The Payment Reconciliation resource provides provides the details including amount of a payment and allocates the payment items being paid. These are the payment reconciliation details which may align to the individual payment amounts indicated on discrete Claim Responses 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 Payment Reconciliation resource serves to correlate a payment amount to the adjudicated claim amounts appearing on one or more Claim Responses. Payment Reconciliation 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 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 occurences is required for regulatory or business purposes. 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 occurred. For reporting out to patients or transferring data to patient centered applications, such as Patient Health Record (PHR) application, the Explanation Of Benefit should be used instead.