Resource type: paymentnotice

Description

This resource provides the status of the payment for goods and services rendered, and the request and response resource references.

Elements

PathShortDefinitionComments
PaymentNotice requestThis resource provides the status of the payment for goods and services rendered, and the request and response resource references.
identifierBusiness Identifier for the payment nocticeA unique identifier assigned to this payment notice.
statusactive | cancelled | draft | entered-in-errorThe status of the resource instance.This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
requestRequest referenceReference of resource for which payment is being made.
responseResponse referenceReference of response to resource for which payment is being made.
createdCreation dateThe date when this resource was created.
providerResponsible practitionerThe practitioner who is responsible for the services rendered to the patient.
paymentPayment referenceA reference to the payment which is the subject of this notice.
paymentDatePayment or clearing dateThe date when the above payment action occurred.
payeeParty being paidThe party who will receive or has received payment that is the subject of this notification.
recipientParty being notifiedThe party who is notified of the payment status.
amountMonetary amount of the paymentThe amount sent to the payee.
paymentStatusIssued or cleared Status of the paymentA code indicating whether payment has been sent or cleared.Typically paid: payment sent, cleared: payment received.

Scope and Usage

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

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

Boundaries and Relationships

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.


Search Parameters

createdCreation date fro the noticePaymentNotice.created
identifierThe business identifier of the noticePaymentNotice.identifier
payment-statusThe type of payment noticePaymentNotice.paymentStatus
providerThe reference to the providerPaymentNotice.provider
requestThe ClaimPaymentNotice.request
responseThe ClaimResponsePaymentNotice.response
statusThe status of the payment noticePaymentNotice.status

Extension Definitions

These are extension definitions for this resource defined by the spec