PaymentNotice Example: paymentnotice-example

Narrative

A human-readable rendering of the PaymentNotice

Example XML

<PaymentNotice xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/remittance.xsd">
    <id value="77654"/>

    <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the PaymentNotice</div>
    </text>

    <identifier>
        <system value="http://benefitsinc.com/paymentnotice"/>
        <value value="776543"/>
    </identifier>

    <status value="active"/>

    <request>
        <reference value="http://benefitsinc.com/fhir/claim/12345"/>
    </request>

    <response>
        <reference value="http://benefitsinc.com/fhir/claimresponse/CR12345"/>
    </response>

    <created value="2014-08-16"/>

    <reporter>
        <reference value="Organization/1"/>
    </reporter>

    <payment>
        <reference value="PaymentReconciliation/ER2500"/>
    </payment>

    <paymentDate value="2014-08-15"/>

    <payee>
        <reference value="Organization/1"/>
    </payee>

    <recipient>
        <identifier>
            <system value="http://regulators.gov"/>
            <value value="AB123"/>
        </identifier>
    </recipient>

    <amount>
        <value value="12500.00"/>
        <currency value="USD"/> 
    </amount>

    <paymentStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/paymentstatus"/>
            <code value="paid"/>
        </coding>
    </paymentStatus>

</PaymentNotice>