PaymentNotice

Introduction

Scope and Usage

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)for example to provide payment status information or to document the forwarding or receipt of payment to support regulatory requirements. Employers or Insurance Exchanges may also 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

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.

Boundaries and Relationships

The PaymentNotice resource is used to indicate that a payment has been initiated. 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

Background and Context

Provides additional detail on exactly how the resource is to be used

StructureDefinition

Elements (Simplified)

• PaymentNotice [0..*]: - PaymentNotice request
• PaymentNotice.identifier [0..*]: Identifier Business Identifier for the payment notice
• PaymentNotice.status [1..1]: code required:fm-status active | cancelled | draft | entered-in-error
• PaymentNotice.statusReason [0..1]: string Reason for status change
• PaymentNotice.request [0..1]: Reference(Resource) Request reference
• PaymentNotice.response [0..1]: Reference(Resource) Response reference
• PaymentNotice.created [1..1]: dateTime Creation date
• PaymentNotice.reporter [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization)) Responsible practitioner
• PaymentNotice.payment [0..1]: Reference(PaymentReconciliation) Payment reference
• PaymentNotice.paymentDate [0..1]: date Payment or clearing date
• PaymentNotice.payee [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization)) Party being paid
• PaymentNotice.recipient [1..1]: Reference(Organization) Party being notified
• PaymentNotice.amount [1..1]: Money Monetary amount of the payment
• PaymentNotice.paymentStatus [0..1]: CodeableConcept preferred:payment-status Issued or cleared Status of the payment

Mappings

• PaymentNotice Mappings — 23 mapping entries

Resource Packs

list-PaymentNotice-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir">
  <id value="PaymentNotice-packs"/>
  <status value="current"/>
  <mode value="working"/>
</List>

Search Parameters

• created — date — Creation date for the notice — PaymentNotice.created
• identifier — token — The business identifier of the notice — PaymentNotice.identifier
• payment-status — token — The type of payment notice — PaymentNotice.paymentStatus
• reporter — reference — The reference to the reporter — PaymentNotice.reporter
• request — reference — The Claim — PaymentNotice.request
• response — reference — The ClaimResponse — PaymentNotice.response
• status — token — The status of the payment notice — PaymentNotice.status

Full Search Parameters

Examples

• 77654 — paymentnotice-example — Claim PaymentNotice Example
• paymentnotice-example — paymentnotice-example
• paymentnotice-examples-header — paymentnotice-examples-header

Full Examples

Mapping Exceptions

paymentnotice-event-mapping-exceptions.xml

Divergent Elements

• Event.identifier → PaymentNotice.identifier
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Business identifier for payment notice | resource=Business Identifier for the payment notice
  • definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this payment notice by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=A unique identifier assigned to this payment notice.
  • commentsUnmatched | reason=Unknown | pattern=Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
  • requirementsUnmatched | reason=Unknown | pattern=Allows identification of the payment notice as it is known by various participating systems and in a way that remains consistent across servers. | resource=Allows payment notices to be distinguished and referenced.
• Event.basedOn → PaymentNotice.request
  • missingTypes | reason=Unknown | pattern=Reference(Request)
  • extraTypes | reason=Unknown
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Fulfills plan, proposal or order | resource=Request reference
  • definitionUnmatched | reason=Unknown | pattern=A plan, proposal or order that is fulfilled in whole or in part by this payment notice. | resource=Reference of resource for which payment is being made.
  • requirementsUnmatched | reason=Unknown | pattern=Allows tracing of authorization for the payment notice and tracking whether proposals/recommendations were acted upon.
• Event.status → PaymentNotice.status
  • shortUnmatched | reason=Unknown | pattern=preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown | resource=active | cancelled | draft | entered-in-error
  • definitionUnmatched | reason=Unknown | pattern=The current state of the payment notice. | resource=The status of the resource instance.
  • commentsUnmatched | reason=Unknown | pattern=A nominal state-transition diagram can be found in the (Event pattern documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. | resource=This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

• Event.occurrence[x] → PaymentNotice.created
  • missingTypes | reason=Unknown | pattern=Period, Timing
  • shortUnmatched | reason=Unknown | pattern=When payment notice occurred/is occurring | resource=Creation date
  • definitionUnmatched | reason=Unknown | pattern=The date, period or timing when the payment notice did occur or is occurring. | resource=The date when this resource was created.
  • commentsUnmatched | reason=Unknown | pattern=This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. .
• Event.performer → PaymentNotice.reporter
  • extraTypes | reason=Unknown
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Who performed payment notice and what they did | resource=Responsible practitioner
  • definitionUnmatched | reason=Unknown | pattern=Indicates who or what performed the payment notice and how they were involved. | resource=The party who reports the payment notice.

Unmapped Elements

• Event.partOf — Unknown
• Event.reported — Unknown
• Event.reason — Unknown
• Event.relevantHistory — Unknown
• Event.code — Unknown
• Event.location — Unknown
• Event.subject — Unknown
• Event.statusReason — Unknown
• Event.performer.actor — Unknown
• Event.performer.function — Unknown
• Event.note — Unknown
• Event.category — Unknown
• Event.encounter — Unknown
• Event.recorded — Unknown
• Event.product — Unknown
• Event.researchStudy — Unknown

paymentnotice-fivews-mapping-exceptions.xml

Unmapped Elements

• FiveWs.what — Unknown
• FiveWs.author — Unknown
• FiveWs.actor — Unknown
• FiveWs.cause — Unknown
• FiveWs.version — Unknown
• FiveWs.witness — Unknown
• FiveWs.class — Unknown
• FiveWs.where — Unknown
• FiveWs.context — Unknown
• FiveWs.init — Unknown
• FiveWs.why — Unknown
• FiveWs.who — Unknown
• FiveWs.grade — Unknown
• FiveWs.planned — Unknown
• FiveWs.done — Unknown