DSTU2

This page is part of the FHIR Specification (v0.0.82: (v1.0.2: DSTU 1). 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 . Page versions: R5 R4B R4 R3 R2

7.10 Resource PaymentReconciliation - Content

This resource maintained by the
Financial Management Work Group Maturity Level : 0 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

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

7.10.2 Resource Content

Structure

UML Diagram

PaymentReconciliation ( DomainResource ) The Response Business Identifier business identifier identifier : Identifier 0..* [0..*] Original request resource reference request : Reference ( [0..1] « ProcessRequest ) 0..1 » Transaction status: error, complete outcome : code 0..1 [0..1] « The outcome of the processing. (Strength=Required) RemittanceOutcome ! » 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 ruleset : Coding 0..1 [0..1] « ( The static and dynamic model to which contents conform, which may be business version or standard and version. standard/version. (Strength=Example) Ruleset ) ?? » 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 and version. standard/version. (Strength=Example) Ruleset ) ?? » 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 period : Period 0..1 [0..1] The Insurer who produced this adjudicated response organization : Reference ( [0..1] « Organization ) 0..1 » The practitioner who is responsible for the services rendered to the patient requestProvider : Reference ( [0..1] « Practitioner ) 0..1 » The organization which is responsible for the services rendered to the patient requestOrganization : Reference ( [0..1] « Organization ) 0..1 » The form to be used for printing the content form : Coding 0..1 [0..1] « The forms codes codes. (Strength=Required) Forms Form ! » Total payment amount total : Quantity ( Money 1..1 ) [1..1] Details 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) PaymentType Payment Type ) ?? » The claim or financial resource request : Reference ( [0..1] « Any ) 0..1 » The claim response resource responce : Reference ( [0..1] « Any ) 0..1 » The Organization which submitted the invoice or financial transaction submitter : Reference ( [0..1] « Organization ) 0..1 » The organization which is receiving the payment payee : Reference ( [0..1] « Organization ) 0..1 » The date of the invoice or financial resource date : date 0..1 [0..1] Amount paid for this detail amount : Quantity ( Money 0..1 ) [0..1] Notes The note purpose: Print/Display type : Coding 0..1 [0..1] « The presentation types of notes notes. (Strength=Required) NoteType ! » The note text text : string 0..1 [0..1] List of individual settlement amounts and the corresponding transaction detail 0..* [0..*] Suite of notes note 0..* [0..*]

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>
 <
 <

 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <request><!-- 0..1 Reference(ProcessRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->

 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <
 <</period>
 <</organization>
 <</requestProvider>
 <</requestOrganization>

 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <period><!-- 0..1 Period Period covered --></period>
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></requestProvider>
 <requestOrganization><!-- 0..1 Reference(Organization) Responsible organization --></requestOrganization>

 <detail>  <!-- 0..* Details -->
  <type><!-- 1..1 Coding Type code --></type>
  <</request>
  <</responce>
  <</submitter>
  <</payee>
  <
  <</amount>

  <request><!-- 0..1 Reference(Any) Claim --></request>
  <responce><!-- 0..1 Reference(Any) Claim Response --></responce>
  <submitter><!-- 0..1 Reference(Organization) Submitter --></submitter>
  <payee><!-- 0..1 Reference(Organization) Payee --></payee>
  <date value="[date]"/><!-- 0..1 Invoice date -->
  <amount><!-- 0..1 Quantity(Money) Detail amount --></amount>

 </detail>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <</total>

 <total><!-- 1..1 Quantity(Money) Total amount of Payment --></total>

 <note>  <!-- 0..* Note text -->
  <</type>
  <

  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Notes text -->

 </note>
</PaymentReconciliation>

Structure

UML Diagram

PaymentReconciliation ( DomainResource ) The Response Business Identifier business identifier identifier : Identifier 0..* [0..*] Original request resource reference request : Reference ( [0..1] « ProcessRequest ) 0..1 » Transaction status: error, complete outcome : code 0..1 [0..1] « The outcome of the processing. (Strength=Required) RemittanceOutcome ! » 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 ruleset : Coding 0..1 [0..1] « ( The static and dynamic model to which contents conform, which may be business version or standard and version. standard/version. (Strength=Example) Ruleset ) ?? » 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 and version. standard/version. (Strength=Example) Ruleset ) ?? » 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 period : Period 0..1 [0..1] The Insurer who produced this adjudicated response organization : Reference ( [0..1] « Organization ) 0..1 » The practitioner who is responsible for the services rendered to the patient requestProvider : Reference ( [0..1] « Practitioner ) 0..1 » The organization which is responsible for the services rendered to the patient requestOrganization : Reference ( [0..1] « Organization ) 0..1 » The form to be used for printing the content form : Coding 0..1 [0..1] « The forms codes codes. (Strength=Required) Forms Form ! » Total payment amount total : Quantity ( Money 1..1 ) [1..1] Details 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) PaymentType Payment Type ) ?? » The claim or financial resource request : Reference ( [0..1] « Any ) 0..1 » The claim response resource responce : Reference ( [0..1] « Any ) 0..1 » The Organization which submitted the invoice or financial transaction submitter : Reference ( [0..1] « Organization ) 0..1 » The organization which is receiving the payment payee : Reference ( [0..1] « Organization ) 0..1 » The date of the invoice or financial resource date : date 0..1 [0..1] Amount paid for this detail amount : Quantity ( Money 0..1 ) [0..1] Notes The note purpose: Print/Display type : Coding 0..1 [0..1] « The presentation types of notes notes. (Strength=Required) NoteType ! » The note text text : string 0..1 [0..1] List of individual settlement amounts and the corresponding transaction detail 0..* [0..*] Suite of notes note 0..* [0..*]

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>
 <
 <

 <identifier><!-- 0..* Identifier Business Identifier --></identifier>
 <request><!-- 0..1 Reference(ProcessRequest) Claim reference --></request>
 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->

 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <
 <</period>
 <</organization>
 <</requestProvider>
 <</requestOrganization>

 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <period><!-- 0..1 Period Period covered --></period>
 <organization><!-- 0..1 Reference(Organization) Insurer --></organization>
 <requestProvider><!-- 0..1 Reference(Practitioner) Responsible practitioner --></requestProvider>
 <requestOrganization><!-- 0..1 Reference(Organization) Responsible organization --></requestOrganization>

 <detail>  <!-- 0..* Details -->
  <type><!-- 1..1 Coding Type code --></type>
  <</request>
  <</responce>
  <</submitter>
  <</payee>
  <
  <</amount>

  <request><!-- 0..1 Reference(Any) Claim --></request>
  <responce><!-- 0..1 Reference(Any) Claim Response --></responce>
  <submitter><!-- 0..1 Reference(Organization) Submitter --></submitter>
  <payee><!-- 0..1 Reference(Organization) Payee --></payee>
  <date value="[date]"/><!-- 0..1 Invoice date -->
  <amount><!-- 0..1 Quantity(Money) Detail amount --></amount>

 </detail>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <</total>

 <total><!-- 1..1 Quantity(Money) Total amount of Payment --></total>

 <note>  <!-- 0..* Note text -->
  <</type>
  <

  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Notes text -->

 </note>
</PaymentReconciliation>

 

Alternate definitions: Schema / Schematron , Resource Profile ( XML , JSON ), Questionnaire

7.10.2.1 Terminology Bindings

Path Definition Type Reference
PaymentReconciliation.outcome The outcome of the processing. Required http://hl7.org/fhir/RS-link RemittanceOutcome
PaymentReconciliation.ruleset
PaymentReconciliation.originalRuleset 		The static and dynamic model to which contents conform, which may be business version or standard and version. standard/version. Example http://hl7.org/fhir/vs/ruleset Ruleset Codes
PaymentReconciliation.detail.type The reason for the amount: payment, adjustment, advance. Example http://hl7.org/fhir/vs/payment-type Payment Type Codes
PaymentReconciliation.form The forms codes codes. Required http://hl7.org/fhir/vs/forms Form Codes
PaymentReconciliation.note.type The presentation types of notes notes. Required http://hl7.org/fhir/NT-link NoteType

7.10.3 Search Parameters

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

Name Type Description Paths
identifier token The business identifier of the Explanation of Benefit PaymentReconciliation.identifier