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13.9 Resource PaymentReconciliation - Content

Financial Management icon Work GroupMaturity Level: 4 Trial UseSecurity Category: Patient Compartments: Practitioner

This resource provides the details including amount of a payment and allocates the payment items being paid.

13.9.1 Scope and Usage

The PaymentReconciliation resource provides the bulk payment details associated with a payment by the payor for receivable amounts, such as for goods and services rendered by a provider to patients covered by insurance plans offered by that payor. These are the payment reconciliation details which may align to the individual payment amounts indicated on discrete ClaimResponses or Invoices for example.

Bulk payments need to provide a means to associate the amounts paid against specific Claims, Invoices, and other financial exchanges and adjustments, to the bulk payment itself in order to reconcile accounts receivable.

The PaymentReconciliation resource is a "event" resource from a FHIR workflow perspective - see Workflow Event.

13.9.1.1 Additional Information

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

13.9.2 Boundaries and Relationships

The PaymentReconciliation resource serves to correlate a payment amount to the adjudicated claim amounts appearing on one or more ClaimResponses. 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.

The PaymentNotice resource is used to indicate that a payment has, or is about to occur. The resource is used commonly when tracking of payment occurences is required for regulatory or business purposes.

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.

For reporting out to patients or transferring data to patient centered applications, such as patient health Record (PHR) application, the ExplanationOfBenefit should be used instead.

The eClaim domain includes a number of related resources

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.
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.
ExplanationOfBenefit This resource combines the information from the Claim and the ClaimResponse, stripping out any provider or payor proprietary information, into a unified information model suitable for use for: patient reporting; transferring information to a Patient Health Record system; and, supporting complete claim and adjudication information exchange with regulatory and analytics organizations and other parts of the provider's organization.
PaymentNotice An indication that a payment has occured, is about to occur, or has been cancelled.

13.9.3 References to this Resource

13.9.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. PaymentReconciliation TU DomainResource PaymentReconciliation resource

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier Business Identifier for a payment reconciliation

... type Σ 1..1 CodeableConcept Category of payment
Binding: Payment Type Codes (Extensible)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (Required)
... kind 0..1 CodeableConcept Workflow originating payment
Binding: Payment Kind (Extensible)
... period Σ 0..1 Period Period covered
... created Σ 1..1 dateTime Creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole | Organization) Who entered the payment
... issuerType 0..1 CodeableConcept Nature of the source
Binding: Payment Issuer Type (Extensible)
... paymentIssuer Σ 0..1 Reference(Organization | Patient | RelatedPerson) Party generating payment
... request 0..1 Reference(Task) Reference to requesting resource
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Responsible practitioner
... outcome 0..1 code queued | complete | error | partial
Binding: Payment Outcome (Required)
... disposition 0..1 string Disposition message
... date Σ 1..1 date When payment issued
... location 0..1 Reference(Location) Where payment collected
... method 0..1 CodeableConcept Payment instrument
Binding: hl7VS-paymentMethodCode icon (Extensible)
... cardBrand 0..1 string Type of card
... accountNumber 0..1 string Digits for verification
... expirationDate 0..1 date Expiration year-month
... processor 0..1 string Processor name
... referenceNumber 0..1 string Check number or payment reference
... authorization 0..1 string Authorization number
... tenderedAmount 0..1 Money Amount offered by the issuer
... returnedAmount 0..1 Money Amount returned by the receiver
... amount Σ 1..1 Money Total amount of Payment
... paymentIdentifier 0..1 Identifier Business identifier for the payment
... allocation 0..* BackboneElement Settlement particulars

.... identifier 0..1 Identifier Business identifier of the payment detail
.... predecessor 0..1 Identifier Business identifier of the prior payment detail
.... target 0..1 Reference(Claim | Account | Invoice | ChargeItem | Encounter | Contract) Subject of the payment
.... targetItem[x] 0..1 Sub-element of the subject
..... targetItemString string
..... targetItemIdentifier Identifier
..... targetItemPositiveInt positiveInt
.... encounter 0..1 Reference(Encounter) Applied-to encounter
.... account 0..1 Reference(Account) Applied-to account
.... type 0..1 CodeableConcept Category of payment
Binding: Payment Type Codes (Extensible)
.... submitter 0..1 Reference(Practitioner | PractitionerRole | Organization) Submitter of the request
.... response 0..1 Reference(ClaimResponse) Response committing to a payment
.... date 0..1 date Date of commitment to pay
.... responsible 0..1 Reference(PractitionerRole) Contact for the response
.... payee 0..1 Reference(Practitioner | PractitionerRole | Organization) Recipient of the payment
.... amount 0..1 Money Amount allocated to this payable
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (Example)
... processNote 0..* BackboneElement Note concerning processing

.... type 0..1 code display | print | printoper
Binding: NoteType (Required)
.... text 0..1 string Note explanatory text

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

PaymentReconciliation (DomainResource)A unique identifier assigned to this payment reconciliationidentifier : Identifier [0..*]Code to indicate the nature of the payment such as payment, adjustmenttype : CodeableConcept [1..1] « null (Strength=Extensible)PaymentTypeCodes+ »The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)FinancialResourceStatusCodes! »The workflow or activity which gave rise to or during which the payment ocurred such as a kiosk, deposit on account, periodic payment etckind : CodeableConcept [0..1] « null (Strength=Extensible)PaymentKind+ »The period of time for which payments have been gathered into this bulk payment for settlementperiod : Period [0..1]The date when the resource was createdcreated : dateTime [1..1]Payment enterer if not the actual payment issuerenterer : Reference [0..1] « Practitioner|PractitionerRole| Organization »The type of the source such as patient or insuranceissuerType : CodeableConcept [0..1] « null (Strength=Extensible)PaymentIssuerType+ »The party who generated the paymentpaymentIssuer : Reference [0..1] « Organization|Patient| RelatedPerson »Original request resource referencerequest : Reference [0..1] « Task »The practitioner who is responsible for the services rendered to the patientrequestor : Reference [0..1] « Practitioner|PractitionerRole| Organization »The outcome of a request for a reconciliationoutcome : code [0..1] « null (Strength=Required)PaymentOutcome! »A human readable description of the status of the request for the reconciliationdisposition : string [0..1]The date of payment as indicated on the financial instrumentdate : date [1..1]The location of the site or device for electronic transfers or physical location for cash paymentslocation : Reference [0..1] « Location »The means of payment such as check, card cash, or electronic funds transfermethod : CodeableConcept [0..1] « null (Strength=Extensible)Hl7VSPaymentMethodCode+ »The card brand such as debit, Visa, Amex etc. used if a card is the method of paymentcardBrand : string [0..1]A portion of the account number, often the last 4 digits, used for verification not charging purposesaccountNumber : string [0..1]The year and month (YYYY-MM) when the instrument, typically card, expiresexpirationDate : date [0..1]The name of the card processor, etf processor, bank for checksprocessor : string [0..1]The check number, eft reference, car processor referencereferenceNumber : string [0..1]An alphanumeric issued by the processor to confirm the successful issuance of paymentauthorization : string [0..1]The amount offered by the issuer, typically applies to cash when the issuer provides an amount in bank note denominations equal to or excess of the amount actually being paidtenderedAmount : Money [0..1]The amount returned by the receiver which is excess to the amount payable, often referred to as 'change'returnedAmount : Money [0..1]Total payment amount as indicated on the financial instrumentamount : Money [1..1]Issuer's unique identifier for the payment instrumentpaymentIdentifier : Identifier [0..1]A code for the form to be used for printing the contentformCode : CodeableConcept [0..1] « null (Strength=Example)FormCodes?? »AllocationUnique identifier for the current payment item for the referenced payableidentifier : Identifier [0..1]Unique identifier for the prior payment item for the referenced payablepredecessor : Identifier [0..1]Specific resource to which the payment/adjustment/advance appliestarget : Reference [0..1] « Claim|Account|Invoice|ChargeItem| Encounter|Contract » Identifies the claim line item, encounter or other sub-element being paid. Note payment may be partial, that is not match the then outstanding balance or amount incurredtargetItem[x] : DataType [0..1] « string|Identifier|positiveInt »The Encounter to which this payment applies, may be completed by the receiver, used for searchencounter : Reference [0..1] « Encounter »The Account to which this payment applies, may be completed by the receiver, used for searchaccount : Reference [0..1] « Account »Code to indicate the nature of the paymenttype : CodeableConcept [0..1] « null (Strength=Extensible)PaymentTypeCodes+ »The party which submitted the claim or financial transactionsubmitter : Reference [0..1] « Practitioner|PractitionerRole| Organization »A resource, such as a ClaimResponse, which contains a commitment to paymentresponse : Reference [0..1] « ClaimResponse »The date from the response resource containing a commitment to paydate : date [0..1]A reference to the individual who is responsible for inquiries regarding the response and its paymentresponsible : Reference [0..1] « PractitionerRole »The party which is receiving the paymentpayee : Reference [0..1] « Practitioner|PractitionerRole| Organization »The monetary amount allocated from the total payment to the payableamount : Money [0..1]NotesThe business purpose of the note texttype : code [0..1] « null (Strength=Required)NoteType! »The explanation or description associated with the processingtext : string [0..1]Distribution of the payment amount for a previously acknowledged payableallocation[0..*]A note that describes or explains the processing in a human readable formprocessNote[0..*]

XML Template

<PaymentReconciliation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for a payment reconciliation --></identifier>
 <type><!-- 1..1 CodeableConcept Category of payment --></type>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <kind><!-- 0..1 CodeableConcept Workflow originating payment --></kind>
 <period><!-- 0..1 Period Period covered --></period>
 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <enterer><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Who entered the payment --></enterer>
 <issuerType><!-- 0..1 CodeableConcept Nature of the source --></issuerType>
 <paymentIssuer><!-- 0..1 Reference(Organization|Patient|RelatedPerson) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <date value="[date]"/><!-- 1..1 When payment issued -->
 <location><!-- 0..1 Reference(Location) Where payment collected --></location>
 <method><!-- 0..1 CodeableConcept Payment instrument icon --></method>
 <cardBrand value="[string]"/><!-- 0..1 Type of card -->
 <accountNumber value="[string]"/><!-- 0..1 Digits for verification -->
 <expirationDate value="[date]"/><!-- 0..1 Expiration year-month -->
 <processor value="[string]"/><!-- 0..1 Processor name -->
 <referenceNumber value="[string]"/><!-- 0..1 Check number or payment reference -->
 <authorization value="[string]"/><!-- 0..1 Authorization number -->
 <tenderedAmount><!-- 0..1 Money Amount offered by the issuer --></tenderedAmount>
 <returnedAmount><!-- 0..1 Money Amount returned by the receiver --></returnedAmount>
 <amount><!-- 1..1 Money Total amount of Payment --></amount>
 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <allocation>  <!-- 0..* Settlement particulars -->
  <identifier><!-- 0..1 Identifier Business identifier of the payment detail --></identifier>
  <predecessor><!-- 0..1 Identifier Business identifier of the prior payment detail --></predecessor>
  <target><!-- 0..1 Reference(Account|ChargeItem|Claim|Contract|Encounter|Invoice) Subject of the payment --></target>
  <targetItem[x]><!-- 0..1 string|Identifier|positiveInt Sub-element of the subject --></targetItem[x]>
  <encounter><!-- 0..1 Reference(Encounter) Applied-to encounter --></encounter>
  <account><!-- 0..1 Reference(Account) Applied-to account --></account>
  <type><!-- 0..1 CodeableConcept Category of payment --></type>
  <submitter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(ClaimResponse) Response committing to a payment --></response>
  <date value="[date]"/><!-- 0..1 Date of commitment to pay -->
  <responsible><!-- 0..1 Reference(PractitionerRole) Contact for the response --></responsible>
  <payee><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>
 </allocation>
 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->
 </processNote>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "type" : { CodeableConcept }, // R!  Category of payment
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "kind" : { CodeableConcept }, // Workflow originating payment
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // R!  Creation date
  "enterer" : { Reference(Organization|Practitioner|PractitionerRole) }, // Who entered the payment
  "issuerType" : { CodeableConcept }, // Nature of the source
  "paymentIssuer" : { Reference(Organization|Patient|RelatedPerson) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "date" : "<date>", // R!  When payment issued
  "location" : { Reference(Location) }, // Where payment collected
  "method" : { CodeableConcept }, // Payment instrument icon
  "cardBrand" : "<string>", // Type of card
  "accountNumber" : "<string>", // Digits for verification
  "expirationDate" : "<date>", // Expiration year-month
  "processor" : "<string>", // Processor name
  "referenceNumber" : "<string>", // Check number or payment reference
  "authorization" : "<string>", // Authorization number
  "tenderedAmount" : { Money }, // Amount offered by the issuer
  "returnedAmount" : { Money }, // Amount returned by the receiver
  "amount" : { Money }, // R!  Total amount of Payment
  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "allocation" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "target" : { Reference(Account|ChargeItem|Claim|Contract|Encounter|Invoice) }, // Subject of the payment
    // targetItem[x]: Sub-element of the subject. One of these 3:
    "targetItemString" : "<string>",
    "targetItemIdentifier" : { Identifier },
    "targetItemPositiveInt" : "<positiveInt>",
    "encounter" : { Reference(Encounter) }, // Applied-to encounter
    "account" : { Reference(Account) }, // Applied-to account
    "type" : { CodeableConcept }, // Category of payment
    "submitter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Submitter of the request
    "response" : { Reference(ClaimResponse) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Recipient of the payment
    "amount" : { Money } // Amount allocated to this payable
  }],
  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "type" : "<code>", // display | print | printoper
    "text" : "<string>" // Note explanatory text
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:PaymentReconciliation;
  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 a payment reconciliation
  fhir:type [ CodeableConcept ] ; # 1..1 Category of payment
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:kind [ CodeableConcept ] ; # 0..1 Workflow originating payment
  fhir:period [ Period ] ; # 0..1 Period covered
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:enterer [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Who entered the payment
  fhir:issuerType [ CodeableConcept ] ; # 0..1 Nature of the source
  fhir:paymentIssuer [ Reference(Organization|Patient|RelatedPerson) ] ; # 0..1 Party generating payment
  fhir:request [ Reference(Task) ] ; # 0..1 Reference to requesting resource
  fhir:requestor [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:outcome [ code ] ; # 0..1 queued | complete | error | partial
  fhir:disposition [ string ] ; # 0..1 Disposition message
  fhir:date [ date ] ; # 1..1 When payment issued
  fhir:location [ Reference(Location) ] ; # 0..1 Where payment collected
  fhir:method [ CodeableConcept ] ; # 0..1 Payment instrument
  fhir:cardBrand [ string ] ; # 0..1 Type of card
  fhir:accountNumber [ string ] ; # 0..1 Digits for verification
  fhir:expirationDate [ date ] ; # 0..1 Expiration year-month
  fhir:processor [ string ] ; # 0..1 Processor name
  fhir:referenceNumber [ string ] ; # 0..1 Check number or payment reference
  fhir:authorization [ string ] ; # 0..1 Authorization number
  fhir:tenderedAmount [ Money ] ; # 0..1 Amount offered by the issuer
  fhir:returnedAmount [ Money ] ; # 0..1 Amount returned by the receiver
  fhir:amount [ Money ] ; # 1..1 Total amount of Payment
  fhir:paymentIdentifier [ Identifier ] ; # 0..1 Business identifier for the payment
  fhir:allocation ( [ # 0..* Settlement particulars
    fhir:identifier [ Identifier ] ; # 0..1 Business identifier of the payment detail
    fhir:predecessor [ Identifier ] ; # 0..1 Business identifier of the prior payment detail
    fhir:target [ Reference(Account|ChargeItem|Claim|Contract|Encounter|Invoice) ] ; # 0..1 Subject of the payment
    # targetItem[x] : 0..1 Sub-element of the subject. One of these 3
      fhir:targetItem [  a fhir:string ; string ]
      fhir:targetItem [  a fhir:Identifier ; Identifier ]
      fhir:targetItem [  a fhir:positiveInt ; positiveInt ]
    fhir:encounter [ Reference(Encounter) ] ; # 0..1 Applied-to encounter
    fhir:account [ Reference(Account) ] ; # 0..1 Applied-to account
    fhir:type [ CodeableConcept ] ; # 0..1 Category of payment
    fhir:submitter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Submitter of the request
    fhir:response [ Reference(ClaimResponse) ] ; # 0..1 Response committing to a payment
    fhir:date [ date ] ; # 0..1 Date of commitment to pay
    fhir:responsible [ Reference(PractitionerRole) ] ; # 0..1 Contact for the response
    fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Recipient of the payment
    fhir:amount [ Money ] ; # 0..1 Amount allocated to this payable
  ] ... ) ;
  fhir:formCode [ CodeableConcept ] ; # 0..1 Printed form identifier
  fhir:processNote ( [ # 0..* Note concerning processing
    fhir:type [ code ] ; # 0..1 display | print | printoper
    fhir:text [ string ] ; # 0..1 Note explanatory text
  ] ... ) ;
]

Changes from both R4 and R4B

PaymentReconciliation
PaymentReconciliation.type
  • Added Mandatory Element
PaymentReconciliation.kind
  • Added Element
PaymentReconciliation.enterer
  • Added Element
PaymentReconciliation.issuerType
  • Added Element
PaymentReconciliation.paymentIssuer
  • Type Reference: Added Target Types Patient, RelatedPerson
PaymentReconciliation.outcome
  • Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to Payment Outcome
PaymentReconciliation.date
  • Added Mandatory Element
PaymentReconciliation.location
  • Added Element
PaymentReconciliation.method
  • Added Element
PaymentReconciliation.cardBrand
  • Added Element
PaymentReconciliation.accountNumber
  • Added Element
PaymentReconciliation.expirationDate
  • Added Element
PaymentReconciliation.processor
  • Added Element
PaymentReconciliation.referenceNumber
  • Added Element
PaymentReconciliation.authorization
  • Added Element
PaymentReconciliation.tenderedAmount
  • Added Element
PaymentReconciliation.returnedAmount
  • Added Element
PaymentReconciliation.amount
  • Added Mandatory Element
PaymentReconciliation.allocation
  • Added Element
PaymentReconciliation.allocation.identifier
  • Added Element
PaymentReconciliation.allocation.predecessor
  • Added Element
PaymentReconciliation.allocation.target
  • Added Element
PaymentReconciliation.allocation.targetItem[x]
  • Added Element
PaymentReconciliation.allocation.encounter
  • Added Element
PaymentReconciliation.allocation.account
  • Added Element
PaymentReconciliation.allocation.type
  • Added Element
PaymentReconciliation.allocation.submitter
  • Added Element
PaymentReconciliation.allocation.response
  • Added Element
PaymentReconciliation.allocation.date
  • Added Element
PaymentReconciliation.allocation.responsible
  • Added Element
PaymentReconciliation.allocation.payee
  • Added Element
PaymentReconciliation.allocation.amount
  • Added Element
PaymentReconciliation.paymentDate
  • Deleted
PaymentReconciliation.paymentAmount
  • Deleted
PaymentReconciliation.detail
  • 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
.. PaymentReconciliation TU DomainResource PaymentReconciliation resource

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier Business Identifier for a payment reconciliation

... type Σ 1..1 CodeableConcept Category of payment
Binding: Payment Type Codes (Extensible)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (Required)
... kind 0..1 CodeableConcept Workflow originating payment
Binding: Payment Kind (Extensible)
... period Σ 0..1 Period Period covered
... created Σ 1..1 dateTime Creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole | Organization) Who entered the payment
... issuerType 0..1 CodeableConcept Nature of the source
Binding: Payment Issuer Type (Extensible)
... paymentIssuer Σ 0..1 Reference(Organization | Patient | RelatedPerson) Party generating payment
... request 0..1 Reference(Task) Reference to requesting resource
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Responsible practitioner
... outcome 0..1 code queued | complete | error | partial
Binding: Payment Outcome (Required)
... disposition 0..1 string Disposition message
... date Σ 1..1 date When payment issued
... location 0..1 Reference(Location) Where payment collected
... method 0..1 CodeableConcept Payment instrument
Binding: hl7VS-paymentMethodCode icon (Extensible)
... cardBrand 0..1 string Type of card
... accountNumber 0..1 string Digits for verification
... expirationDate 0..1 date Expiration year-month
... processor 0..1 string Processor name
... referenceNumber 0..1 string Check number or payment reference
... authorization 0..1 string Authorization number
... tenderedAmount 0..1 Money Amount offered by the issuer
... returnedAmount 0..1 Money Amount returned by the receiver
... amount Σ 1..1 Money Total amount of Payment
... paymentIdentifier 0..1 Identifier Business identifier for the payment
... allocation 0..* BackboneElement Settlement particulars

.... identifier 0..1 Identifier Business identifier of the payment detail
.... predecessor 0..1 Identifier Business identifier of the prior payment detail
.... target 0..1 Reference(Claim | Account | Invoice | ChargeItem | Encounter | Contract) Subject of the payment
.... targetItem[x] 0..1 Sub-element of the subject
..... targetItemString string
..... targetItemIdentifier Identifier
..... targetItemPositiveInt positiveInt
.... encounter 0..1 Reference(Encounter) Applied-to encounter
.... account 0..1 Reference(Account) Applied-to account
.... type 0..1 CodeableConcept Category of payment
Binding: Payment Type Codes (Extensible)
.... submitter 0..1 Reference(Practitioner | PractitionerRole | Organization) Submitter of the request
.... response 0..1 Reference(ClaimResponse) Response committing to a payment
.... date 0..1 date Date of commitment to pay
.... responsible 0..1 Reference(PractitionerRole) Contact for the response
.... payee 0..1 Reference(Practitioner | PractitionerRole | Organization) Recipient of the payment
.... amount 0..1 Money Amount allocated to this payable
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (Example)
... processNote 0..* BackboneElement Note concerning processing

.... type 0..1 code display | print | printoper
Binding: NoteType (Required)
.... text 0..1 string Note explanatory text

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

PaymentReconciliation (DomainResource)A unique identifier assigned to this payment reconciliationidentifier : Identifier [0..*]Code to indicate the nature of the payment such as payment, adjustmenttype : CodeableConcept [1..1] « null (Strength=Extensible)PaymentTypeCodes+ »The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)FinancialResourceStatusCodes! »The workflow or activity which gave rise to or during which the payment ocurred such as a kiosk, deposit on account, periodic payment etckind : CodeableConcept [0..1] « null (Strength=Extensible)PaymentKind+ »The period of time for which payments have been gathered into this bulk payment for settlementperiod : Period [0..1]The date when the resource was createdcreated : dateTime [1..1]Payment enterer if not the actual payment issuerenterer : Reference [0..1] « Practitioner|PractitionerRole| Organization »The type of the source such as patient or insuranceissuerType : CodeableConcept [0..1] « null (Strength=Extensible)PaymentIssuerType+ »The party who generated the paymentpaymentIssuer : Reference [0..1] « Organization|Patient| RelatedPerson »Original request resource referencerequest : Reference [0..1] « Task »The practitioner who is responsible for the services rendered to the patientrequestor : Reference [0..1] « Practitioner|PractitionerRole| Organization »The outcome of a request for a reconciliationoutcome : code [0..1] « null (Strength=Required)PaymentOutcome! »A human readable description of the status of the request for the reconciliationdisposition : string [0..1]The date of payment as indicated on the financial instrumentdate : date [1..1]The location of the site or device for electronic transfers or physical location for cash paymentslocation : Reference [0..1] « Location »The means of payment such as check, card cash, or electronic funds transfermethod : CodeableConcept [0..1] « null (Strength=Extensible)Hl7VSPaymentMethodCode+ »The card brand such as debit, Visa, Amex etc. used if a card is the method of paymentcardBrand : string [0..1]A portion of the account number, often the last 4 digits, used for verification not charging purposesaccountNumber : string [0..1]The year and month (YYYY-MM) when the instrument, typically card, expiresexpirationDate : date [0..1]The name of the card processor, etf processor, bank for checksprocessor : string [0..1]The check number, eft reference, car processor referencereferenceNumber : string [0..1]An alphanumeric issued by the processor to confirm the successful issuance of paymentauthorization : string [0..1]The amount offered by the issuer, typically applies to cash when the issuer provides an amount in bank note denominations equal to or excess of the amount actually being paidtenderedAmount : Money [0..1]The amount returned by the receiver which is excess to the amount payable, often referred to as 'change'returnedAmount : Money [0..1]Total payment amount as indicated on the financial instrumentamount : Money [1..1]Issuer's unique identifier for the payment instrumentpaymentIdentifier : Identifier [0..1]A code for the form to be used for printing the contentformCode : CodeableConcept [0..1] « null (Strength=Example)FormCodes?? »AllocationUnique identifier for the current payment item for the referenced payableidentifier : Identifier [0..1]Unique identifier for the prior payment item for the referenced payablepredecessor : Identifier [0..1]Specific resource to which the payment/adjustment/advance appliestarget : Reference [0..1] « Claim|Account|Invoice|ChargeItem| Encounter|Contract » Identifies the claim line item, encounter or other sub-element being paid. Note payment may be partial, that is not match the then outstanding balance or amount incurredtargetItem[x] : DataType [0..1] « string|Identifier|positiveInt »The Encounter to which this payment applies, may be completed by the receiver, used for searchencounter : Reference [0..1] « Encounter »The Account to which this payment applies, may be completed by the receiver, used for searchaccount : Reference [0..1] « Account »Code to indicate the nature of the paymenttype : CodeableConcept [0..1] « null (Strength=Extensible)PaymentTypeCodes+ »The party which submitted the claim or financial transactionsubmitter : Reference [0..1] « Practitioner|PractitionerRole| Organization »A resource, such as a ClaimResponse, which contains a commitment to paymentresponse : Reference [0..1] « ClaimResponse »The date from the response resource containing a commitment to paydate : date [0..1]A reference to the individual who is responsible for inquiries regarding the response and its paymentresponsible : Reference [0..1] « PractitionerRole »The party which is receiving the paymentpayee : Reference [0..1] « Practitioner|PractitionerRole| Organization »The monetary amount allocated from the total payment to the payableamount : Money [0..1]NotesThe business purpose of the note texttype : code [0..1] « null (Strength=Required)NoteType! »The explanation or description associated with the processingtext : string [0..1]Distribution of the payment amount for a previously acknowledged payableallocation[0..*]A note that describes or explains the processing in a human readable formprocessNote[0..*]

XML Template

<PaymentReconciliation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for a payment reconciliation --></identifier>
 <type><!-- 1..1 CodeableConcept Category of payment --></type>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <kind><!-- 0..1 CodeableConcept Workflow originating payment --></kind>
 <period><!-- 0..1 Period Period covered --></period>
 <created value="[dateTime]"/><!-- 1..1 Creation date -->
 <enterer><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Who entered the payment --></enterer>
 <issuerType><!-- 0..1 CodeableConcept Nature of the source --></issuerType>
 <paymentIssuer><!-- 0..1 Reference(Organization|Patient|RelatedPerson) Party generating payment --></paymentIssuer>
 <request><!-- 0..1 Reference(Task) Reference to requesting resource --></request>
 <requestor><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Responsible practitioner --></requestor>
 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition message -->
 <date value="[date]"/><!-- 1..1 When payment issued -->
 <location><!-- 0..1 Reference(Location) Where payment collected --></location>
 <method><!-- 0..1 CodeableConcept Payment instrument icon --></method>
 <cardBrand value="[string]"/><!-- 0..1 Type of card -->
 <accountNumber value="[string]"/><!-- 0..1 Digits for verification -->
 <expirationDate value="[date]"/><!-- 0..1 Expiration year-month -->
 <processor value="[string]"/><!-- 0..1 Processor name -->
 <referenceNumber value="[string]"/><!-- 0..1 Check number or payment reference -->
 <authorization value="[string]"/><!-- 0..1 Authorization number -->
 <tenderedAmount><!-- 0..1 Money Amount offered by the issuer --></tenderedAmount>
 <returnedAmount><!-- 0..1 Money Amount returned by the receiver --></returnedAmount>
 <amount><!-- 1..1 Money Total amount of Payment --></amount>
 <paymentIdentifier><!-- 0..1 Identifier Business identifier for the payment --></paymentIdentifier>
 <allocation>  <!-- 0..* Settlement particulars -->
  <identifier><!-- 0..1 Identifier Business identifier of the payment detail --></identifier>
  <predecessor><!-- 0..1 Identifier Business identifier of the prior payment detail --></predecessor>
  <target><!-- 0..1 Reference(Account|ChargeItem|Claim|Contract|Encounter|Invoice) Subject of the payment --></target>
  <targetItem[x]><!-- 0..1 string|Identifier|positiveInt Sub-element of the subject --></targetItem[x]>
  <encounter><!-- 0..1 Reference(Encounter) Applied-to encounter --></encounter>
  <account><!-- 0..1 Reference(Account) Applied-to account --></account>
  <type><!-- 0..1 CodeableConcept Category of payment --></type>
  <submitter><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Submitter of the request --></submitter>
  <response><!-- 0..1 Reference(ClaimResponse) Response committing to a payment --></response>
  <date value="[date]"/><!-- 0..1 Date of commitment to pay -->
  <responsible><!-- 0..1 Reference(PractitionerRole) Contact for the response --></responsible>
  <payee><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Recipient of the payment --></payee>
  <amount><!-- 0..1 Money Amount allocated to this payable --></amount>
 </allocation>
 <formCode><!-- 0..1 CodeableConcept Printed form identifier --></formCode>
 <processNote>  <!-- 0..* Note concerning processing -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->
 </processNote>
</PaymentReconciliation>

JSON Template

{doco
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for a payment reconciliation
  "type" : { CodeableConcept }, // R!  Category of payment
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "kind" : { CodeableConcept }, // Workflow originating payment
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // R!  Creation date
  "enterer" : { Reference(Organization|Practitioner|PractitionerRole) }, // Who entered the payment
  "issuerType" : { CodeableConcept }, // Nature of the source
  "paymentIssuer" : { Reference(Organization|Patient|RelatedPerson) }, // Party generating payment
  "request" : { Reference(Task) }, // Reference to requesting resource
  "requestor" : { Reference(Organization|Practitioner|PractitionerRole) }, // Responsible practitioner
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition message
  "date" : "<date>", // R!  When payment issued
  "location" : { Reference(Location) }, // Where payment collected
  "method" : { CodeableConcept }, // Payment instrument icon
  "cardBrand" : "<string>", // Type of card
  "accountNumber" : "<string>", // Digits for verification
  "expirationDate" : "<date>", // Expiration year-month
  "processor" : "<string>", // Processor name
  "referenceNumber" : "<string>", // Check number or payment reference
  "authorization" : "<string>", // Authorization number
  "tenderedAmount" : { Money }, // Amount offered by the issuer
  "returnedAmount" : { Money }, // Amount returned by the receiver
  "amount" : { Money }, // R!  Total amount of Payment
  "paymentIdentifier" : { Identifier }, // Business identifier for the payment
  "allocation" : [{ // Settlement particulars
    "identifier" : { Identifier }, // Business identifier of the payment detail
    "predecessor" : { Identifier }, // Business identifier of the prior payment detail
    "target" : { Reference(Account|ChargeItem|Claim|Contract|Encounter|Invoice) }, // Subject of the payment
    // targetItem[x]: Sub-element of the subject. One of these 3:
    "targetItemString" : "<string>",
    "targetItemIdentifier" : { Identifier },
    "targetItemPositiveInt" : "<positiveInt>",
    "encounter" : { Reference(Encounter) }, // Applied-to encounter
    "account" : { Reference(Account) }, // Applied-to account
    "type" : { CodeableConcept }, // Category of payment
    "submitter" : { Reference(Organization|Practitioner|PractitionerRole) }, // Submitter of the request
    "response" : { Reference(ClaimResponse) }, // Response committing to a payment
    "date" : "<date>", // Date of commitment to pay
    "responsible" : { Reference(PractitionerRole) }, // Contact for the response
    "payee" : { Reference(Organization|Practitioner|PractitionerRole) }, // Recipient of the payment
    "amount" : { Money } // Amount allocated to this payable
  }],
  "formCode" : { CodeableConcept }, // Printed form identifier
  "processNote" : [{ // Note concerning processing
    "type" : "<code>", // display | print | printoper
    "text" : "<string>" // Note explanatory text
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:PaymentReconciliation;
  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 a payment reconciliation
  fhir:type [ CodeableConcept ] ; # 1..1 Category of payment
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:kind [ CodeableConcept ] ; # 0..1 Workflow originating payment
  fhir:period [ Period ] ; # 0..1 Period covered
  fhir:created [ dateTime ] ; # 1..1 Creation date
  fhir:enterer [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Who entered the payment
  fhir:issuerType [ CodeableConcept ] ; # 0..1 Nature of the source
  fhir:paymentIssuer [ Reference(Organization|Patient|RelatedPerson) ] ; # 0..1 Party generating payment
  fhir:request [ Reference(Task) ] ; # 0..1 Reference to requesting resource
  fhir:requestor [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Responsible practitioner
  fhir:outcome [ code ] ; # 0..1 queued | complete | error | partial
  fhir:disposition [ string ] ; # 0..1 Disposition message
  fhir:date [ date ] ; # 1..1 When payment issued
  fhir:location [ Reference(Location) ] ; # 0..1 Where payment collected
  fhir:method [ CodeableConcept ] ; # 0..1 Payment instrument
  fhir:cardBrand [ string ] ; # 0..1 Type of card
  fhir:accountNumber [ string ] ; # 0..1 Digits for verification
  fhir:expirationDate [ date ] ; # 0..1 Expiration year-month
  fhir:processor [ string ] ; # 0..1 Processor name
  fhir:referenceNumber [ string ] ; # 0..1 Check number or payment reference
  fhir:authorization [ string ] ; # 0..1 Authorization number
  fhir:tenderedAmount [ Money ] ; # 0..1 Amount offered by the issuer
  fhir:returnedAmount [ Money ] ; # 0..1 Amount returned by the receiver
  fhir:amount [ Money ] ; # 1..1 Total amount of Payment
  fhir:paymentIdentifier [ Identifier ] ; # 0..1 Business identifier for the payment
  fhir:allocation ( [ # 0..* Settlement particulars
    fhir:identifier [ Identifier ] ; # 0..1 Business identifier of the payment detail
    fhir:predecessor [ Identifier ] ; # 0..1 Business identifier of the prior payment detail
    fhir:target [ Reference(Account|ChargeItem|Claim|Contract|Encounter|Invoice) ] ; # 0..1 Subject of the payment
    # targetItem[x] : 0..1 Sub-element of the subject. One of these 3
      fhir:targetItem [  a fhir:string ; string ]
      fhir:targetItem [  a fhir:Identifier ; Identifier ]
      fhir:targetItem [  a fhir:positiveInt ; positiveInt ]
    fhir:encounter [ Reference(Encounter) ] ; # 0..1 Applied-to encounter
    fhir:account [ Reference(Account) ] ; # 0..1 Applied-to account
    fhir:type [ CodeableConcept ] ; # 0..1 Category of payment
    fhir:submitter [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Submitter of the request
    fhir:response [ Reference(ClaimResponse) ] ; # 0..1 Response committing to a payment
    fhir:date [ date ] ; # 0..1 Date of commitment to pay
    fhir:responsible [ Reference(PractitionerRole) ] ; # 0..1 Contact for the response
    fhir:payee [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Recipient of the payment
    fhir:amount [ Money ] ; # 0..1 Amount allocated to this payable
  ] ... ) ;
  fhir:formCode [ CodeableConcept ] ; # 0..1 Printed form identifier
  fhir:processNote ( [ # 0..* Note concerning processing
    fhir:type [ code ] ; # 0..1 display | print | printoper
    fhir:text [ string ] ; # 0..1 Note explanatory text
  ] ... ) ;
]

Changes from both R4 and R4B

PaymentReconciliation
PaymentReconciliation.type
  • Added Mandatory Element
PaymentReconciliation.kind
  • Added Element
PaymentReconciliation.enterer
  • Added Element
PaymentReconciliation.issuerType
  • Added Element
PaymentReconciliation.paymentIssuer
  • Type Reference: Added Target Types Patient, RelatedPerson
PaymentReconciliation.outcome
  • Change value set from http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.0 to Payment Outcome
PaymentReconciliation.date
  • Added Mandatory Element
PaymentReconciliation.location
  • Added Element
PaymentReconciliation.method
  • Added Element
PaymentReconciliation.cardBrand
  • Added Element
PaymentReconciliation.accountNumber
  • Added Element
PaymentReconciliation.expirationDate
  • Added Element
PaymentReconciliation.processor
  • Added Element
PaymentReconciliation.referenceNumber
  • Added Element
PaymentReconciliation.authorization
  • Added Element
PaymentReconciliation.tenderedAmount
  • Added Element
PaymentReconciliation.returnedAmount
  • Added Element
PaymentReconciliation.amount
  • Added Mandatory Element
PaymentReconciliation.allocation
  • Added Element
PaymentReconciliation.allocation.identifier
  • Added Element
PaymentReconciliation.allocation.predecessor
  • Added Element
PaymentReconciliation.allocation.target
  • Added Element
PaymentReconciliation.allocation.targetItem[x]
  • Added Element
PaymentReconciliation.allocation.encounter
  • Added Element
PaymentReconciliation.allocation.account
  • Added Element
PaymentReconciliation.allocation.type
  • Added Element
PaymentReconciliation.allocation.submitter
  • Added Element
PaymentReconciliation.allocation.response
  • Added Element
PaymentReconciliation.allocation.date
  • Added Element
PaymentReconciliation.allocation.responsible
  • Added Element
PaymentReconciliation.allocation.payee
  • Added Element
PaymentReconciliation.allocation.amount
  • Added Element
PaymentReconciliation.paymentDate
  • Deleted
PaymentReconciliation.paymentAmount
  • Deleted
PaymentReconciliation.detail
  • 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

13.9.4.1 Terminology Bindings

Path ValueSet Type Documentation
PaymentReconciliation.type PaymentTypeCodes Extensible

This value set includes sample Payment Type codes.
PaymentReconciliation.status FinancialResourceStatusCodes Required

This value set includes Status codes.
PaymentReconciliation.kind PaymentKind (a valid code from Payment Kind Codes) Extensible

The type of workflow from which this payment arose.
PaymentReconciliation.issuerType PaymentIssuerType (a valid code from Payment Issuer Type Codes) Extensible

The type of payment issuer.
PaymentReconciliation.outcome PaymentOutcome (a valid code from Claim Processing Codes) Required

The outcome of the processing.
PaymentReconciliation.method Hl7VSPaymentMethodCode icon (a valid code from paymentMethod icon) Extensible

Value Set of codes used to specify the method for the movement of payment.
PaymentReconciliation.allocation.type PaymentTypeCodes Extensible

This value set includes sample Payment Type codes.
PaymentReconciliation.formCode FormCodes Example

This value set includes a sample set of Forms codes.
PaymentReconciliation.processNote.type NoteType Required

The presentation types of notes.



13.9.5 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
allocation-account reference The account to which payment or adjustment was applied. PaymentReconciliation.allocation.account
(Account)
allocation-encounter reference The encounter to which payment or adjustment was applied. PaymentReconciliation.allocation.encounter
(Encounter)
created date The creation date PaymentReconciliation.created
disposition string The contents of the disposition message PaymentReconciliation.disposition
identifier token The business identifier of the ExplanationOfBenefit PaymentReconciliation.identifier
outcome token The processing outcome PaymentReconciliation.outcome
payment-issuer reference The organization which generated this resource PaymentReconciliation.paymentIssuer
(Organization, Patient, RelatedPerson)
request reference The reference to the claim PaymentReconciliation.request
(Task)
requestor reference The reference to the provider who submitted the claim PaymentReconciliation.requestor
(Practitioner, Organization, PractitionerRole)
status token The status of the payment reconciliation PaymentReconciliation.status