The Payment Notice 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/Electronic Funds Transfer (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.
Additional information regarding electronic payment notice content and usage may be found at:
– Financial Resource Status Lifecycle: how status is used in the financial resources.
– Batches: how eClaims may handle batches of eligibility, claims, payments and responses.
The Payment Notice resource is used to indicate that a payment has occurred or is about to occur. The resource is used commonly when tracking of payment occurrences is required for regulatory or business purposes, such as ensuring that payment of claim adjudications occurs within a specific timeframe. The Payment Notice is not used to report adjudicated amounts or to reconcile adjudicated amounts against actual payment.
The Claim Response 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 Payment Reconciliation resource serves to correlate payment amounts to the adjudicated claim amounts appearing on one or more Claim Responses.