Release 4B R5 Final QA

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-draft-final: Final QA Preview for R5 - STU see ballot notes ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Paymentreconciliation-example.ttl

Example PaymentReconciliation/ER2500 (Turtle)

Financial Management Work Group Maturity Level : N/A Standards Status : Informative Compartments : Practitioner

Raw Turtle (+ also see Turtle/RDF Format Specification )

General Payment Reconciliation Example 

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/PaymentReconciliation/ER2500> a fhir:PaymentReconciliation;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "ER2500"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentReconciliation</div>"
  ];
  fhir:PaymentReconciliation.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/enrollmentresponse" ];
     fhir:Identifier.value [ fhir:value "781234" ]
  ];
  fhir:PaymentReconciliation.status [ fhir:value "active"];
  fhir:PaymentReconciliation.period [
     fhir:Period.start [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Period.end [ fhir:value "2014-08-31"^^xsd:date ]
  ];
  fhir:PaymentReconciliation.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:PaymentReconciliation.paymentIssuer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:PaymentReconciliation.request [
     fhir:link <http://www.BenefitsInc.com/fhir/eligibility/225476332402>;
     fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/eligibility/225476332402" ]
  ];
  fhir:PaymentReconciliation.requestor [
     fhir:link <http://hl7.org/fhir/Organization/1>;
     fhir:Reference.reference [ fhir:value "Organization/1" ]
  ];
  fhir:PaymentReconciliation.outcome [ fhir:value "complete"];
  fhir:PaymentReconciliation.disposition [ fhir:value "2014 August mid-month settlement."];
  fhir:PaymentReconciliation.paymentDate [ fhir:value "2014-08-01"^^xsd:date];
  fhir:PaymentReconciliation.paymentAmount [
     fhir:Money.value [ fhir:value "7000.00"^^xsd:decimal ];
     fhir:Money.currency [ fhir:value "USD" ]
  ];
  fhir:PaymentReconciliation.paymentIdentifier [
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018" ];
     fhir:Identifier.value [ fhir:value "10-12345" ]
  ];
  fhir:PaymentReconciliation.detail [
     fhir:index 0;
     fhir:PaymentReconciliation.detail.identifier [
       fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018/detail" ];
       fhir:Identifier.value [ fhir:value "10-12345-001" ]
     ];
     fhir:PaymentReconciliation.detail.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];
         fhir:Coding.code [ fhir:value "payment" ]
       ]
     ];
     fhir:PaymentReconciliation.detail.request [
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://happyvalleyclinic.com/claim" ];
         fhir:Identifier.value [ fhir:value "AB12345" ]
       ]
     ];
     fhir:PaymentReconciliation.detail.submitter [
       fhir:link <http://hl7.org/fhir/Organization/1>;
       fhir:Reference.reference [ fhir:value "Organization/1" ]
     ];
     fhir:PaymentReconciliation.detail.response [
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/claimresponse" ];
         fhir:Identifier.value [ fhir:value "CR20140815-AB12345" ]

[a fhir:PaymentReconciliation ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ER2500"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentReconciliation</div>"
  ] ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/enrollmentresponse"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "781234" ]
  ] ) ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "payment" ]
     ] )
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:period [
     fhir:start [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:end [ fhir:v "2014-08-31"^^xsd:date ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:paymentIssuer [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:request [
     fhir:link <http://www.BenefitsInc.com/fhir/eligibility/225476332402> ;
     fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/eligibility/225476332402" ]
  ] ; # 
  fhir:requestor [
     fhir:reference [ fhir:v "Organization/1" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "2014 August mid-month settlement."] ; # 
  fhir:date [ fhir:v "2014-08-01"^^xsd:date] ; # 
  fhir:amount [
     fhir:value [ fhir:v "7000.00"^^xsd:decimal ] ;
     fhir:currency [ fhir:v "USD" ]
  ] ; # 
  fhir:paymentIdentifier [
     fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "10-12345" ]
  ] ; # 
  fhir:allocation ( [
     fhir:identifier [
       fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018/detail"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "10-12345-001" ]
     ] ;
     fhir:target [
       fhir:identifier [
         fhir:system [ fhir:v "http://happyvalleyclinic.com/claim"^^xsd:anyURI ] ;
         fhir:value [ fhir:v "AB12345" ]

       ]
     ];
     fhir:PaymentReconciliation.detail.date [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:PaymentReconciliation.detail.payee [
       fhir:link <http://hl7.org/fhir/Organization/1>;
       fhir:Reference.reference [ fhir:value "Organization/1" ]
     ];
     fhir:PaymentReconciliation.detail.amount [
       fhir:Money.value [ fhir:value "3500.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ]
  ], [
     fhir:index 1;
     fhir:PaymentReconciliation.detail.identifier [
       fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018/detail" ];
       fhir:Identifier.value [ fhir:value "10-12345-002" ]
     ];
     fhir:PaymentReconciliation.detail.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];
         fhir:Coding.code [ fhir:value "payment" ]

     ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "payment" ]
       ] )
     ] ;
     fhir:submitter [
       fhir:reference [ fhir:v "Organization/1" ]
     ] ;
     fhir:response [
       fhir:identifier [
         fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/claimresponse"^^xsd:anyURI ] ;
         fhir:value [ fhir:v "CR20140815-AB12345" ]

       ]
     ];
     fhir:PaymentReconciliation.detail.request [
       fhir:link <http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699>;
       fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699" ]
     ];
     fhir:PaymentReconciliation.detail.date [ fhir:value "2014-08-12"^^xsd:date ];
     fhir:PaymentReconciliation.detail.amount [
       fhir:Money.value [ fhir:value "4000.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

     ] ;
     fhir:date [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:payee [
       fhir:reference [ fhir:v "Organization/1" ]
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "3500.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ], [
     fhir:index 2;
     fhir:PaymentReconciliation.detail.identifier [
       fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018/detail" ];
       fhir:Identifier.value [ fhir:value "10-12345-003" ]
     ];
     fhir:PaymentReconciliation.detail.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];
         fhir:Coding.code [ fhir:value "advance" ]
       ]
     ];
     fhir:PaymentReconciliation.detail.date [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:PaymentReconciliation.detail.amount [
       fhir:Money.value [ fhir:value "-1500.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

  ] [
     fhir:identifier [
       fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018/detail"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "10-12345-002" ]
     ] ;
     fhir:target [
       fhir:link <http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699> ;
       fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699" ]
     ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "payment" ]
       ] )
     ] ;
     fhir:date [ fhir:v "2014-08-12"^^xsd:date ] ;
     fhir:amount [
       fhir:value [ fhir:v "4000.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ];
  fhir:PaymentReconciliation.formCode [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://ncforms.org/formid" ];
       fhir:Coding.code [ fhir:value "PAYREC/2016/01B" ]

  ] [
     fhir:identifier [
       fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018/detail"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "10-12345-003" ]
     ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "advance" ]
       ] )
     ] ;
     fhir:date [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:amount [
       fhir:value [ fhir:v "-1500.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ];
  fhir:PaymentReconciliation.processNote [
     fhir:index 0;
     fhir:PaymentReconciliation.processNote.type [ fhir:value "display" ];
     fhir:PaymentReconciliation.processNote.text [ fhir:value "Due to the year end holiday the cutoff for submissions for December will be the 28th." ]
  ] .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

<http://hl7.org/fhir/Organization/1> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/PaymentReconciliation/ER2500.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/PaymentReconciliation/ER2500.ttl> .

  ] ) ; # 
  fhir:formCode [
     fhir:coding ( [
       fhir:system [ fhir:v "http://ncforms.org/formid"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "PAYREC/2016/01B" ]
     ] )
  ] ; # 
  fhir:processNote ( [
     fhir:type [ fhir:v "display" ] ;
     fhir:text [ fhir:v "Due to the year end holiday the cutoff for submissions for December will be the 28th." ]
  ] )] . # 


# -------------------------------------------------------------------------------------

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.