Resource type: paymentreconciliation

Description

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

Elements

PathShortDefinitionComments
PaymentReconciliation resourceThis resource provides the details including amount of a payment and allocates the payment items being paid.
identifierBusiness Identifier for a payment reconciliationA unique identifier assigned to this payment reconciliation.
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.
periodPeriod coveredThe period of time for which payments have been gathered into this bulk payment for settlement.
createdCreation dateThe date when the resource was created.
paymentIssuerParty generating paymentThe party who generated the payment.This party is also responsible for the reconciliation.
requestReference to requesting resourceOriginal request resource reference.
requestorResponsible practitionerThe practitioner who is responsible for the services rendered to the patient.
outcomequeued | complete | error | partialThe outcome of a request for a reconciliation.The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
dispositionDisposition messageA human readable description of the status of the request for the reconciliation.
paymentDateWhen payment issuedThe date of payment as indicated on the financial instrument.
paymentAmountTotal amount of PaymentTotal payment amount as indicated on the financial instrument.
paymentIdentifierBusiness identifier for the paymentIssuer's unique identifier for the payment instrument.For example: EFT number or check number.
detailSettlement particularsDistribution of the payment amount for a previously acknowledged payable.
detail.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
detail.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
detail.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
detail.identifierBusiness identifier of the payment detailUnique identifier for the current payment item for the referenced payable.
detail.predecessorBusiness identifier of the prior payment detailUnique identifier for the prior payment item for the referenced payable.
detail.typeCategory of paymentCode to indicate the nature of the payment.For example: payment, adjustment, funds advance, etc.
detail.requestRequest giving rise to the paymentA resource, such as a Claim, the evaluation of which could lead to payment.
detail.submitterSubmitter of the requestThe party which submitted the claim or financial transaction.
detail.responseResponse committing to a paymentA resource, such as a ClaimResponse, which contains a commitment to payment.
detail.dateDate of commitment to payThe date from the response resource containing a commitment to pay.
detail.responsibleContact for the responseA reference to the individual who is responsible for inquiries regarding the response and its payment.
detail.payeeRecipient of the paymentThe party which is receiving the payment.
detail.amountAmount allocated to this payableThe monetary amount allocated from the total payment to the payable.
formCodePrinted form identifierA code for the form to be used for printing the content.May be needed to identify specific jurisdictional forms.
processNoteNote concerning processingA note that describes or explains the processing in a human readable form.
processNote.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
processNote.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
processNote.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
processNote.typedisplay | print | printoperThe business purpose of the note text.
processNote.textNote explanatory textThe explanation or description associated with the processing.

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.

Additional Information

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

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.


Search Parameters

createdThe creation datePaymentReconciliation.created
dispositionThe contents of the disposition messagePaymentReconciliation.disposition
identifierThe business identifier of the ExplanationOfBenefitPaymentReconciliation.identifier
outcomeThe processing outcomePaymentReconciliation.outcome
payment-issuerThe organization which generated this resourcePaymentReconciliation.paymentIssuer
requestThe reference to the claimPaymentReconciliation.request
requestorThe reference to the provider who submitted the claimPaymentReconciliation.requestor
statusThe status of the payment reconciliationPaymentReconciliation.status

Extension Definitions

These are extension definitions for this resource defined by the spec