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| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Practitioner |
Raw Turtle (+ 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 rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@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:id [ fhir:v "ER2500"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentReconciliation</div>"^^rdf:XMLLiteral
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/enrollmentresponse"^^xsd:anyURI ] ;
fhir:value [ fhir:v "781234" ]
] ) ; #
fhir:type [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "payment" ]
] )
] ; #
fhir:status [ fhir:v "active"] ; #
fhir:period [
fhir:start [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:end [ fhir:v "2014-08-31"^^xsd:date ]
] ; #
fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; #
fhir:paymentIssuer [
fhir:link <http://hl7.org/fhir/Organization/2> ;
fhir:reference [ fhir:v "Organization/2" ]
] ; #
fhir:request [
fhir:link <http://www.BenefitsInc.com/fhir/eligibility/225476332402> ;
fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/eligibility/225476332402" ]
] ; #
fhir:requestor [
fhir:link <http://hl7.org/fhir/Organization/1> ;
fhir:reference [ fhir:v "Organization/1" ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:disposition [ fhir:v "2014 August mid-month settlement."] ; #
fhir:date [ fhir:v "2014-08-01"^^xsd:date] ; #
fhir:amount [
fhir:value [ fhir:v 7000.00 ] ;
fhir:currency [ fhir:v "USD" ]
] ; #
fhir:paymentIdentifier [
fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018"^^xsd:anyURI ] ;
fhir:value [ fhir:v "10-12345" ]
] ; #
fhir:allocation ( [
fhir:identifier [
fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018/detail"^^xsd:anyURI ] ;
fhir:value [ fhir:v "10-12345-001" ]
] ;
fhir:target [
fhir:identifier [
fhir:system [ fhir:v "http://happyvalleyclinic.com/claim"^^xsd:anyURI ] ;
fhir:value [ fhir:v "AB12345" ]
]
] ;
fhir:type [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "payment" ]
] )
] ;
fhir:submitter [
fhir:link <http://hl7.org/fhir/Organization/1> ;
fhir:reference [ fhir:v "Organization/1" ]
] ;
fhir:response [
fhir:identifier [
fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/claimresponse"^^xsd:anyURI ] ;
fhir:value [ fhir:v "CR20140815-AB12345" ]
]
] ;
fhir:date [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:payee [
fhir:link <http://hl7.org/fhir/Organization/1> ;
fhir:reference [ fhir:v "Organization/1" ]
] ;
fhir:amount [
fhir:value [ fhir:v 3500.00 ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:identifier [
fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018/detail"^^xsd:anyURI ] ;
fhir:value [ fhir:v "10-12345-002" ]
] ;
fhir:target [
fhir:link <http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699> ;
fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699" ]
] ;
fhir:type [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "payment" ]
] )
] ;
fhir:date [ fhir:v "2014-08-12"^^xsd:date ] ;
fhir:amount [
fhir:value [ fhir:v 4000.00 ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:identifier [
fhir:system [ fhir:v "http://www.BenefitsInc.com/payment/2018/detail"^^xsd:anyURI ] ;
fhir:value [ fhir:v "10-12345-003" ]
] ;
fhir:type [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "advance" ]
] )
] ;
fhir:date [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:amount [
fhir:value [ fhir:v -1500.00 ] ;
fhir:currency [ fhir:v "USD" ]
]
] ) ; #
fhir:formCode [
fhir:coding ( [
fhir:system [ fhir:v "http://ncforms.org/formid"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PAYREC/2016/01B" ]
] )
] ; #
fhir:processNote ( [
fhir:type [ fhir:v "display" ] ;
fhir:text [ fhir:v "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/Organization/1> a fhir:Organization .
# -------------------------------------------------------------------------------------
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.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot3 generated on Sat, Nov 1, 2025 17:26+0000.
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