Paymentreconciliation-example.json

General Payment Reconciliation Example

{
  "resourceType": "PaymentReconciliation",
  "id": "ER2500",
  "text": {
    "status": "generated",
    "div": "<div>!-- Snipped for Brevity --></div>"

    "div": "<div>A human-readable rendering of the PaymentReconciliation</div>"

  },
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/enrollmentresponse",
      "value": "781234"
    }
  ],
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/eligibility/225476332402"
  },
  "outcome": "complete",
  "disposition": "2014 August mid-month settlement.",
  "created": "2014-08-16",
  "organization": {
    "reference": "Organization/2"
  },
  "requestOrganization": {
    "reference": "Organization/1"
  },
  "detail": [
    {
      "type": {
        "system": "http://hl7.org/fhir/paymenttype",
        "code": "payment"
      },
      "request": {
        "reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332402"
      },
      "date": "2014-08-16",
      "amount": {
        "value": 1000.00,
        "system": "urn:std:iso:4217",

        "system": "urn:iso:std:iso:4217",

        "code": "USD"
      }
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/paymenttype",
        "code": "payment"
      },
      "request": {
        "reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699"
      },
      "date": "2014-08-12",
      "amount": {
        "value": 4000.00,
        "system": "urn:std:iso:4217",

        "system": "urn:iso:std:iso:4217",

        "code": "USD"
      }
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/paymenttype",
        "code": "advance"
      },
      "date": "2014-08-16",
      "amount": {
        "value": -1500.00,
        "system": "urn:std:iso:4217",

        "system": "urn:iso:std:iso:4217",

        "code": "USD"
      }
    }
  ],
  "total": {
    "value": 3500.00,
    "system": "urn:std:iso:4217",

    "system": "urn:iso:std:iso:4217",

    "code": "USD"
  }
}