FHIR Implementation Guide for ABDM
6.0.0 - active
FHIR Implementation Guide for ABDM
6.0.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.0.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Official URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentReconciliation | Version: 6.0.0 | |||
| Draft as of 2024-01-24 | Computable Name: PaymentReconciliation | |||
This profile provides the bulk payment details associated with a payment for goods and services rendered by a provider to patients covered by insurance plans offered by that payor.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from PaymentReconciliation
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  PaymentReconciliation | PaymentReconciliation | |||
  paymentIssuer | 0..1 | Reference(Organization) | Party generating payment | |
| requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |
  detail | ||||
 submitter | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |
| responsible | 0..1 | Reference(PractitionerRole) | Contact for the response | |
 payee | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PaymentReconciliation | 0..* | PaymentReconciliation | PaymentReconciliation resource | |
 implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| created | Σ | 1..1 | dateTime | Creation date |
| paymentIssuer | Σ | 0..1 | Reference(Organization) | Party generating payment |
| requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |
| paymentDate | Σ | 1..1 | date | When payment issued |
 paymentAmount | Σ | 1..1 | Money | Total amount of Payment |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| PaymentReconciliation | 0..* | PaymentReconciliation | PaymentReconciliation resource | |||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
 extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 0..* | Identifier | Business Identifier for a payment reconciliation | |||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| period | Σ | 0..1 | Period | Period covered | ||||
| created | Σ | 1..1 | dateTime | Creation date | ||||
| paymentIssuer | Σ | 0..1 | Reference(Organization) | Party generating payment | ||||
| request | 0..1 | Reference(Task) | Reference to requesting resource | |||||
| requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |||||
| outcome | 0..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. | |||||
| disposition | 0..1 | string | Disposition message | |||||
| paymentDate | Σ | 1..1 | date | When payment issued | ||||
| paymentAmount | Σ | 1..1 | Money | Total amount of Payment | ||||
| paymentIdentifier | 0..1 | Identifier | Business identifier for the payment | |||||
 detail | 0..* | BackboneElement | Settlement particulars | |||||
 id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | 0..1 | Identifier | Business identifier of the payment detail | |||||
| predecessor | 0..1 | Identifier | Business identifier of the prior payment detail | |||||
| type | 1..1 | CodeableConcept | Category of payment Binding: PaymentTypeCodes (example): The reason for the amount: payment, adjustment, advance. | |||||
| request | 0..1 | Reference(Resource) | Request giving rise to the payment | |||||
| submitter | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |||||
| response | 0..1 | Reference(Resource) | Response committing to a payment | |||||
| date | 0..1 | date | Date of commitment to pay | |||||
| responsible | 0..1 | Reference(PractitionerRole) | Contact for the response | |||||
| payee | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |||||
| amount | 0..1 | Money | Amount allocated to this payable | |||||
| formCode | 0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| processNote | 0..* | BackboneElement | Note concerning processing | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text | 0..1 | string | Note explanatory text | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| PaymentReconciliation.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.detail.type | example | PaymentTypeCodeshttp://hl7.org/fhir/ValueSet/payment-typefrom the FHIR Standard | ||||
| PaymentReconciliation.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/formsfrom the FHIR Standard | ||||
| PaymentReconciliation.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from PaymentReconciliation
Differential View
This structure is derived from PaymentReconciliation
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PaymentReconciliation | PaymentReconciliation | |||
| paymentIssuer | 0..1 | Reference(Organization) | Party generating payment | |
| requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |
| detail | ||||
| submitter | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |
| responsible | 0..1 | Reference(PractitionerRole) | Contact for the response | |
| payee | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |
| Documentation for this format | ||||
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PaymentReconciliation | 0..* | PaymentReconciliation | PaymentReconciliation resource | |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| created | Σ | 1..1 | dateTime | Creation date |
| paymentIssuer | Σ | 0..1 | Reference(Organization) | Party generating payment |
| requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |
| paymentDate | Σ | 1..1 | date | When payment issued |
| paymentAmount | Σ | 1..1 | Money | Total amount of Payment |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| PaymentReconciliation | 0..* | PaymentReconciliation | PaymentReconciliation resource | |||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 0..* | Identifier | Business Identifier for a payment reconciliation | |||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| period | Σ | 0..1 | Period | Period covered | ||||
| created | Σ | 1..1 | dateTime | Creation date | ||||
| paymentIssuer | Σ | 0..1 | Reference(Organization) | Party generating payment | ||||
| request | 0..1 | Reference(Task) | Reference to requesting resource | |||||
| requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |||||
| outcome | 0..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. | |||||
| disposition | 0..1 | string | Disposition message | |||||
| paymentDate | Σ | 1..1 | date | When payment issued | ||||
| paymentAmount | Σ | 1..1 | Money | Total amount of Payment | ||||
| paymentIdentifier | 0..1 | Identifier | Business identifier for the payment | |||||
| detail | 0..* | BackboneElement | Settlement particulars | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | 0..1 | Identifier | Business identifier of the payment detail | |||||
| predecessor | 0..1 | Identifier | Business identifier of the prior payment detail | |||||
| type | 1..1 | CodeableConcept | Category of payment Binding: PaymentTypeCodes (example): The reason for the amount: payment, adjustment, advance. | |||||
| request | 0..1 | Reference(Resource) | Request giving rise to the payment | |||||
| submitter | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |||||
| response | 0..1 | Reference(Resource) | Response committing to a payment | |||||
| date | 0..1 | date | Date of commitment to pay | |||||
| responsible | 0..1 | Reference(PractitionerRole) | Contact for the response | |||||
| payee | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |||||
| amount | 0..1 | Money | Amount allocated to this payable | |||||
| formCode | 0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| processNote | 0..* | BackboneElement | Note concerning processing | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text | 0..1 | string | Note explanatory text | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| PaymentReconciliation.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.detail.type | example | PaymentTypeCodeshttp://hl7.org/fhir/ValueSet/payment-typefrom the FHIR Standard | ||||
| PaymentReconciliation.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/formsfrom the FHIR Standard | ||||
| PaymentReconciliation.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from PaymentReconciliation
Other representations of profile: CSV, Excel, Schematron