FHIR Release 3 (STU) 4

This page is part of the FHIR Specification (v3.0.2: (v4.0.1: R4 - Mixed Normative and STU 3). ) in it's permanent home (it will always be available at this URL). 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 R4 R3 R2

13.8 Resource PaymentNotice - Content

Financial Management Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Practitioner

This resource provides the status of the payment for goods and services rendered, and the request and response resource references.

13.8.1 Scope and Usage

The PaymentNotice resource indicates the resource for which the payment has been indicated and reports the current status information of that payment. The payment notice may be used by providers and payors payers to advise the Provider provider or regulatory bodies of the state of a payment (cheque (check in the mail/EFT sent, payment cashed, payment cancelled). canceled). Employers or Insurance Exchanges may use this to advise payors payers of premium payment.

Payors and /or Payers and/or providers may have the need to advise providers and/or regulators of the status of claim settlement and payment completion. This same resource may be used by employers and insurance exchanges to advise payors payers that premium payments have been issued and settled.

The PaymentNotice resource is a "event" resource from a FHIR workflow perspective - see Workflow Event.

13.8.1.1 Additional Information

Additional information regarding electronic payment notice content and usage may be found at:

13.8.2 Boundaries and Relationships

The PaymentNotice resource is used to indicate that a payment is, or is about to occur. The resource is used commonly when tracking of payment occurences is required for regulatory or business purposes, such as ensuring that payment of claim adjudications occurs within a specific timeframe. The PaymentNotice is not used to report adjudicated amounts (see ClaimResponse ) or to reconcile adjudicated amounts against actual payment (see PaymentReconciliation )

The ClaimResponse resource is an insurer's adjudication and/or authorization of a set of healthcare-related goods and services for a patient against the patient's insurance coverages and does not indicate that payment has occured.

The PaymentReconciliation resource serves to correlate payment amounts to the adjudicated claim amounts appearing on one or more ClaimResponses .

The eClaim domain includes a number of related resources

PaymentNotice An indication that a payment has occured, is about to occur, or has been cancelled.
ClaimResponse A payor's adjudication and/or authorization response to the suite of services provided in a Claim. Typically the ClaimResponse references the Claim but does not duplicate the clinical or financial information provided in the claim.
PaymentReconciliation 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.

13.8.2 13.8.3 Resource Content

Structure

date Payment or clearing Insurer or Regulatory body Responsible practitioner
Name Flags Card. Type Description & Constraints doco
. . PaymentNotice TU DomainResource PaymentNotice request
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier for the payment noctice
. . . status ?! Σ 0..1 1..1 code active | cancelled | draft | entered-in-error
Financial Resource Status Codes ( Required )
. . . request 0..1 Reference ( Any ) Request reference
. . . response 0..1 Reference ( Any ) Response reference
. . statusDate . created Σ 0..1 1..1 dateTime Creation date
. . created . provider 0..1 dateTime Reference ( Practitioner | PractitionerRole | Organization ) Creation date Responsible practitioner
. . target . payment Σ 0..1 1..1 Reference ( Organization PaymentReconciliation ) Payment reference
. . provider . paymentDate 0..1 date Payment or clearing date
... payee 0..1 Reference ( Practitioner | PractitionerRole | Organization ) Party being paid
. . . organization recipient Σ 0..1 1..1 Reference ( Organization ) Responsible organization Party being notified
... amount Σ 1..1 Money Monetary amount of the payment
. . . paymentStatus 0..1 CodeableConcept Whether payment has been sent Issued or cleared Status of the payment
Payment Status Codes ( Example )

doco Documentation for this format

UML Diagram ( Legend )

PaymentNotice ( DomainResource ) The notice business A unique identifier assigned to this payment notice identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » Reference of resource for which payment is being made request : Reference [0..1] « Any » Reference of response to resource for which payment is being made response : Reference [0..1] « Any » The date when this resource was created created : dateTime [1..1] The practitioner who is responsible for the above payment action occurrred services rendered to the patient statusDate provider : date Reference [0..1] « Practitioner | PractitionerRole | Organization » A reference to the payment which is the subject of this notice payment : Reference [1..1] « PaymentReconciliation » The date when this resource was created the above payment action occurred created paymentDate : dateTime date [0..1] The Insurer party who will receive or has received payment that is target of the request subject of this notification target payee : Reference [0..1] « Practitioner | PractitionerRole | Organization » The practitioner party who is responsible for the services rendered to notified of the patient payment status provider recipient : Reference [0..1] Practitioner [1..1] « Organization » The organization which is responsible for the services rendered amount sent to the patient payee organization amount : Reference [0..1] Organization Money [1..1] The payment status, typically paid: payment sent, cleared: A code indicating whether payment received has been sent or cleared paymentStatus : CodeableConcept [0..1] « The payment conveyance status codes codes. (Strength=Example) Payment Status PaymentStatusCodes ?? »

XML Template 

<

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <

 <identifier><!-- 0..* Identifier Business Identifier for the payment noctice --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->

 <request><!-- 0..1 Reference(Any) Request reference --></request>
 <response><!-- 0..1 Reference(Any) Response reference --></response>
 <
 <
 <</target>
 <</provider>
 <</organization>
 <</paymentStatus>

 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <provider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></provider>
 <payment><!-- 1..1 Reference(PaymentReconciliation) Payment reference --></payment>
 <paymentDate value="[date]"/><!-- 0..1 Payment or clearing date -->
 <payee><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Party being paid --></payee>
 <recipient><!-- 1..1 Reference(Organization) Party being notified --></recipient>
 <amount><!-- 1..1 Money Monetary amount of the payment --></amount>
 <paymentStatus><!-- 0..1 CodeableConcept Issued or cleared Status of the payment --></paymentStatus>

</PaymentNotice>

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:PaymentNotice;
  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:
  fhir:

  fhir:PaymentNotice.identifier [ Identifier ], ... ; # 0..* Business Identifier for the payment noctice
  fhir:PaymentNotice.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error

  fhir:PaymentNotice.request [ Reference(Any) ]; # 0..1 Request reference
  fhir:PaymentNotice.response [ Reference(Any) ]; # 0..1 Response reference
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:PaymentNotice.created [ dateTime ]; # 1..1 Creation date
  fhir:PaymentNotice.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner
  fhir:PaymentNotice.payment [ Reference(PaymentReconciliation) ]; # 1..1 Payment reference
  fhir:PaymentNotice.paymentDate [ date ]; # 0..1 Payment or clearing date
  fhir:PaymentNotice.payee [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Party being paid
  fhir:PaymentNotice.recipient [ Reference(Organization) ]; # 1..1 Party being notified
  fhir:PaymentNotice.amount [ Money ]; # 1..1 Monetary amount of the payment
  fhir:PaymentNotice.paymentStatus [ CodeableConcept ]; # 0..1 Issued or cleared Status of the payment

]

Changes since DSTU2 R3

PaymentNotice
PaymentNotice.status
  • Min Cardinality changed from 0 to 1
  • Change value set from http://hl7.org/fhir/ValueSet/fm-status to http://hl7.org/fhir/ValueSet/fm-status|4.0.1
PaymentNotice.created
  • Min Cardinality changed from 0 to 1
PaymentNotice.provider
  • Renamed from organization to provider
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentNotice.payment
  • Added Mandatory Element
PaymentNotice.paymentDate
  • Renamed from statusDate to paymentDate
PaymentNotice.statusDate PaymentNotice.payee
  • Added Element
PaymentNotice.paymentStatus PaymentNotice.recipient
  • Min Cardinality changed Renamed from 1 target to 0 recipient
  • Type Min Cardinality changed from Coding 0 to CodeableConcept 1
PaymentNotice.ruleset PaymentNotice.amount
  • deleted Added Mandatory Element
PaymentNotice.originalRuleset PaymentNotice.provider
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors). )

Structure

date Payment or clearing Insurer or Regulatory body Responsible practitioner
Name Flags Card. Type Description & Constraints doco
. . PaymentNotice TU DomainResource PaymentNotice request
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier for the payment noctice
. . . status ?! Σ 0..1 1..1 code active | cancelled | draft | entered-in-error
Financial Resource Status Codes ( Required )
. . . request 0..1 Reference ( Any ) Request reference
. . . response 0..1 Reference ( Any ) Response reference
. . statusDate . created Σ 0..1 1..1 dateTime Creation date
. . created . provider 0..1 dateTime Reference ( Practitioner | PractitionerRole | Organization ) Creation date Responsible practitioner
. . target . payment Σ 0..1 1..1 Reference ( Organization PaymentReconciliation ) Payment reference
. . provider . paymentDate 0..1 date Payment or clearing date
... payee 0..1 Reference ( Practitioner | PractitionerRole | Organization ) Party being paid
. . . organization recipient Σ 0..1 1..1 Reference ( Organization ) Responsible organization Party being notified
... amount Σ 1..1 Money Monetary amount of the payment
. . . paymentStatus 0..1 CodeableConcept Whether payment has been sent Issued or cleared Status of the payment
Payment Status Codes ( Example )

doco Documentation for this format

UML Diagram ( Legend )

PaymentNotice ( DomainResource ) The notice business A unique identifier assigned to this payment notice identifier : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » Reference of resource for which payment is being made request : Reference [0..1] « Any » Reference of response to resource for which payment is being made response : Reference [0..1] « Any » The date when this resource was created created : dateTime [1..1] The practitioner who is responsible for the above payment action occurrred services rendered to the patient statusDate provider : date Reference [0..1] « Practitioner | PractitionerRole | Organization » A reference to the payment which is the subject of this notice payment : Reference [1..1] « PaymentReconciliation » The date when this resource was created the above payment action occurred created paymentDate : dateTime date [0..1] The Insurer party who will receive or has received payment that is target of the request subject of this notification target payee : Reference [0..1] « Practitioner | PractitionerRole | Organization » The practitioner party who is responsible for the services rendered to notified of the patient payment status provider recipient : Reference [0..1] Practitioner [1..1] « Organization » The organization which is responsible for the services rendered amount sent to the patient payee organization amount : Reference [0..1] Organization Money [1..1] The payment status, typically paid: payment sent, cleared: A code indicating whether payment received has been sent or cleared paymentStatus : CodeableConcept [0..1] « The payment conveyance status codes codes. (Strength=Example) Payment Status PaymentStatusCodes ?? »

XML Template 

<

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <

 <identifier><!-- 0..* Identifier Business Identifier for the payment noctice --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->

 <request><!-- 0..1 Reference(Any) Request reference --></request>
 <response><!-- 0..1 Reference(Any) Response reference --></response>
 <
 <
 <</target>
 <</provider>
 <</organization>
 <</paymentStatus>

 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <provider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></provider>
 <payment><!-- 1..1 Reference(PaymentReconciliation) Payment reference --></payment>
 <paymentDate value="[date]"/><!-- 0..1 Payment or clearing date -->
 <payee><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Party being paid --></payee>
 <recipient><!-- 1..1 Reference(Organization) Party being notified --></recipient>
 <amount><!-- 1..1 Money Monetary amount of the payment --></amount>
 <paymentStatus><!-- 0..1 CodeableConcept Issued or cleared Status of the payment --></paymentStatus>

</PaymentNotice>

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:PaymentNotice;
  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:
  fhir:

  fhir:PaymentNotice.identifier [ Identifier ], ... ; # 0..* Business Identifier for the payment noctice
  fhir:PaymentNotice.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error

  fhir:PaymentNotice.request [ Reference(Any) ]; # 0..1 Request reference
  fhir:PaymentNotice.response [ Reference(Any) ]; # 0..1 Response reference
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:PaymentNotice.created [ dateTime ]; # 1..1 Creation date
  fhir:PaymentNotice.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner
  fhir:PaymentNotice.payment [ Reference(PaymentReconciliation) ]; # 1..1 Payment reference
  fhir:PaymentNotice.paymentDate [ date ]; # 0..1 Payment or clearing date
  fhir:PaymentNotice.payee [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Party being paid
  fhir:PaymentNotice.recipient [ Reference(Organization) ]; # 1..1 Party being notified
  fhir:PaymentNotice.amount [ Money ]; # 1..1 Monetary amount of the payment
  fhir:PaymentNotice.paymentStatus [ CodeableConcept ]; # 0..1 Issued or cleared Status of the payment

]

Changes since DSTU2 Release 3

PaymentNotice
PaymentNotice.status
  • Min Cardinality changed from 0 to 1
  • Change value set from http://hl7.org/fhir/ValueSet/fm-status to http://hl7.org/fhir/ValueSet/fm-status|4.0.1
PaymentNotice.created
  • Min Cardinality changed from 0 to 1
PaymentNotice.provider
  • Renamed from organization to provider
  • Type Reference: Added Target Types Practitioner, PractitionerRole
PaymentNotice.payment
  • Added Mandatory Element
PaymentNotice.paymentDate
  • Renamed from statusDate to paymentDate
PaymentNotice.statusDate PaymentNotice.payee
  • Added Element
PaymentNotice.paymentStatus PaymentNotice.recipient
  • Min Cardinality changed Renamed from 1 target to 0 recipient
  • Type Min Cardinality changed from Coding 0 to CodeableConcept 1
PaymentNotice.ruleset PaymentNotice.amount
  • deleted Added Mandatory Element
PaymentNotice.originalRuleset PaymentNotice.provider
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors). )

 

Alternate See the Profiles & Extensions and the alternate definitions: Master Definition ( XML , + JSON ), , XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

13.8.2.1 13.8.3.1 Terminology Bindings

Path Definition Type Reference
PaymentNotice.status A code specifying the state of the resource instance. Required Financial Resource Status Codes FinancialResourceStatusCodes
PaymentNotice.paymentStatus The payment conveyance status codes codes. Example Payment Status Codes PaymentStatusCodes

13.8.3 13.8.4 Search Parameters

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

organization The organization who generated this resource PaymentNotice.organization ( Organization )
Name Type Description Expression In Common
created date Creation date fro the notice PaymentNotice.created
identifier token The business identifier of the notice PaymentNotice.identifier reference
payment-status token The type of payment notice PaymentNotice.paymentStatus
provider reference The reference to the provider PaymentNotice.provider
( Practitioner , Organization , PractitionerRole )
request reference The Claim PaymentNotice.request
(Any)
response reference The ClaimResponse PaymentNotice.response
(Any)
statusdate status date token The date status of the payment action notice PaymentNotice.statusDate PaymentNotice.status