FHIR Implementation Guide for ABDM - Local Development build (v5.0.0). See the Directory of published versions

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: PaymentReconciliation/example-01 - XML Representation

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<PaymentReconciliation xmlns="http://hl7.org/fhir">
  <id value="example-01"/>
  <meta>
    <profile
             value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentReconciliation"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the PaymentReconciliation</div>
  </text>
  <identifier>
    <system value="http://www.BenefitsInc.com/fhir/enrollmentresponse"/>
    <value value="781234"/>
  </identifier>
  <status value="active"/>
  <period>
    <start value="2014-08-16"/>
    <end value="2014-08-31"/>
  </period>
  <created value="2014-08-16"/>
  <paymentIssuer>
    <reference value="Organization/example-01"/>
  </paymentIssuer>
  <requestor>
    <reference value="Organization/example-01"/>
  </requestor>
  <outcome value="complete"/>
  <disposition value="2014 August mid-month settlement."/>
  <paymentDate value="2014-08-01"/>
  <paymentAmount>
    <value value="7000.00"/>
    <currency value="INR"/>
  </paymentAmount>
  <paymentIdentifier>
    <system value="http://www.BenefitsInc.com/payment/2018"/>
    <value value="10-12345"/>
  </paymentIdentifier>
  <detail>
    <identifier>
      <system value="http://www.BenefitsInc.com/payment/2018/detail"/>
      <value value="10-12345-001"/>
    </identifier>
    <predecessor>
      <system value="http://www.BenefitsInc.com/payment/2018/detail"/>
      <value value="10-12345-001"/>
    </predecessor>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/payment-type"/>
        <code value="payment"/>
      </coding>
    </type>
    <request>
      <identifier>
        <system value="http://happyvalleyclinic.com/claim"/>
        <value value="AB12345"/>
      </identifier>
    </request>
    <submitter>
      <reference value="Organization/example-01"/>
    </submitter>
    <response>
      <identifier>
        <system value="http://www.BenefitsInc.com/fhir/claimresponse"/>
        <value value="CR20140815-AB12345"/>
      </identifier>
    </response>
    <date value="2014-08-16"/>
    <payee>
      <reference value="Organization/example-01"/>
    </payee>
    <amount>
      <value value="3500.00"/>
      <currency value="INR"/>
    </amount>
  </detail>
  <detail>
    <identifier>
      <system value="http://www.BenefitsInc.com/payment/2018/detail"/>
      <value value="10-12345-002"/>
    </identifier>
    <predecessor>
      <system value="http://www.BenefitsInc.com/payment/2018/detail"/>
      <value value="10-12345-002"/>
    </predecessor>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/payment-type"/>
        <code value="payment"/>
      </coding>
    </type>
    <date value="2014-08-12"/>
    <amount>
      <value value="4000.00"/>
      <currency value="INR"/>
    </amount>
  </detail>
  <detail>
    <identifier>
      <system value="http://www.BenefitsInc.com/payment/2018/detail"/>
      <value value="10-12345-003"/>
    </identifier>
    <predecessor>
      <system value="http://www.BenefitsInc.com/payment/2018/detail"/>
      <value value="10-12345-001"/>
    </predecessor>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/payment-type"/>
        <code value="advance"/>
      </coding>
    </type>
    <date value="2014-08-16"/>
    <amount>
      <value value="-1500.00"/>
      <currency value="INR"/>
    </amount>
  </detail>
  <formCode>
    <coding>
      <system value="http://ncforms.org/formid"/>
      <code value="PAYREC/2016/01B"/>
    </coding>
  </formCode>
  <processNote>
    <type value="display"/>
    <text
          value="Due to the year end holiday the cutoff for submissions for December will be the 28th."/>
  </processNote>
</PaymentReconciliation>