconciliation.processNote.class

Added Element

PaymentReconciliation.processNote.number

Added Element

PaymentReconciliation.processNote.text

Type changed from string to markdown

PaymentReconciliation.paymentDate

Deleted

PaymentReconciliation.paymentAmount

Deleted

PaymentReconciliation.detail

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

~~1..1~~

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
PaymentReconciliation	TU		DomainResource	PaymentReconciliation resource Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
identifier		0..*	Identifier	Business Identifier for a payment reconciliation
type	Σ	1..1	CodeableConcept	Category of payment Binding: Payment Type Codes ( Extensible )
status	?! Σ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: Financial Resource Status Codes ( Required )
statusReason	Σ	0..1	string	Reason for status change
kind		0..1	CodeableConcept	Workflow originating payment Binding: Payment Kind ( Extensible )
period	Σ	0..1	Period	Period covered
created	Σ	1..1	dateTime	Creation date
enterer		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Who entered the payment
issuerType		0..1	CodeableConcept	Nature of the source Binding: Payment Issuer Type ( Extensible )
paymentIssuer	Σ	0..1	Reference ( Organization \| Patient \| RelatedPerson )	Party generating payment
request		0..1	Reference ( Task )	Reference to requesting resource
requestor		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Responsible practitioner
outcome		0..1	code	queued \| complete \| error \| partial Binding: Payment Outcome ( Required )
disposition		0..1	string	Disposition message
date	Σ	1..1	date	When payment issued
location		0..1	Reference ( Location )	Where payment collected
method		0..1	CodeableConcept	Payment instrument Binding: hl7VS-paymentMethodCode ( Extensible )
cardBrand		0..1	string	Type of card
accountNumber		0..1	string	Digits for verification
expirationDate		0..1	date	Expiration year-month
processor		0..1	string	Processor name
referenceNumber		0..1	string	Check number or payment reference
authorization		0..1	string	Authorization number
tenderedAmount		0..1	Money	Amount offered by the issuer
returnedAmount		0..1	Money	Amount returned by the receiver
amount	Σ	0..1	Money	Total amount of Payment
paymentIdentifier		0..1	Identifier	Business identifier for the payment
allocation		0..*	BackboneElement	Settlement particulars
identifier		0..1	Identifier	Business identifier of the payment detail
predecessor		0..1	Identifier	Business identifier of the prior payment detail
target		0..1	Reference ( Claim \| Account \| Invoice \| ~~ChargeItem \|~~ Encounter \| Contract )	Subject of the payment
targetItem[x]		0..1		Sub-element of the subject
targetItemString			string
targetItemIdentifier			Identifier
targetItemPositiveInt			positiveInt
encounter		0..1	Reference ( Encounter )	Applied-to encounter
account		0..1	Reference ( Account )	Applied-to account
type		0..1	CodeableConcept	Category of payment Binding: Payment Type Codes ( Extensible )
submitter		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Submitter of the request
response		0..1	Reference ( ClaimResponse )	Response committing to a payment
date		0..1	date	Date of commitment to pay
responsible		0..1	Reference ( PractitionerRole )	Contact for the response
payee		0..1	Reference ( Practitioner \| PractitionerRole \| Organization )	Recipient of the payment
amount		0..1	Money	Amount allocated to this payable
noteNumber		0..*	positiveInt	Applicable note numbers
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes ( Example )
processNote		0..*	BackboneElement	Note concerning processing
class		0..1	CodeableConcept	Business kind of note Binding: ProcessNoteClass ( Example )
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display \| print \| printoper Binding: NoteType ( Required )
text		0..1	~~string~~ markdown	Note explanatory text
Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

XML Template

<PaymentReconciliation 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 a payment reconciliation --></identifier>
 <type><!-- 1..1 CodeableConcept Category of payment --></type>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <statusReason value="[string]"/><!-- 0..1 Reason for status change -->

 <kind><!-- 0..1 CodeableConcept Workflow originating payment --></kind>
 <period><!-- 0..1 Period Period covered --></period>
 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <enterer><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Who entered the payment --></enterer>
 <issuerType><!-- 0..1 CodeableConcept Nature of the source --></issuerType>
 <paymentIssuer><!-- 0..1 Reference(Organization|Patient|RelatedPerson) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <date value="[date]"/><!-- 1..1 When payment issued -->
 <location><!-- 0..1 Reference(Location) Where payment collected --></location>
 <</method>

 <method><!-- 0..1 CodeableConcept Payment instrument  --></method>

 <cardBrand value="[string]"/><!-- 0..1 Type of card -->
 <accountNumber value="[string]"/><!-- 0..1 Digits for verification -->
 <expirationDate value="[date]"/><!-- 0..1 Expiration year-month -->
 <processor value="[string]"/><!-- 0..1 Processor name -->
 <referenceNumber value="[string]"/><!-- 0..1 Check number or payment reference -->
 <authorization value="[string]"/><!-- 0..1 Authorization number -->
 <tenderedAmount><!-- 0..1 Money Amount offered by the issuer --></tenderedAmount>
 <returnedAmount><!-- 0..1 Money Amount returned by the receiver --></returnedAmount>
 <</amount>

 <amount><!-- 0..1 Money Total amount of Payment --></amount>

 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <allocation>  <!-- 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>
  <</target>

  <target><!-- 0..1 Reference(Account|Claim|Contract|Encounter|Invoice) Subject of the payment --></target>

  <targetItem[x]><!-- 0..1 string|Identifier|positiveInt Sub-element of the subject --></targetItem[x]>
  <encounter><!-- 0..1 Reference(Encounter) Applied-to encounter --></encounter>
  <account><!-- 0..1 Reference(Account) Applied-to account --></account>
  <type><!-- 0..1 CodeableConcept Category of payment --></type>
  <submitter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(ClaimResponse) 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(Organization|Practitioner|PractitionerRole) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>
  <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->

 </allocation>
 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <class><!-- 0..1 CodeableConcept Business kind of note --></class>
  <number value="[positiveInt]"/><!-- 0..1 Note instance identifier -->

  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <

  <text value="[markdown]"/><!-- 0..1 Note explanatory text -->

 </processNote>
</PaymentReconciliation>

JSON Template

{
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "type" : { CodeableConcept }, // R!  Category of payment
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "statusReason" : "<string>", // Reason for status change

  "kind" : { CodeableConcept }, // Workflow originating payment
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // R!  Creation date
  "enterer" : { Reference(Organization|Practitioner|PractitionerRole) }, // Who entered the payment
  "issuerType" : { CodeableConcept }, // Nature of the source
  "paymentIssuer" : { Reference(Organization|Patient|RelatedPerson) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "date" : "<date>", // R!  When payment issued
  "location" : { Reference(Location) }, // Where payment collected
  "

  "method" : { CodeableConcept }, // Payment instrument 

  "cardBrand" : "<string>", // Type of card
  "accountNumber" : "<string>", // Digits for verification
  "expirationDate" : "<date>", // Expiration year-month
  "processor" : "<string>", // Processor name
  "referenceNumber" : "<string>", // Check number or payment reference
  "authorization" : "<string>", // Authorization number
  "tenderedAmount" : { Money }, // Amount offered by the issuer
  "returnedAmount" : { Money }, // Amount returned by the receiver
  "

  "amount" : { Money }, // Total amount of Payment

  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "allocation" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "

    "target" : { Reference(Account|Claim|Contract|Encounter|Invoice) }, // Subject of the payment

    // targetItem[x]: Sub-element of the subject. One of these 3:
    "targetItemString" : "<string>",
    "targetItemIdentifier" : { Identifier },
    "targetItemPositiveInt" : "<positiveInt>",
    "encounter" : { Reference(Encounter) }, // Applied-to encounter
    "account" : { Reference(Account) }, // Applied-to account
    "type" : { CodeableConcept }, // Category of payment
    "submitter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Submitter of the request
    "response" : { Reference(ClaimResponse) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Recipient of the payment
    "

    "amount" : { Money }, // Amount allocated to this payable
    "noteNumber" : ["<positiveInt>"] // Applicable note numbers

  }],
  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "class" : { CodeableConcept }, // Business kind of note
    "number" : "<positiveInt>", // Note instance identifier

    "type" : "<code>", // display | print | printoper
    "

    "text" : "<markdown>" // Note explanatory text

  }]
}

Turtle Template

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


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

  # from 
  # from 

  # 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 a payment reconciliation
  fhir:type [ CodeableConcept ] ; # 1..1 Category of payment
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:statusReason [ string ] ; # 0..1 Reason for status change

  fhir:kind [ CodeableConcept ] ; # 0..1 Workflow originating payment
  fhir:period [ Period ] ; # 0..1 Period covered
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:enterer [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Who entered the payment
  fhir:issuerType [ CodeableConcept ] ; # 0..1 Nature of the source
  fhir:paymentIssuer [ Reference(Organization|Patient|RelatedPerson) ] ; # 0..1 Party generating payment
  fhir:request [ Reference(Task) ] ; # 0..1 Reference to requesting resource
  fhir:requestor [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:outcome [ code ] ; # 0..1 queued | complete | error | partial
  fhir:disposition [ string ] ; # 0..1 Disposition message
  fhir:date [ date ] ; # 1..1 When payment issued
  fhir:location [ Reference(Location) ] ; # 0..1 Where payment collected
  fhir:method [ CodeableConcept ] ; # 0..1 Payment instrument
  fhir:cardBrand [ string ] ; # 0..1 Type of card
  fhir:accountNumber [ string ] ; # 0..1 Digits for verification
  fhir:expirationDate [ date ] ; # 0..1 Expiration year-month
  fhir:processor [ string ] ; # 0..1 Processor name
  fhir:referenceNumber [ string ] ; # 0..1 Check number or payment reference
  fhir:authorization [ string ] ; # 0..1 Authorization number
  fhir:tenderedAmount [ Money ] ; # 0..1 Amount offered by the issuer
  fhir:returnedAmount [ Money ] ; # 0..1 Amount returned by the receiver
  fhir:

  fhir:amount [ Money ] ; # 0..1 Total amount of Payment

  fhir:paymentIdentifier [ Identifier ] ; # 0..1 Business identifier for the payment
  fhir:allocation ( [ # 0..* Settlement particulars
    fhir:identifier [ Identifier ] ; # 0..1 Business identifier of the payment detail
    fhir:predecessor [ Identifier ] ; # 0..1 Business identifier of the prior payment detail
    fhir:

    fhir:target [ Reference(Account|Claim|Contract|Encounter|Invoice) ] ; # 0..1 Subject of the payment

    # targetItem[x] : 0..1 Sub-element of the subject. One of these 3
      fhir: ]

      fhir:targetItem [  a fhir:String ; string ]

      fhir:targetItem [  a fhir:Identifier ; Identifier ]
      fhir: ]

      fhir:targetItem [  a fhir:PositiveInt ; positiveInt ]

    fhir:encounter [ Reference(Encounter) ] ; # 0..1 Applied-to encounter
    fhir:account [ Reference(Account) ] ; # 0..1 Applied-to account
    fhir:type [ CodeableConcept ] ; # 0..1 Category of payment
    fhir:submitter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Submitter of the request
    fhir:response [ Reference(ClaimResponse) ] ; # 0..1 Response committing to a payment
    fhir:date [ date ] ; # 0..1 Date of commitment to pay
    fhir:responsible [ Reference(PractitionerRole) ] ; # 0..1 Contact for the response
    fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Recipient of the payment
    fhir:amount [ Money ] ; # 0..1 Amount allocated to this payable
    fhir:noteNumber  ( [ positiveInt ] ... ) ; # 0..* Applicable note numbers

  ] ... ) ;
  fhir:formCode [ CodeableConcept ] ; # 0..1 Printed form identifier
  fhir:processNote ( [ # 0..* Note concerning processing
    fhir:class [ CodeableConcept ] ; # 0..1 Business kind of note
    fhir:number [ positiveInt ] ; # 0..1 Note instance identifier

    fhir:type [ code ] ; # 0..1 display | print | printoper
    fhir:

    fhir:text [ markdown ] ; # 0..1 Note explanatory text

  ] ... ) ;
]

Changes from both R4 and R4B

PaymentReconciliation

PaymentReconciliation.type

Added Mandatory Element

PaymentReconciliation.statusReason

Added Element

PaymentReconciliation.kind

Added Element

PaymentReconciliation.enterer

Added Element

PaymentReconciliation.issuerType

Added Element

PaymentReconciliation.paymentIssuer

Type Reference: Added Target Types Patient, RelatedPerson

PaymentReconciliation.outcome

Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to Payment Outcome

PaymentReconciliation.date

Added Mandatory Element

PaymentReconciliation.location

Added Element

PaymentReconciliation.method

Added Element

PaymentReconciliation.cardBrand

Added Element

PaymentReconciliation.accountNumber

Added Element

PaymentReconciliation.expirationDate

Added Element

PaymentReconciliation.processor

Added Element

PaymentReconciliation.referenceNumber

Added Element

PaymentReconciliation.authorization

Added Element

PaymentReconciliation.tenderedAmount

Added Element

PaymentReconciliation.returnedAmount

Added Element

PaymentReconciliation.amount

Added ~~Mandatory~~ Element

PaymentReconciliation.allocation

Added Element

PaymentReconciliation.allocation.identifier

Added Element

PaymentReconciliation.allocation.predecessor

Added Element

PaymentReconciliation.allocation.target

Added Element

PaymentReconciliation.allocation.targetItem[x]

Added Element

PaymentReconciliation.allocation.encounter

Added Element

PaymentReconciliation.allocation.account

Added Element

PaymentReconciliation.allocation.type

Added Element

PaymentReconciliation.allocation.submitter

Added Element

PaymentReconciliation.allocation.response

Added Element

PaymentReconciliation.allocation.date

Added Element

PaymentReconciliation.allocation.responsible

Added Element

PaymentReconciliation.allocation.payee

Added Element

PaymentReconciliation.allocation.amount

Added Element

PaymentReconciliation.allocation.noteNumber

Added Element

PaymentReconciliation.processNote.class

Added Element

PaymentReconciliation.processNote.number

Added Element

PaymentReconciliation.processNote.text

Type changed from string to markdown

PaymentReconciliation.paymentDate

Deleted

PaymentReconciliation.paymentAmount

Deleted

PaymentReconciliation.detail

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 .

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

13.9.4.1 Terminology Bindings

Path	ValueSet	Type	Documentation
PaymentReconciliation.type	PaymentTypeCodes	Extensible	This value set includes sample Payment Type codes.
PaymentReconciliation.status	FinancialResourceStatusCodes	Required	This value set includes Status codes.
PaymentReconciliation.kind	PaymentKind (a valid code from Payment Kind Codes )	Extensible	The type of workflow from which this payment arose.
PaymentReconciliation.issuerType	PaymentIssuerType (a valid code from Payment Issuer Type Codes )	Extensible	The type of payment issuer.
PaymentReconciliation.outcome	PaymentOutcome (a valid code from Claim Processing Codes )	Required	The outcome of the processing.
PaymentReconciliation.method	Hl7VSPaymentMethodCode (a valid code from paymentMethod )	Extensible	Value Set of codes used to specify the method for the movement of payment.
PaymentReconciliation.allocation.type	PaymentTypeCodes	Extensible	This value set includes sample Payment Type codes.
PaymentReconciliation.formCode	FormCodes	Example	This value set includes a sample set of Forms codes.
PaymentReconciliation.processNote.class		Example
PaymentReconciliation.processNote.type	NoteType	Required	The presentation types of notes.

Path

ValueSet

Type

Documentation

PaymentReconciliation.type

PaymentTypeCodes

Extensible

This value set includes sample Payment Type codes.

PaymentReconciliation.status

FinancialResourceStatusCodes

Required

This value set includes Status codes.

PaymentReconciliation.kind

PaymentKind (a valid code from Payment Kind Codes )

Extensible

The type of workflow from which this payment arose.

PaymentReconciliation.issuerType

PaymentIssuerType (a valid code from Payment Issuer Type Codes )

Extensible

The type of payment issuer.

PaymentReconciliation.outcome

PaymentOutcome (a valid code from Claim Processing Codes )

Required

The outcome of the processing.

PaymentReconciliation.method

Hl7VSPaymentMethodCode icon

(a valid code from paymentMethod icon

)

Extensible

Value Set of codes used to specify the method for the movement of payment.

PaymentReconciliation.allocation.type

PaymentTypeCodes

Extensible

This value set includes sample Payment Type codes.

PaymentReconciliation.formCode

FormCodes

Example

This value set includes a sample set of Forms codes.

PaymentReconciliation.processNote.class

Example

PaymentReconciliation.processNote.type

NoteType

Required

The presentation types of notes.

13.9.5 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.

Name	Type	Description	Expression	In Common
allocation-account	reference	The account to which payment or adjustment was applied.	PaymentReconciliation.allocation.account ( Account )
allocation-encounter	reference	The encounter to which payment or adjustment was applied.	PaymentReconciliation.allocation.encounter ( Encounter )
created	date	The creation date	PaymentReconciliation.created
disposition	string	The contents of the disposition message	PaymentReconciliation.disposition
identifier	token	The business identifier of the ExplanationOfBenefit	PaymentReconciliation.identifier
outcome	token	The processing outcome	PaymentReconciliation.outcome
payment-issuer	reference	The organization which generated this resource	PaymentReconciliation.paymentIssuer ( Organization , Patient , RelatedPerson )
request	reference	The reference to the claim	PaymentReconciliation.request ( Task )
requestor	reference	The reference to the provider who submitted the claim	PaymentReconciliation.requestor ( Practitioner , Organization , PractitionerRole )
status	token	The status of the payment reconciliation	PaymentReconciliation.status