Payment Reconciliation

$10 / year

The Payment Reconciliation resource 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.

Complexity

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.

Date Created

2018-09-20

Last Modified

2019-11-01

Version

4.0.1

Update Frequency

Annual

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Health Level Seven International;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

FHIR, HL7, Medical Terminology, Processes Data, Processes Information, Processes Documentation, Health Information Exchange, Electronic Health Records, FHIR Smart, Smart on FHIR

Other Titles

FHIR Payment Reconciliation Resource, Electronic Health Records Exchange Through FHIR

NameDescriptionTypeConstraints
Concept_NameName of the concept in the FHIR structure.stringrequired : 1
Computer_Ready_NameA Computer-ready name (e.g. a token) that identifies the structure - suitable for code generation. Note that this name (and other names relevant for code generation, including element & slice names, codes etc) may collide with reserved words in the relevant target language, and code generators will need to handle this.string-
TypeThe type the structure describes.string-
Dollar_RefThe "$ref" string value contains a Uniform Resource Identifier (URI) which identifies the location of the JSON value being referenced.string-
DescriptionA free text natural language description of the structure and its use.string-
ItemsThe value of the keyword should be an object or an array of objects. If the keyword value is an object, then for the data array to be valid each item of the array should be valid according to the schema in this value.string-
EnumThe enum is used to restrict a value to a fixed set of values. It must be an array with at least one element, where each element is unique.string-
RequiredThe value of the keyword should be an array of unique strings. The data object to be valid should contain all properties with names equal to the elements in the keyword value.string-
ConstThe value of this keyword can be anything. The data is valid if it is deeply equal to the value of the keyword.string-
Concept NameComputer Ready NameTypeDollar RefDescriptionItemsEnumRequiredConst
PaymentReconciliationresourceTypeThis is a PaymentReconciliation resourcePaymentReconciliation
PaymentReconciliationid#/definitions/idThe logical id of the resource as used in the URL for the resource. Once assigned this value never changes.
PaymentReconciliationmeta#/definitions/MetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
PaymentReconciliationimplicitRules#/definitions/uriA reference to a set of rules that were followed when the resource was constructed and which must be understood when processing the content. Often this is a reference to an implementation guide that defines the special rules along with other profiles etc.
PaymentReconciliation_implicitRules#/definitions/ElementExtensions for implicitRules
PaymentReconciliationlanguage#/definitions/codeThe base language in which the resource is written.
PaymentReconciliation_language#/definitions/ElementExtensions for language
PaymentReconciliationtext#/definitions/NarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
PaymentReconciliationcontainedarrayThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently and nor can they have their own independent transaction scope.{'$ref': '#/definitions/ResourceList'}
PaymentReconciliationextensionarrayMay be used to represent additional information that is not part of the basic definition of the resource. 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.{'$ref': '#/definitions/Extension'}
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