Da Vinci Postable Remittance
1.0.0 - STU 1 United States of America flag

Da Vinci Postable Remittance, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pr/ and changes regularly. See the Directory of published versions

: ExampleSearchResult - XML Representation

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<Parameters xmlns="http://hl7.org/fhir">
  <id value="ExampleSearchResult"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchResultParameters"/>
  </meta>
  <parameter>
    <name value="TIN"/>
    <valueString value="123485858"/>
  </parameter>
  <parameter>
    <name value="Payer"/>
    <part>
      <name value="PayerID"/>
      <valueString value="52415"/>
    </part>
    <part>
      <name value="PayerName"/>
      <valueString value="Acme Payment Inc"/>
    </part>
  </parameter>
  <parameter>
    <name value="Claim"/>
    <part>
      <name value="ProviderClaimID"/>
      <valueString value="12345V54321"/>
    </part>
    <part>
      <name value="ClaimReceivedDate"/>
      <valueDate value="2023-10-05"/>
    </part>
    <part>
      <name value="ProviderID"/>
      <valueString value="52415"/>
    </part>
    <part>
      <name value="PayerClaimID"/>
      <valueString value="TYU7894562"/>
    </part>
    <part>
      <name value="PaymentInfo"/>
      <part>
        <name value="PaymentDate"/>
        <valueDate value="2023-11-02"/>
      </part>
      <part>
        <name value="PaymentNumber"/>
        <valueString value="A12385858"/>
      </part>
      <part>
        <name value="PaymentAmount"/>
        <valueMoney>
          <value value="30"/>
          <currency value="USD"/>
        </valueMoney>
      </part>
      <part>
        <name value="Remittance"/>
        <part>
          <name value="RemittanceAdviceIdentifier"/>
          <valueString value="A123456BCDEF"/>
        </part>
        <part>
          <name value="RemittanceAdviceType"/>
          <valueCode value="application/EDI-X12"/>
        </part>
        <part>
          <name value="RemittanceAdviceDate"/>
          <valueDate value="2023-11-02"/>
        </part>
        <part>
          <name value="RemittanceAdviceFileSize"/>
          <valueInteger value="1536"/>
        </part>
      </part>
    </part>
  </parameter>
  <parameter>
    <name value="Claim"/>
    <part>
      <name value="ProviderClaimID"/>
      <valueString value="12345V54321"/>
    </part>
    <part>
      <name value="ClaimReceivedDate"/>
      <valueDate value="2023-10-04"/>
    </part>
    <part>
      <name value="ProviderID"/>
      <valueString value="52415"/>
    </part>
    <part>
      <name value="PayerClaimID"/>
      <valueString value="TYU7894566"/>
    </part>
    <part>
      <name value="PaymentInfo"/>
      <part>
        <name value="PaymentDate"/>
        <valueDate value="2023-11-03"/>
      </part>
      <part>
        <name value="PaymentNumber"/>
        <valueString value="A12385859"/>
      </part>
      <part>
        <name value="PaymentAmount"/>
        <valueMoney>
          <value value="30"/>
          <currency value="USD"/>
        </valueMoney>
      </part>
      <part>
        <name value="Remittance"/>
        <part>
          <name value="RemittanceAdviceIdentifier"/>
          <valueString value="A123456BCDXY"/>
        </part>
        <part>
          <name value="RemittanceAdviceType"/>
          <valueCode value="application/EDI-X12"/>
        </part>
        <part>
          <name value="RemittanceAdviceDate"/>
          <valueDate value="2023-11-04"/>
        </part>
        <part>
          <name value="RemittanceAdviceFileSize"/>
          <valueInteger value="2048"/>
        </part>
      </part>
    </part>
  </parameter>
  <parameter>
    <name value="Patient"/>
    <part>
      <name value="DateOfBirth"/>
      <valueDate value="1970-11-27"/>
    </part>
    <part>
      <name value="PatientID"/>
      <valueString value="M12345513215"/>
    </part>
    <part>
      <name value="PatientFirstName"/>
      <valueString value="Adam"/>
    </part>
    <part>
      <name value="PatientLastName"/>
      <valueString value="Patient"/>
    </part>
  </parameter>
</Parameters>