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13.8 Resource PaymentNotice - Content

Financial Management Work GroupMaturity Level: 2 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.

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.

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

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.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentNotice TUDomainResourcePaymentNotice request
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for the payment noctice
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... request 0..1Reference(Any)Request reference
... response 0..1Reference(Any)Response reference
... created Σ1..1dateTimeCreation date
... provider 0..1Reference(Practitioner | PractitionerRole | Organization)Responsible practitioner
... payment Σ1..1Reference(PaymentReconciliation)Payment reference
... paymentDate 0..1datePayment or clearing date
... payee 0..1Reference(Practitioner | PractitionerRole | Organization)Party being paid
... recipient Σ1..1Reference(Organization)Party being notified
... amount Σ1..1MoneyMonetary amount of the payment
... paymentStatus 0..1CodeableConceptIssued or cleared Status of the payment
Payment Status Codes (Example)

doco Documentation for this format

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: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: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 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|4.0.0
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.payee
  • Added Element
PaymentNotice.recipient
  • Renamed from target to recipient
  • Min Cardinality changed from 0 to 1
PaymentNotice.amount
  • Added Mandatory Element
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

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentNotice TUDomainResourcePaymentNotice request
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for the payment noctice
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... request 0..1Reference(Any)Request reference
... response 0..1Reference(Any)Response reference
... created Σ1..1dateTimeCreation date
... provider 0..1Reference(Practitioner | PractitionerRole | Organization)Responsible practitioner
... payment Σ1..1Reference(PaymentReconciliation)Payment reference
... paymentDate 0..1datePayment or clearing date
... payee 0..1Reference(Practitioner | PractitionerRole | Organization)Party being paid
... recipient Σ1..1Reference(Organization)Party being notified
... amount Σ1..1MoneyMonetary amount of the payment
... paymentStatus 0..1CodeableConceptIssued or cleared Status of the payment
Payment Status Codes (Example)

doco Documentation for this format

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: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: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 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|4.0.0
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.payee
  • Added Element
PaymentNotice.recipient
  • Renamed from target to recipient
  • Min Cardinality changed from 0 to 1
PaymentNotice.amount
  • Added Mandatory Element
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).)

 

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

PathDefinitionTypeReference
PaymentNotice.status A code specifying the state of the resource instance.RequiredFinancialResourceStatusCodes
PaymentNotice.paymentStatus The payment conveyance status codes.ExamplePaymentStatusCodes

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

NameTypeDescriptionExpressionIn Common
createddateCreation date fro the noticePaymentNotice.created
identifiertokenThe business identifier of the noticePaymentNotice.identifier
payment-statustokenThe type of payment noticePaymentNotice.paymentStatus
providerreferenceThe reference to the providerPaymentNotice.provider
(Practitioner, Organization, PractitionerRole)
requestreferenceThe ClaimPaymentNotice.request
(Any)
responsereferenceThe ClaimResponsePaymentNotice.response
(Any)
statustokenThe status of the payment noticePaymentNotice.status