Release 4 5

This page is part of the FHIR Specification (v4.0.1: R4 (v5.0.0: R5 - Mixed Normative and STU ) ). This is the current published version 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 R2

Paymentnotice-example.json

Example PaymentNotice/77654 (JSON)

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

Raw JSON ( canonical form + also see JSON Format Specification )

Claim PaymentNotice Example 

{
  "resourceType": "PaymentNotice",
  "id": "77654",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentNotice</div>"

  "resourceType" : "PaymentNotice",
  "id" : "77654",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentNotice</div>"

  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/paymentnotice",
      "value": "776543"
    }
  ],
  "status": "active",
  "request": {
    "reference": "http://benefitsinc.com/fhir/claim/12345"

  "identifier" : [{
    "system" : "http://benefitsinc.com/paymentnotice",
    "value" : "776543"
  }],
  "status" : "active",
  "request" : {
    "reference" : "http://benefitsinc.com/fhir/claim/12345"

  },
  "response": {
    "reference": "http://benefitsinc.com/fhir/claimresponse/CR12345"

  "response" : {
    "reference" : "http://benefitsinc.com/fhir/claimresponse/CR12345"

  },
  "created": "2014-08-16",
  "provider": {
    "reference": "Organization/1"

  "created" : "2014-08-16",
  "reporter" : {
    "reference" : "Organization/1"

  },
  "payment": {
    "reference": "PaymentReconciliation/ER2500"

  "payment" : {
    "reference" : "PaymentReconciliation/ER2500"

  },
  "paymentDate": "2014-08-15",
  "payee": {
    "reference": "Organization/1"

  "paymentDate" : "2014-08-15",
  "payee" : {
    "reference" : "Organization/1"

  },
  "recipient": {
    "identifier": {
      "system": "http://regulators.gov",
      "value": "AB123"

  "recipient" : {
    "identifier" : {
      "system" : "http://regulators.gov",
      "value" : "AB123"

    }
  },
  "amount": {
    "value": 12500.00,
    "currency": "USD"

  "amount" : {
    "value" : 12500.00,
    "currency" : "USD"

  },
  "paymentStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/paymentstatus",
        "code": "paid"
      }
    ]

  "paymentStatus" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/paymentstatus",
      "code" : "paid"
    }]

  }
}

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.