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13.8 Resource PaymentNotice - Content

Financial Management icon Work GroupMaturity Level: 4 Trial UseSecurity 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 payers to advise the provider or regulatory bodies of the state of a payment (check in the mail/EFT sent, payment cashed, payment canceled). Employers or Insurance Exchanges may use this to advise payers of premium payment.

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 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.

13.8.3 References to this Resource

13.8.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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 notice

... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (Required)
... request 0..1 Reference(Any) Request reference
... created Σ 1..1 dateTime Creation date
... reporter 0..1 Reference(Practitioner | PractitionerRole | Organization) Responsible practitioner
... payment Σ 0..1 Reference(PaymentReconciliation) Payment reference
... paymentDate 0..1 date Payment or clearing date
... payee 0..1 Reference(Practitioner | PractitionerRole | Organization) Party being paid
... recipient Σ 1..1 Reference(Organization) Party being notified
... amount Σ 1..1 Money Monetary amount of the payment
... paymentStatus 0..1 CodeableConcept Issued or cleared Status of the payment
Binding: Payment Status Codes (Example)

doco Documentation for this format icon

See the Extensions for this resource

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:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for the payment notice
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:request [ Reference(Any) ] ; # 0..1 Request reference
  fhir:response [ Reference(Any) ] ; # 0..1 Response reference
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:reporter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:payment [ Reference(PaymentReconciliation) ] ; # 0..1 Payment reference
  fhir:paymentDate [ date ] ; # 0..1 Payment or clearing date
  fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Party being paid
  fhir:recipient [ Reference(Organization) ] ; # 1..1 Party being notified
  fhir:amount [ Money ] ; # 1..1 Monetary amount of the payment
  fhir:paymentStatus [ CodeableConcept ] ; # 0..1 Issued or cleared Status of the payment
]

Changes from both R4 and R4B

PaymentNotice
PaymentNotice.reporter
  • Added Element
PaymentNotice.payment
  • Min Cardinality changed from 1 to 0
PaymentNotice.provider
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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 notice

... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (Required)
... request 0..1 Reference(Any) Request reference
... created Σ 1..1 dateTime Creation date
... reporter 0..1 Reference(Practitioner | PractitionerRole | Organization) Responsible practitioner
... payment Σ 0..1 Reference(PaymentReconciliation) Payment reference
... paymentDate 0..1 date Payment or clearing date
... payee 0..1 Reference(Practitioner | PractitionerRole | Organization) Party being paid
... recipient Σ 1..1 Reference(Organization) Party being notified
... amount Σ 1..1 Money Monetary amount of the payment
... paymentStatus 0..1 CodeableConcept Issued or cleared Status of the payment
Binding: Payment Status Codes (Example)

doco Documentation for this format icon

See the Extensions for this resource

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:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for the payment notice
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:request [ Reference(Any) ] ; # 0..1 Request reference
  fhir:response [ Reference(Any) ] ; # 0..1 Response reference
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:reporter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:payment [ Reference(PaymentReconciliation) ] ; # 0..1 Payment reference
  fhir:paymentDate [ date ] ; # 0..1 Payment or clearing date
  fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Party being paid
  fhir:recipient [ Reference(Organization) ] ; # 1..1 Party being notified
  fhir:amount [ Money ] ; # 1..1 Monetary amount of the payment
  fhir:paymentStatus [ CodeableConcept ] ; # 0..1 Issued or cleared Status of the payment
]

Changes from both R4 and R4B

PaymentNotice
PaymentNotice.reporter
  • Added Element
PaymentNotice.payment
  • Min Cardinality changed from 1 to 0
PaymentNotice.provider
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

13.8.4.1 Terminology Bindings

Path ValueSet Type Documentation
PaymentNotice.status FinancialResourceStatusCodes Required

This value set includes Status codes.
PaymentNotice.paymentStatus PaymentStatusCodes Example

This value set includes a sample set of Payment Status codes.



13.8.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
created date Creation date for the notice PaymentNotice.created
identifier token The business identifier of the notice PaymentNotice.identifier
payment-status token The type of payment notice PaymentNotice.paymentStatus
reporter reference The reference to the reporter PaymentNotice.reporter
(Practitioner, Organization, PractitionerRole)
request reference The Claim PaymentNotice.request
(Any)
response reference The ClaimResponse PaymentNotice.response
(Any)
status token The status of the payment notice PaymentNotice.status