Path | Short | Definition | Comments |
---|---|---|---|
PaymentNotice request | This resource provides the status of the payment for goods and services rendered, and the request and response resource references. | ||
identifier | Business Identifier for the payment noctice | A unique identifier assigned to this payment notice. | |
status | active | cancelled | draft | entered-in-error | The 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. |
request | Request reference | Reference of resource for which payment is being made. | |
response | Response reference | Reference of response to resource for which payment is being made. | |
created | Creation date | The date when this resource was created. | |
provider | Responsible practitioner | The practitioner who is responsible for the services rendered to the patient. | |
payment | Payment reference | A reference to the payment which is the subject of this notice. | |
paymentDate | Payment or clearing date | The date when the above payment action occurred. | |
payee | Party being paid | The party who will receive or has received payment that is the subject of this notification. | |
recipient | Party being notified | The party who is notified of the payment status. | |
amount | Monetary amount of the payment | The amount sent to the payee. | |
paymentStatus | Issued or cleared Status of the payment | A code indicating whether payment has been sent or cleared. | Typically paid: payment sent, cleared: payment received. |
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 regarding electronic payment notice content and usage may be found at:
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. |
created | Creation date fro the notice | PaymentNotice.created |
identifier | The business identifier of the notice | PaymentNotice.identifier |
payment-status | The type of payment notice | PaymentNotice.paymentStatus |
provider | The reference to the provider | PaymentNotice.provider |
request | The Claim | PaymentNotice.request |
response | The ClaimResponse | PaymentNotice.response |
status | The status of the payment notice | PaymentNotice.status |