DSTU2
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This page is part of the FHIR Specification (v1.0.2: DSTU 2). 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 h2>

h2> <span class="sectioncount"> 7.0 <a name="7.0"> Financial Resources
FHIR Infrastructure Work Group Maturity Level : N/A Ballot Status : DSTU 2

The table below details various common business activities which occur in the financial realm, and the focal resources which may be exchanged, along with supporting resources, to accomplish the business activities. Whether or not the resources specified are actually needed requires consideration of the business itself and the exchange methodology and transport being used.

For example, if a definitive 'Request' does not need to be documented and communicating parties are using REST then a GET may be used in place of a CREATE of the request resource. Alternately, if FHIR Operations are being used then the specified focal resource may not be required or may be employed as one of the Operation parameters.

Note: The SupportingDocumentation resource has been deprecated in favour of DocumentManifest for the excahnge of attachments and supporting materials, PDF, Images, XRays, etc.

Business Activity Request Resource Response Resource
Eligibility Check EligibilityRequest EligibilityResponse
Enrollment Update EnrollmentRequest EnrollmentResponse
Claim Claim (type={discipline}, use=complete) ClaimResponse
Pre-determination Claim (type={discipline}, use=exploratory) ClaimResponse
Pre-Authorization Claim (type={discipline}, use=proposed) ClaimResponse
Reversal ProcessRequest (action=cancel, nullify=false) ClaimResponse
Nullify ProcessRequest (action=cancel, nullify=true) ClaimResponse
Re-adjudication Readjudication ProcessRequest (action=reprocess) ClaimResponse
Status Check ProcessRequest (action=status) ProcessResponse
Pended Check (Polling) ProcessRequest (action=poll) {Resource} {Resource } or ProcessResponse
Payment Notice PaymentNotice ProcessResponse
Payment Reconciliation ProcessRequest (action=poll, include=PaymentReconciliation) include= PaymentReconciliation ) PaymentReconciliation
Send Attachments SupportingDocumentation DocumentManifest ProcessResponse
Request an Explanation of Benefits    ProcessRequest (action=poll, include=ExplanationOfBenefit) include= ExplanationOfBenefit ) ExplanationOfBenefit

{disipline} means the type of claim: OralHealth, Vision, Pharmacy, Professional or Institutional.

{Resource} means any pended or undelivered resource subject to the selection details specified in the request.

ProcessRequest This resource provides the target, request and response, and action details for an action to be performed by the target on or about existing resources. ProcessResponse This resource provides processing status, errors and notes from the processing of a resource. SupportingDocumentation Attachments Supporting Information This resource provides the supporting information for a process, for example clinical or financial information related to a claim or pre-authorization.
Support
Administrative
Name Aliases Description
Contract A formal agreement between parties regarding the conduct of business, exchange of information or other matters. Coverage Financial instrument which may be used to pay for or reimburse for health care products and services.
EligibilityRequest This resource provides the insurance eligibility details from the insurer regarding a specified coverage and optionally some class of service.
EligibilityResponse This resource provides eligibility and plan details from the processing of an Eligibility resource.
EnrollmentRequest This resource provides the insurance Enrollment enrollment details to the insurer regarding a specified coverage.
EnrollmentResponse This resource provides Enrollment enrollment and plan details from the processing of an Enrollment resource.
Billing
Claims, processing and responses
Name Aliases Description
Claim A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.
ClaimResponse Remittance Advice This resource provides the adjudication details from the processing of a Claim resource.
Payment
Used to support service payment processing and reporting
Name Aliases Description
PaymentNotice This resource provides the status of the payment for goods and services rendered, and the request and response resource references.
PaymentReconciliation This resource provides payment details and claim references supporting a bulk payment.
Other
Patient reporting and other purposes
Name Aliases Description
ExplanationOfBenefit EOB This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.

Additional Resources will be added in the future. A list of hypothesized resources can be found on the HL7 wiki . Feel free to add any you think are missing or engage with one of the HL7 Work Groups to submit a proposal to define a resource of particular interest.