type: resource-definitionsresource: PaymentReconciliation

PaymentReconciliation Definitions

PaymentReconciliation

PaymentReconciliation resource

Definition: This resource provides the details including amount of a payment and allocates the payment items being paid.

Cardinality: 0..*

Mappings: workflow=Event; w5=financial.payment

PaymentReconciliation.identifier

Business Identifier for a payment reconciliation

Definition: A unique identifier assigned to this payment reconciliation.

Requirements: Allows payment reconciliations to be distinguished and referenced.

Cardinality: 0..*

Type: Identifier

Mappings: workflow=Event.identifier; w5=FiveWs.identifier

PaymentReconciliation.type

Category of payment

Definition: Code to indicate the nature of the payment such as payment, adjustment.

Cardinality: 1..1

Type: CodeableConcept

Binding: extensible:payment-type

Summary: true

PaymentReconciliation.status

active | cancelled | draft | entered-in-error

Definition: The status of the resource instance.

Comments: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Requirements: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

Cardinality: 1..1

Type: code

Binding: required:fm-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: workflow=Event.status; w5=FiveWs.status

PaymentReconciliation.statusReason

Reason for status change

Definition: Used to indicate why the status has changed.

Comments: Implementation guides may consider adding invariants such that if status = cancelled, statusReason SHALL be supplied.

Requirements: This is used to implement conformance on other elements.

Cardinality: 0..1

Type: string

Summary: true

PaymentReconciliation.kind

Workflow originating payment

Definition: The workflow or activity which gave rise to or during which the payment ocurred such as a kiosk, deposit on account, periodic payment etc.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:payment-kind

PaymentReconciliation.period

Period covered

Definition: The period of time for which payments have been gathered into this bulk payment for settlement.

Requirements: Needed to allow receivers to monitor and reconcile payment issuer schedules.

Cardinality: 0..1

Type: Period

Summary: true

Mappings: w5=FiveWs.done[x]

PaymentReconciliation.created

Creation date

Definition: The date when the resource was created.

Requirements: Need to record a timestamp for use by both the recipient and the issuer.

Cardinality: 1..1

Type: dateTime

Summary: true

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.recorded

PaymentReconciliation.enterer

Who entered the payment

Definition: Payment enterer if not the actual payment issuer.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, Organization)

PaymentReconciliation.issuerType

Nature of the source

Definition: The type of the source such as patient or insurance.

Requirements: Providers may need to identify the source to know to which sub-ledger to apply the payment.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:payment-issuertype

PaymentReconciliation.paymentIssuer

Party generating payment

Definition: The party who generated the payment.

Comments: This party is also responsible for the reconciliation.

Requirements: Need to identify the party resonsible for the payment and this resource.

Cardinality: 0..1

Type: Reference(Organization, Patient, RelatedPerson)

Summary: true

Mappings: workflow=Event.performer.actor; w5=FiveWs.source

PaymentReconciliation.request

Reference to requesting resource

Definition: Original request resource reference.

Requirements: Needed to allow the response to be linked to the request.

Cardinality: 0..1

Type: Reference(Task)

Mappings: w5=FiveWs.why[x]; cdanetv4=A02|G01

PaymentReconciliation.requestor

Responsible practitioner

Definition: The practitioner who is responsible for the services rendered to the patient.

Requirements: Need to identify the party responsible for the request.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, Organization)

Mappings: cdanetv4=B01

PaymentReconciliation.outcome

queued | complete | error | partial

Definition: The outcome of a request for a reconciliation.

Comments: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

Requirements: To advise the requestor of an overall processing outcome.

Cardinality: 0..1

Type: code

Binding: required:payment-outcome

PaymentReconciliation.disposition

Disposition message

Definition: A human readable description of the status of the request for the reconciliation.

Requirements: Provided for user display.

Cardinality: 0..1

Type: string

Mappings: workflow=Event.note

PaymentReconciliation.date

When payment issued

Definition: The date of payment as indicated on the financial instrument.

Requirements: To advise the payee when payment can be expected.

Cardinality: 1..1

Type: date

Summary: true

PaymentReconciliation.location

Where payment collected

Definition: The location of the site or device for electronic transfers or physical location for cash payments.

Cardinality: 0..1

Type: Reference(Location)

PaymentReconciliation.method

Payment instrument

Definition: The means of payment such as check, card cash, or electronic funds transfer.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:v2-0570

PaymentReconciliation.cardBrand

Type of card

Definition: The card brand such as debit, Visa, Amex etc. used if a card is the method of payment.

Cardinality: 0..1

Type: string

PaymentReconciliation.accountNumber

Digits for verification

Definition: A portion of the account number, often the last 4 digits, used for verification not charging purposes.

Cardinality: 0..1

Type: string

PaymentReconciliation.expirationDate

Expiration year-month

Definition: The year and month (YYYY-MM) when the instrument, typically card, expires.

Cardinality: 0..1

Type: date

PaymentReconciliation.processor

Processor name

Definition: The name of the card processor, etf processor, bank for checks.

Cardinality: 0..1

Type: string

PaymentReconciliation.referenceNumber

Check number or payment reference

Definition: The check number, eft reference, car processor reference.

Cardinality: 0..1

Type: string

PaymentReconciliation.authorization

Authorization number

Definition: An alphanumeric issued by the processor to confirm the successful issuance of payment.

Cardinality: 0..1

Type: string

PaymentReconciliation.tenderedAmount

Amount offered by the issuer

Definition: The amount offered by the issuer, typically applies to cash when the issuer provides an amount in bank note denominations equal to or excess of the amount actually being paid.

Cardinality: 0..1

Type: Money

PaymentReconciliation.returnedAmount

Amount returned by the receiver

Definition: The amount returned by the receiver which is excess to the amount payable, often referred to as 'change'.

Comments: For profiles where the intention is to support actual payment advice then the cardinality must be set to 1..1.

Cardinality: 0..1

Type: Money

PaymentReconciliation.amount

Total amount of Payment

Definition: Total payment amount as indicated on the financial instrument.

Requirements: Needed to provide the actual payment amount.

Cardinality: 0..1

Type: Money

Summary: true

PaymentReconciliation.paymentIdentifier

Business identifier for the payment

Definition: Issuer's unique identifier for the payment instrument.

Comments: For example: EFT number or check number.

Requirements: Enable the receiver to reconcile when payment is received.

Cardinality: 0..1

Type: Identifier

PaymentReconciliation.allocation

Settlement particulars

Definition: Distribution of the payment amount for a previously acknowledged payable.

Requirements: Needed to show how the payment amount is distributed across the payables.

Cardinality: 0..*

Type: BackboneElement

PaymentReconciliation.allocation.identifier

Business identifier of the payment detail

Definition: Unique identifier for the current payment item for the referenced payable.

Requirements: Needed for reconciliation of payments.

Cardinality: 0..1

Type: Identifier

PaymentReconciliation.allocation.predecessor

Business identifier of the prior payment detail

Definition: Unique identifier for the prior payment item for the referenced payable.

Requirements: Needed for reconciliation of payments.

Cardinality: 0..1

Type: Identifier

PaymentReconciliation.allocation.target

Subject of the payment

Definition: Specific resource to which the payment/adjustment/advance applies.

Cardinality: 0..1

Type: Reference(Claim, Account, Invoice, Encounter, Contract)

PaymentReconciliation.allocation.targetItem[x]

Sub-element of the subject

Definition: Identifies the claim line item, encounter or other sub-element being paid. Note payment may be partial, that is not match the then outstanding balance or amount incurred.

Cardinality: 0..1

Type: string, Identifier, positiveInt

PaymentReconciliation.allocation.encounter

Applied-to encounter

Definition: The Encounter to which this payment applies, may be completed by the receiver, used for search.

Cardinality: 0..1

Type: Reference(Encounter)

PaymentReconciliation.allocation.account

Applied-to account

Definition: The Account to which this payment applies, may be completed by the receiver, used for search.

Cardinality: 0..1

Type: Reference(Account)

PaymentReconciliation.allocation.type

Category of payment

Definition: Code to indicate the nature of the payment.

Comments: For example: payment, adjustment, funds advance, etc.

Requirements: Needed to provide context for the amount.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:payment-type

PaymentReconciliation.allocation.submitter

Submitter of the request

Definition: The party which submitted the claim or financial transaction.

Requirements: Needed for audit and validation.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, Organization)

PaymentReconciliation.allocation.response

Response committing to a payment

Definition: A resource, such as a ClaimResponse, which contains a commitment to payment.

Requirements: Needed to provide a linkage to the payment commitment.

Cardinality: 0..1

Type: Reference(ClaimResponse)

PaymentReconciliation.allocation.date

Date of commitment to pay

Definition: The date from the response resource containing a commitment to pay.

Requirements: Needed for audit and validation.

Cardinality: 0..1

Type: date

PaymentReconciliation.allocation.responsible

Contact for the response

Definition: A reference to the individual who is responsible for inquiries regarding the response and its payment.

Requirements: To provide contact information.

Cardinality: 0..1

Type: Reference(PractitionerRole)

PaymentReconciliation.allocation.payee

Recipient of the payment

Definition: The party which is receiving the payment.

Requirements: Needed for audit and validation.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, Organization)

PaymentReconciliation.allocation.amount

Amount allocated to this payable

Definition: The monetary amount allocated from the total payment to the payable.

Requirements: Needed to explain the distribution of the payment to the payables.

Cardinality: 0..1

Type: Money

PaymentReconciliation.allocation.noteNumber

Applicable note numbers

Definition: The numbers associated with notes below which apply to the adjudication of this item.

Requirements: Provides a condensed manner for associating human readable descriptive explanations on the allocation item.

Cardinality: 0..*

Type: positiveInt

PaymentReconciliation.formCode

Printed form identifier

Definition: A code for the form to be used for printing the content.

Comments: May be needed to identify specific jurisdictional forms.

Requirements: Needed to specify the specific form used for producing output for this response.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:forms

PaymentReconciliation.processNote

Note concerning processing

Definition: A note that describes or explains the processing in a human readable form.

Requirements: Provides the specific textual explanations associated with the processing.

Cardinality: 0..*

Type: BackboneElement

PaymentReconciliation.processNote.class

Business kind of note

Definition: A code to indicate the business purpose of the note.

Requirements: Process Notes may encompass a significant number of kinds of notes. These could be disclaimers (particularly useful for predetermination), a statement about adjudication, a conditional statement, or others.

Cardinality: 0..1

Type: CodeableConcept

Binding: example