DSTU2 STU 3 Ballot
This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is

This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . For a full list of available versions, see the Directory of published versions . Page versions: . Page versions: R5 R4B R4 R3 R2

7.10 13.10 Resource PaymentReconciliation - Content Resource PaymentReconciliation - Content

This resource provides payment details and claim references supporting a bulk payment.
Financial Management Financial Management Work Group Work Group Maturity Level : 0 Maturity Level : 1 Compartments : Not linked to any defined compartments : Not linked to any defined compartments

This resource provides payment details and claim references supporting a bulk payment.

7.10.1 Scope and Usage 13.10.1 Scope and Usage The PaymentReconciliation resource 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. These are the payment reconciliation details which align to the individual payment amounts indicated on discrete ClaimResponses. Bulk payments need to provide a means to associate the amounts paid again specific Claims, and other financial exchanges and adjustments, to the bulk payment itself in order to reconcile provider accounts receivable. Todo

The PaymentReconciliation resource 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. These are the payment reconciliation details which align to the individual payment amounts indicated on discrete ClaimResponses.

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

7.10.2 Resource Content 13.10.2 Resource Content

Structure

Σ Σ Claim reference Σ Σ Σ Σ Σ Σ Σ Insurer Σ Responsible practitioner Σ Responsible organization Σ Σ Σ Claim Σ Claim Response Σ Submitter Σ Payee Σ Σ Σ Σ Σ Σ Σ
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . PaymentReconciliation DomainResource PaymentReconciliation resource
. . . identifier 0..* DomainResource Identifier PaymentReconciliation resource Business Identifier
. . identifier . status ?! Σ 0..* 1..1 Identifier code Business Identifier active | cancelled | draft | entered-in-error
PaymentReconciliationStatus ( Required )
. . request . request[x] 0..1 Claim reference
.... requestIdentifier 0..1 Identifier
. . . . requestReference Reference ( ProcessRequest )
. . . outcome 0..1 code complete | error complete | error | partial
RemittanceOutcome ( ( Required )
. . . disposition 0..1 string Disposition Message Disposition Message
. . . ruleset 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created 0..1 dateTime Creation date Creation date
. . . period 0..1 Period Period covered Period covered
. . organization . organization[x] 0..1 Insurer
. . . . organizationIdentifier 0..1 Identifier
. . . . organizationReference Reference ( Organization )
. . requestProvider . requestProvider[x] 0..1 Responsible practitioner
.... requestProviderIdentifier 0..1 Identifier
. . . . requestProviderReference Reference ( Practitioner )
. . requestOrganization . requestOrganization[x] 0..1 Responsible organization
.... requestOrganizationIdentifier 0..1 Identifier
. . . . requestOrganizationReference Reference ( Organization )
. . . detail 0..* BackboneElement Details
. . . . type 1..1 Coding Type code Type code
Payment Type Codes ( Payment Type Codes ( Example )
. . . request . request[x] 0..1 Claim
..... requestIdentifier 0..1 Identifier
. . . . . requestReference Reference ( Any )
. . . responce . response[x] 0..1 Claim Response
..... responseIdentifier 0..1 Identifier
..... responseReference Reference ( Any )
. . . submitter . submitter[x] 0..1 Submitter
..... submitterIdentifier 0..1 Identifier
. . . . . submitterReference Reference ( Organization )
. . . payee . payee[x] 0..1 Payee
..... payeeIdentifier 0..1 Identifier
..... payeeReference Reference ( Organization )
. . . . date 0..1 date Invoice date Invoice date
. . . . amount 0..1 Money Detail amount Detail amount
. . . form 0..1 Coding Printed Form Identifier Printed Form Identifier
Form Codes ( Form Codes ( Required )
. . . total 1..1 Money Total amount of Payment Total amount of Payment
. . . note 0..* BackboneElement Note text Note text
. . . . type 0..1 Coding display | print | printoper display | print | printoper
NoteType ( ( Required )
. . . . text 0..1 string Notes text Notes text

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram ( Legend )

PaymentReconciliation ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource reference The status of the resource instance (this element modifies the meaning of other elements) request status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required) PaymentReconciliationStatus ! » Original request resource reference request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( ProcessRequest » ) » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The style (standard) and version of the original material which was converted into this resource The style (standard) and version of the original material which was converted into this resource originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The period of time for which payments have been gathered into this bulk payment for settlement The period of time for which payments have been gathered into this bulk payment for settlement period : : Period [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider requestProvider[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Practitioner » ) » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization requestOrganization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The form to be used for printing the content The form to be used for printing the content form : : Coding [0..1] « [0..1] « The forms codes. (Strength=Required) The forms codes. (Strength=Required) Form ! » Form ! » Total payment amount Total payment amount total : Quantity ( : Money ) [1..1] [1..1] Details Code to indicate the nature of the payment, adjustment, funds advance, etc Code to indicate the nature of the payment, adjustment, funds advance, etc type : : Coding [1..1] « [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example) The reason for the amount: payment, adjustment, advance. (Strength=Example) Payment Type ?? » Payment Type ?? » The claim or financial resource The claim or financial resource request request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Any » ) » The claim response resource The claim response resource responce response[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Any » ) » The Organization which submitted the invoice or financial transaction The Organization which submitted the invoice or financial transaction submitter submitter[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The organization which is receiving the payment The organization which is receiving the payment payee payee[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The date of the invoice or financial resource The date of the invoice or financial resource date : : date [0..1] [0..1] Amount paid for this detail Amount paid for this detail amount : Quantity ( : Money ) [0..1] [0..1] Notes The note purpose: Print/Display The note purpose: Print/Display type : : Coding [0..1] « [0..1] « The presentation types of notes. (Strength=Required) The presentation types of notes. (Strength=Required) NoteType ! » ! » The note text The note text text : : string [0..1] [0..1] List of individual settlement amounts and the corresponding transaction List of individual settlement amounts and the corresponding transaction detail [0..*] Suite of notes Suite of notes note [0..*]

XML Template XML Template < 

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <</request>
 <
 <
 <</ruleset>
 <</originalRuleset>
 <
 <</period>
 <</organization>
 <</requestProvider>
 <</requestOrganization>
 <
  <</type>
  <</request>
  <</responce>
  <</submitter>
  <</payee>
  <
  <</amount>

 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <request[x]><!-- 0..1 Identifier|Reference(ProcessRequest) Claim reference --></request[x]>
 <outcome value="[code]"/><!-- 0..1 complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <period><!-- 0..1 Period Period covered --></period>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>
 <detail>  <!-- 0..* Details -->
  <type><!-- 1..1 Coding Type code --></type>
  <request[x]><!-- 0..1 Identifier|Reference(Any) Claim --></request[x]>
  <response[x]><!-- 0..1 Identifier|Reference(Any) Claim Response --></response[x]>
  <submitter[x]><!-- 0..1 Identifier|Reference(Organization) Submitter --></submitter[x]>
  <payee[x]><!-- 0..1 Identifier|Reference(Organization) Payee --></payee[x]>
  <date value="[date]"/><!-- 0..1 Invoice date -->
  <amount><!-- 0..1 Money Detail amount --></amount>

 </detail>
 <</form>
 <</total>
 <
  <</type>
  <

 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <total><!-- 1..1 Money Total amount of Payment --></total>
 <note>  <!-- 0..* Note text -->
  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Notes text -->

 </note>
</PaymentReconciliation>

JSON Template JSON Template { "resourceType" : "", 

{doco
  "resourceType" : "PaymentReconciliation",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "
    "
    "
    "
    "

  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  // request[x]: Claim reference. One of these 2:

  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(ProcessRequest) },
  "outcome" : "<code>", // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "period" : { Period }, // Period covered
  // organization[x]: Insurer. One of these 2:

  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:

  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:

  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },
  "detail" : [{ // Details
    "type" : { Coding }, // R!  Type code
    // request[x]: Claim. One of these 2:

    "requestIdentifier" : { Identifier },
    "requestReference" : { Reference(Any) },
    // response[x]: Claim Response. One of these 2:

    "responseIdentifier" : { Identifier },
    "responseReference" : { Reference(Any) },
    // submitter[x]: Submitter. One of these 2:

    "submitterIdentifier" : { Identifier },
    "submitterReference" : { Reference(Organization) },
    // payee[x]: Payee. One of these 2:

    "payeeIdentifier" : { Identifier },
    "payeeReference" : { Reference(Organization) },
    "date" : "<date>", // Invoice date
    "amount" : { Money } // Detail amount

  }],
  "
  "
  "
    "
    "

  "form" : { Coding }, // Printed Form Identifier
  "total" : { Money }, // R!  Total amount of Payment
  "note" : [{ // Note text
    "type" : { Coding }, // display | print | printoper
    "text" : "<string>" // Notes 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
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  # PaymentReconciliation.request[x] : 0..1 Claim reference. One of these 2
    fhir:PaymentReconciliation.requestIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestReference [ Reference(ProcessRequest) ]
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition Message
  fhir:PaymentReconciliation.ruleset [ Coding ]; # 0..1 Resource version
  fhir:PaymentReconciliation.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:PaymentReconciliation.created [ dateTime ]; # 0..1 Creation date
  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  # PaymentReconciliation.organization[x] : 0..1 Insurer. One of these 2
    fhir:PaymentReconciliation.organizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.organizationReference [ Reference(Organization) ]
  # PaymentReconciliation.requestProvider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:PaymentReconciliation.requestProviderIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestProviderReference [ Reference(Practitioner) ]
  # PaymentReconciliation.requestOrganization[x] : 0..1 Responsible organization. One of these 2
    fhir:PaymentReconciliation.requestOrganizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestOrganizationReference [ Reference(Organization) ]
  fhir:PaymentReconciliation.detail [ # 0..* Details
    fhir:PaymentReconciliation.detail.type [ Coding ]; # 1..1 Type code
    # PaymentReconciliation.detail.request[x] : 0..1 Claim. One of these 2
      fhir:PaymentReconciliation.detail.requestIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.requestReference [ Reference(Any) ]
    # PaymentReconciliation.detail.response[x] : 0..1 Claim Response. One of these 2
      fhir:PaymentReconciliation.detail.responseIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.responseReference [ Reference(Any) ]
    # PaymentReconciliation.detail.submitter[x] : 0..1 Submitter. One of these 2
      fhir:PaymentReconciliation.detail.submitterIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.submitterReference [ Reference(Organization) ]
    # PaymentReconciliation.detail.payee[x] : 0..1 Payee. One of these 2
      fhir:PaymentReconciliation.detail.payeeIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.payeeReference [ Reference(Organization) ]
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Invoice date
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Detail amount
  ], ...;
  fhir:PaymentReconciliation.form [ Coding ]; # 0..1 Printed Form Identifier
  fhir:PaymentReconciliation.total [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.note [ # 0..* Note text
    fhir:PaymentReconciliation.note.type [ Coding ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.note.text [ string ]; # 0..1 Notes text
  ], ...;
]

Changes since DSTU2

PaymentReconciliation
PaymentReconciliation.status added
PaymentReconciliation.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.organization[x] Renamed from organization to organization[x]
Add Identifier
PaymentReconciliation.requestProvider[x] Renamed from requestProvider to requestProvider[x]
Add Identifier
PaymentReconciliation.requestOrganization[x] Renamed from requestOrganization to requestOrganization[x]
Add Identifier
PaymentReconciliation.detail.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.detail.response[x] added
PaymentReconciliation.detail.submitter[x] Renamed from submitter to submitter[x]
Add Identifier
PaymentReconciliation.detail.payee[x] Renamed from payee to payee[x]
Add Identifier
PaymentReconciliation.detail.amount Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.total Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.detail.responce deleted

See the Full Difference for further information

Structure

Σ DomainResource Σ Claim reference Σ Σ Σ Σ Σ Σ Σ Insurer Σ Responsible practitioner Σ Responsible organization Σ Σ Σ Claim Σ Claim Response Σ Submitter Σ Payee Σ Σ Σ Σ Σ Σ Σ
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . PaymentReconciliation DomainResource PaymentReconciliation resource
. . . identifier 0..* Identifier PaymentReconciliation resource Business Identifier
. . identifier . status ?! Σ 0..* 1..1 Identifier code Business Identifier active | cancelled | draft | entered-in-error
PaymentReconciliationStatus ( Required )
. . request . request[x] 0..1 Claim reference
. . . . requestIdentifier 0..1 Identifier
. . . . requestReference Reference ( ProcessRequest )
. . . outcome 0..1 code complete | error complete | error | partial
RemittanceOutcome ( ( Required )
. . . disposition 0..1 string Disposition Message Disposition Message
. . . ruleset 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created 0..1 dateTime Creation date Creation date
. . . period 0..1 Period Period covered Period covered
. . organization . organization[x] 0..1 Insurer
. . . . organizationIdentifier 0..1 Identifier
. . . . organizationReference Reference ( Organization )
. . requestProvider . requestProvider[x] 0..1 Responsible practitioner
.... requestProviderIdentifier 0..1 Identifier
. . . . requestProviderReference Reference ( Practitioner )
. . requestOrganization . requestOrganization[x] 0..1 Responsible organization
.... requestOrganizationIdentifier 0..1 Identifier
. . . . requestOrganizationReference Reference ( Organization )
. . . detail 0..* BackboneElement Details
. . . . type 1..1 Coding Type code Type code
Payment Type Codes ( Payment Type Codes ( Example )
. . . request . request[x] 0..1 Claim
..... requestIdentifier 0..1 Identifier
. . . . . requestReference Reference ( Any )
. . . responce . response[x] 0..1 Claim Response
..... responseIdentifier 0..1 Identifier
..... responseReference Reference ( Any )
. . . submitter . submitter[x] 0..1 Submitter
..... submitterIdentifier 0..1 Identifier
. . . . . submitterReference Reference ( Organization )
. . . payee . payee[x] 0..1 Payee
..... payeeIdentifier 0..1 Identifier
. . . . . payeeReference Reference ( Organization )
. . . . date 0..1 date Invoice date Invoice date
. . . . amount 0..1 Money Detail amount Detail amount
. . . form 0..1 Coding Printed Form Identifier Printed Form Identifier
Form Codes ( Form Codes ( Required )
. . . total 1..1 Money Total amount of Payment Total amount of Payment
. . . note 0..* BackboneElement Note text Note text
. . . . type 0..1 Coding display | print | printoper display | print | printoper
NoteType ( ( Required )
. . . . text 0..1 string Notes text Notes text

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram ( Legend )

PaymentReconciliation ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource reference The status of the resource instance (this element modifies the meaning of other elements) request status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required) PaymentReconciliationStatus ! » Original request resource reference request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( ProcessRequest » ) » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The style (standard) and version of the original material which was converted into this resource The style (standard) and version of the original material which was converted into this resource originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The period of time for which payments have been gathered into this bulk payment for settlement The period of time for which payments have been gathered into this bulk payment for settlement period : : Period [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider requestProvider[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Practitioner » ) » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization requestOrganization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The form to be used for printing the content The form to be used for printing the content form : : Coding [0..1] « [0..1] « The forms codes. (Strength=Required) The forms codes. (Strength=Required) Form ! » Form ! » Total payment amount Total payment amount total : Quantity ( : Money ) [1..1] [1..1] Details Code to indicate the nature of the payment, adjustment, funds advance, etc Code to indicate the nature of the payment, adjustment, funds advance, etc type : : Coding [1..1] « [1..1] « The reason for the amount: payment, adjustment, advance. (Strength=Example) The reason for the amount: payment, adjustment, advance. (Strength=Example) Payment Type ?? » Payment Type ?? » The claim or financial resource The claim or financial resource request request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Any » ) » The claim response resource The claim response resource responce response[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Any » ) » The Organization which submitted the invoice or financial transaction The Organization which submitted the invoice or financial transaction submitter submitter[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The organization which is receiving the payment The organization which is receiving the payment payee payee[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The date of the invoice or financial resource The date of the invoice or financial resource date : : date [0..1] [0..1] Amount paid for this detail Amount paid for this detail amount : Quantity ( : Money ) [0..1] [0..1] Notes The note purpose: Print/Display The note purpose: Print/Display type : : Coding [0..1] « [0..1] « The presentation types of notes. (Strength=Required) The presentation types of notes. (Strength=Required) NoteType ! » ! » The note text The note text text : : string [0..1] [0..1] List of individual settlement amounts and the corresponding transaction List of individual settlement amounts and the corresponding transaction detail [0..*] Suite of notes Suite of notes note [0..*]

XML Template XML Template < 

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <</request>
 <
 <
 <</ruleset>
 <</originalRuleset>
 <
 <</period>
 <</organization>
 <</requestProvider>
 <</requestOrganization>
 <
  <</type>
  <</request>
  <</responce>
  <</submitter>
  <</payee>
  <
  <</amount>

 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <request[x]><!-- 0..1 Identifier|Reference(ProcessRequest) Claim reference --></request[x]>
 <outcome value="[code]"/><!-- 0..1 complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <period><!-- 0..1 Period Period covered --></period>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>
 <detail>  <!-- 0..* Details -->
  <type><!-- 1..1 Coding Type code --></type>
  <request[x]><!-- 0..1 Identifier|Reference(Any) Claim --></request[x]>
  <response[x]><!-- 0..1 Identifier|Reference(Any) Claim Response --></response[x]>
  <submitter[x]><!-- 0..1 Identifier|Reference(Organization) Submitter --></submitter[x]>
  <payee[x]><!-- 0..1 Identifier|Reference(Organization) Payee --></payee[x]>
  <date value="[date]"/><!-- 0..1 Invoice date -->
  <amount><!-- 0..1 Money Detail amount --></amount>

 </detail>
 <</form>
 <</total>
 <
  <</type>
  <

 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <total><!-- 1..1 Money Total amount of Payment --></total>
 <note>  <!-- 0..* Note text -->
  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Notes text -->

 </note>
</PaymentReconciliation>

JSON Template JSON Template { "resourceType" : "", 

{doco
  "resourceType" : "PaymentReconciliation",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "
    "
    "
    "
    "

  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  // request[x]: Claim reference. One of these 2:

  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(ProcessRequest) },
  "outcome" : "<code>", // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "period" : { Period }, // Period covered
  // organization[x]: Insurer. One of these 2:

  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:

  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:

  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },
  "detail" : [{ // Details
    "type" : { Coding }, // R!  Type code
    // request[x]: Claim. One of these 2:

    "requestIdentifier" : { Identifier },
    "requestReference" : { Reference(Any) },
    // response[x]: Claim Response. One of these 2:

    "responseIdentifier" : { Identifier },
    "responseReference" : { Reference(Any) },
    // submitter[x]: Submitter. One of these 2:

    "submitterIdentifier" : { Identifier },
    "submitterReference" : { Reference(Organization) },
    // payee[x]: Payee. One of these 2:

    "payeeIdentifier" : { Identifier },
    "payeeReference" : { Reference(Organization) },
    "date" : "<date>", // Invoice date
    "amount" : { Money } // Detail amount

  }],
  "
  "
  "
    "
    "

  "form" : { Coding }, // Printed Form Identifier
  "total" : { Money }, // R!  Total amount of Payment
  "note" : [{ // Note text
    "type" : { Coding }, // display | print | printoper
    "text" : "<string>" // Notes text

  }]
}
 
Alternate
definitions:

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
  fhir:PaymentReconciliation.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  # PaymentReconciliation.request[x] : 0..1 Claim reference. One of these 2
    fhir:PaymentReconciliation.requestIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestReference [ Reference(ProcessRequest) ]
  fhir:PaymentReconciliation.outcome [ code ]; # 0..1 complete | error | partial
  fhir:PaymentReconciliation.disposition [ string ]; # 0..1 Disposition Message
  fhir:PaymentReconciliation.ruleset [ Coding ]; # 0..1 Resource version
  fhir:PaymentReconciliation.originalRuleset [ Coding ]; # 0..1 Original version
  fhir:PaymentReconciliation.created [ dateTime ]; # 0..1 Creation date
  fhir:PaymentReconciliation.period [ Period ]; # 0..1 Period covered
  # PaymentReconciliation.organization[x] : 0..1 Insurer. One of these 2
    fhir:PaymentReconciliation.organizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.organizationReference [ Reference(Organization) ]
  # PaymentReconciliation.requestProvider[x] : 0..1 Responsible practitioner. One of these 2
    fhir:PaymentReconciliation.requestProviderIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestProviderReference [ Reference(Practitioner) ]
  # PaymentReconciliation.requestOrganization[x] : 0..1 Responsible organization. One of these 2
    fhir:PaymentReconciliation.requestOrganizationIdentifier [ Identifier ]
    fhir:PaymentReconciliation.requestOrganizationReference [ Reference(Organization) ]
  fhir:PaymentReconciliation.detail [ # 0..* Details
    fhir:PaymentReconciliation.detail.type [ Coding ]; # 1..1 Type code
    # PaymentReconciliation.detail.request[x] : 0..1 Claim. One of these 2
      fhir:PaymentReconciliation.detail.requestIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.requestReference [ Reference(Any) ]
    # PaymentReconciliation.detail.response[x] : 0..1 Claim Response. One of these 2
      fhir:PaymentReconciliation.detail.responseIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.responseReference [ Reference(Any) ]
    # PaymentReconciliation.detail.submitter[x] : 0..1 Submitter. One of these 2
      fhir:PaymentReconciliation.detail.submitterIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.submitterReference [ Reference(Organization) ]
    # PaymentReconciliation.detail.payee[x] : 0..1 Payee. One of these 2
      fhir:PaymentReconciliation.detail.payeeIdentifier [ Identifier ]
      fhir:PaymentReconciliation.detail.payeeReference [ Reference(Organization) ]
    fhir:PaymentReconciliation.detail.date [ date ]; # 0..1 Invoice date
    fhir:PaymentReconciliation.detail.amount [ Money ]; # 0..1 Detail amount
  ], ...;
  fhir:PaymentReconciliation.form [ Coding ]; # 0..1 Printed Form Identifier
  fhir:PaymentReconciliation.total [ Money ]; # 1..1 Total amount of Payment
  fhir:PaymentReconciliation.note [ # 0..* Note text
    fhir:PaymentReconciliation.note.type [ Coding ]; # 0..1 display | print | printoper
    fhir:PaymentReconciliation.note.text [ string ]; # 0..1 Notes text
  ], ...;
]

Changes since DSTU2

PaymentReconciliation
PaymentReconciliation.status added
PaymentReconciliation.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.organization[x] Renamed from organization to organization[x]
Add Identifier
PaymentReconciliation.requestProvider[x] Renamed from requestProvider to requestProvider[x]
Add Identifier
PaymentReconciliation.requestOrganization[x] Renamed from requestOrganization to requestOrganization[x]
Add Identifier
PaymentReconciliation.detail.request[x] Renamed from request to request[x]
Add Identifier
PaymentReconciliation.detail.response[x] added
PaymentReconciliation.detail.submitter[x] Renamed from submitter to submitter[x]
Add Identifier
PaymentReconciliation.detail.payee[x] Renamed from payee to payee[x]
Add Identifier
PaymentReconciliation.detail.amount Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.total Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money
PaymentReconciliation.detail.responce deleted

See the Full Difference for further information

 

Alternate definitions: Master Definition ( XML , JSON ), XML Schema / Schematron , Resource Profile ( XML , (for ) + JSON Schema , ShEx (for Turtle ), Questionnaire )

7.10.2.1 Terminology Bindings 13.10.2.1 Terminology Bindings

PaymentReconciliation.detail.type PaymentReconciliation.form PaymentReconciliation.note.type
Path Definition Type Reference
PaymentReconciliation.status A code specifying the state of the resource instance. Required PaymentReconciliation.outcome The outcome of the processing. PaymentReconciliationStatus
PaymentReconciliation.outcome The outcome of the processing. Required RemittanceOutcome
PaymentReconciliation.ruleset
PaymentReconciliation.originalRuleset PaymentReconciliation.originalRuleset 		The static and dynamic model to which contents conform, which may be business version or standard/version. The static and dynamic model to which contents conform, which may be business version or standard/version. Example Ruleset Codes Ruleset Codes
PaymentReconciliation.detail.type The reason for the amount: payment, adjustment, advance. The reason for the amount: payment, adjustment, advance. Example Payment Type Codes Payment Type Codes
PaymentReconciliation.form The forms codes. The forms codes. Required Form Codes Form Codes
PaymentReconciliation.note.type The presentation types of notes. The presentation types of notes. Required NoteType

7.10.3 Search Parameters 13.10.3 Search Parameters Search parameters for this resource. The common parameters also apply. See

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

© HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100.
Name Type Description Paths
created date The creation date PaymentReconciliation.created
disposition string The contents of the disposition message PaymentReconciliation.disposition
identifier token The business identifier of the Explanation of Benefit The business identifier of the Explanation of Benefit PaymentReconciliation.identifier
organization-identifier token The organization who generated this resource PaymentReconciliation.organizationIdentifier
organization-reference reference The organization who generated this resource PaymentReconciliation.organizationReference
Links: Search ( Organization )
outcome token | Version History The processing outcome PaymentReconciliation.outcome
request-identifier token | Table of Contents The reference to the claim PaymentReconciliation.requestIdentifier
request-organization-identifier token | Compare to DSTU1 The organization who generated this resource PaymentReconciliation.requestOrganizationIdentifier
request-organization-reference reference | The organization who generated this resource PaymentReconciliation.requestOrganizationReference
( Organization | Propose a change )
request-provider-identifier token The reference to the provider who sumbitted the claim PaymentReconciliation.requestProviderIdentifier
request-provider-reference reference The reference to the provider who sumbitted the claim PaymentReconciliation.requestProviderReference
( Practitioner try { var currentTabIndex = sessionStorage.getItem('fhir-resource-tab-index'); } catch(exception){ } if (!currentTabIndex) currentTabIndex = '0'; $( '#tabs' ).tabs({ active: currentTabIndex, activate: function( event, ui ) { var active = $('.selector').tabs('option', 'active'); currentTabIndex = ui.newTab.index(); document.activeElement.blur(); try { sessionStorage.setItem('fhir-resource-tab-index', currentTabIndex); } catch(exception){ } } });
request-reference reference The reference to the claim PaymentReconciliation.requestReference
( ProcessRequest )