PaymentReconciliation - FHIR Resource (stu3)


Resource Attributes

AttributeField is listTypeDescription
createdfalsedateTime Creation date
detailtrueData Type List of settlements
dispositionfalsestring Disposition Message
formfalseCodeableConcept Printed Form Identifier
identifiertrueIdentifier Business Identifier
organizationfalseReference Insurer
outcomefalseCodeableConcept complete | error | partial
periodfalsePeriod Period covered
processNotetrueData Type Processing comments
requestfalseReference Claim reference
requestOrganizationfalseReference Responsible organization
requestProviderfalseReference Responsible practitioner
statusfalsecode active | cancelled | draft | entered-in-error
totalfalseMoney Total amount of Payment

PaymentReconciliation Example

{
  "status": "active",
  "requestOrganization": {
    "reference": "Organization/1"
  },
  "outcome": {
    "coding": [
      {
        "code": "complete",
        "system": "http://hl7.org/fhir/remittance-outcome"
      }
    ]
  },
  "form": {
    "coding": [
      {
        "code": "PAYREC/2016/01B",
        "system": "http://ncforms.org/formid"
      }
    ]
  },
  "created": "2014-08-16",
  "resourceType": "PaymentReconciliation",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentReconciliation</div>"
  },
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/eligibility/225476332402"
  },
  "period": {
    "start": "2014-08-16",
    "end": "2014-08-31"
  },
  "detail": [
    {
      "payee": {
        "reference": "Organization/1"
      },
      "request": {
        "identifier": {
          "system": "http://happyvalleyclinic.com/claim",
          "value": "AB12345"
        }
      },
      "date": "2014-08-16",
      "amount": {
        "code": "USD",
        "system": "urn:iso:std:iso:4217",
        "value": 1000
      },
      "submitter": {
        "reference": "Organization/1"
      },
      "type": {
        "coding": [
          {
            "code": "payment",
            "system": "http://hl7.org/fhir/payment-type"
          }
        ]
      },
      "response": {
        "identifier": {
          "system": "http://www.BenefitsInc.com/fhir/claimresponse",
          "value": "CR20140815-AB12345"
        }
      }
    },
    {
      "date": "2014-08-12",
      "request": {
        "reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699"
      },
      "amount": {
        "code": "USD",
        "system": "urn:iso:std:iso:4217",
        "value": 4000
      },
      "type": {
        "coding": [
          {
            "code": "payment",
            "system": "http://hl7.org/fhir/payment-type"
          }
        ]
      }
    },
    {
      "date": "2014-08-16",
      "amount": {
        "code": "USD",
        "system": "urn:iso:std:iso:4217",
        "value": -1500
      },
      "type": {
        "coding": [
          {
            "code": "advance",
            "system": "http://hl7.org/fhir/payment-type"
          }
        ]
      }
    }
  ],
  "disposition": "2014 August mid-month settlement.",
  "requestProvider": {
    "reference": "Practitioner/example"
  },
  "total": {
    "code": "USD",
    "system": "urn:iso:std:iso:4217",
    "value": 3500
  },
  "organization": {
    "reference": "Organization/2"
  },
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/enrollmentresponse",
      "value": "781234"
    }
  ],
  "processNote": [
    {
      "text": "Due to the year end holiday the cutoff for submissions for December will be the 28th.",
      "type": {
        "coding": [
          {
            "code": "display",
            "system": "http://hl7.org/fhir/note-type"
          }
        ]
      }
    }
  ],
  "id": "ER2500"
}

PaymentReconciliation Structure


  
{
  "resourceType" : "PaymentReconciliation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "period" : { Period }, // Period covered
  "created" : "<dateTime>", // Creation date
  "organization" : { Reference(Organization) }, // Insurer
  "request" : { Reference(ProcessRequest) }, // Claim reference
  "outcome" : { CodeableConcept }, // complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "requestProvider" : { Reference(Practitioner) }, // Responsible practitioner
  "requestOrganization" : { Reference(Organization) }, // Responsible organization
  "detail" : [{ // List of settlements
    "type" : { CodeableConcept }, // R!  Type code
    "request" : { Reference(Any) }, // Claim
    "response" : { Reference(Any) }, // Claim Response
    "submitter" : { Reference(Organization) }, // Organization which submitted the claim
    "payee" : { Reference(Organization) }, // Organization which is receiving the payment
    "date" : "<date>", // Invoice date
    "amount" : { Money } // Amount being paid
  }],
  "form" : { CodeableConcept }, // Printed Form Identifier
  "total" : { Money }, // Total amount of Payment
  "processNote" : [{ // Processing comments
    "type" : { CodeableConcept }, // display | print | printoper
    "text" : "<string>" // Comment on the processing
  }]
}


 

PaymentReconciliation Search Parameters

The following search parameters can be used to query PaymentReconciliation resources. Just submit the like so:

https://api.1up.health/fhir/stu3/PaymentReconciliation?query-param=queryvalue
Search ParameterField TypeResource Fields Searched
createddatecreated
dispositiontextdisposition
identifiertextidentifier
organizationreferenceorganization
outcometextoutcome
requestreferencerequest
request-organizationreferencerequestOrganization
request-providerreferencerequestProvider