FHIR Release 3 (STU) 4

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Paymentreconciliation-example.ttl

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

Raw Turtle , JSON-LD (+ 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.organization [

  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.outcome [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://hl7.org/fhir/remittance-outcome" ];
       fhir:Coding.code [ fhir:value "complete" ]
     ]

  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.requestProvider [
     fhir:link <http://hl7.org/fhir/Practitioner/example>;
     fhir:Reference.reference [ fhir:value "Practitioner/example" ]

  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.requestOrganization [
     fhir:link <http://hl7.org/fhir/Organization/1>;
     fhir:Reference.reference [ fhir:value "Organization/1" ]

  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://hl7.org/fhir/payment-type" ];

         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" ]
       ]
     ];
     fhir:PaymentReconciliation.detail.submitter [
       fhir:link <http://hl7.org/fhir/Organization/1>;
       fhir:Reference.reference [ fhir:value "Organization/1" ]
     ];

     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.date [ fhir:value "2014-08-16"^^xsd:date ];

     fhir:PaymentReconciliation.detail.amount [
       fhir:Quantity.value [ fhir:value "1000.00"^^xsd:decimal ];
       fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
       fhir:Quantity.code [ fhir:value "USD" ]

       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://hl7.org/fhir/payment-type" ];

         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];

         fhir:Coding.code [ fhir:value "payment" ]
       ]
     ];
     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:Quantity.value [ fhir:value "4000.00"^^xsd:decimal ];
       fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
       fhir:Quantity.code [ fhir:value "USD" ]

       fhir:Money.value [ fhir:value "4000.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "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://hl7.org/fhir/payment-type" ];

         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:Quantity.value [ fhir:value "-1500.00"^^xsd:decimal ];
       fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
       fhir:Quantity.code [ fhir:value "USD" ]

       fhir:Money.value [ fhir:value "-1500.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

     ]
  ];
  fhir:PaymentReconciliation.form [

  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:PaymentReconciliation.total [
     fhir:Quantity.value [ fhir:value "3500.00"^^xsd:decimal ];
     fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
     fhir:Quantity.code [ fhir:value "USD" ]
  ];

  fhir:PaymentReconciliation.processNote [
     fhir:index 0;
     fhir:PaymentReconciliation.processNote.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/note-type" ];
         fhir:Coding.code [ fhir:value "display" ]
       ]
     ];

     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/Practitioner/example> a fhir:Practitioner .


<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://hl7.org/fhir/STU3/PaymentReconciliation/ER2500.ttl> .

  owl:versionIRI <http://build.fhir.org/PaymentReconciliation/ER2500.ttl> .


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

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.