Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot Saudi Arabia flag

Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Message: Payment Reconciliation #1 - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="96b80922-b538-4ab3-0176-a80b51242161"/>
  <meta>
    <profile
             value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|0.3.0"/>
  </meta>
  <type value="message"/>
  <timestamp value="2023-12-02T19:36:29.683Z"/>
  <entry>
    <fullUrl value="urn:uuid:000739e8-c8d0-44f8-b0e0-f89310ea1998"/>
    <resource>
      <MessageHeader>
        <id value="000739e8-c8d0-44f8-b0e0-f89310ea1998"/>
        <meta>
          <profile
                   value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|0.3.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_000739e8-c8d0-44f8-b0e0-f89310ea1998"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader 000739e8-c8d0-44f8-b0e0-f89310ea1998</b></p><a name="000739e8-c8d0-44f8-b0e0-f89310ea1998"> </a><a name="hc000739e8-c8d0-44f8-b0e0-f89310ea1998"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-message-header.html">Nphies MessageHeaderversion: null0.3.0)</a></p></div><p><b>event</b>: <a href="CodeSystem-ksa-message-events.html#ksa-message-events-payment-reconciliation">KSA Message Events payment-reconciliation</a>: Payment Reconciliation</p><h3>Destinations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style="display: none">*</td><td><a href="http://saudidentalclinic.com.sa">http://saudidentalclinic.com.sa</a></td><td>Identifier: <code>http://nphies.sa/license/provider-license</code>/DC-FHIR</td></tr></table><p><b>sender</b>: Identifier: <code>http://nphies.sa/license/payer-license</code>/INS-FHIR</p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td><a href="http://sni.com.sa">http://sni.com.sa</a></td></tr></table><p><b>focus</b>: <a href="Bundle-96b80922-b538-4ab3-0176-a80b51242161.html#http-//sni.com.sa/PaymentReconciliation/90581">Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000</a></p></div>
        </text>
        <eventCoding>
          <system
                  value="http://nphies.sa/terminology/CodeSystem/ksa-message-events"/>
          <code value="payment-reconciliation"/>
        </eventCoding>
        <destination>
          <endpoint value="http://saudidentalclinic.com.sa"/>
          <receiver>
            <type value="Organization"/>
            <identifier>
              <system value="http://nphies.sa/license/provider-license"/>
              <value value="DC-FHIR"/>
            </identifier>
          </receiver>
        </destination>
        <sender>
          <type value="Organization"/>
          <identifier>
            <system value="http://nphies.sa/license/payer-license"/>
            <value value="INS-FHIR"/>
          </identifier>
        </sender>
        <source>
          <endpoint value="http://sni.com.sa"/>
        </source>
        <focus>
          <reference value="http://sni.com.sa/PaymentReconciliation/90581"/>
        </focus>
      </MessageHeader>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://sni.com.sa/PaymentReconciliation/90581"/>
    <resource>
      <PaymentReconciliation>
        <id value="90581"/>
        <meta>
          <profile
                   value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/payment-reconciliation|0.3.0"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="PaymentReconciliation_90581"> </a><p class="res-header-id"><b>Generated Narrative: PaymentReconciliation 90581</b></p><a name="90581"> </a><a name="hc90581"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-payment-reconciliation.html">Nphies Payment Reconciliationversion: null0.3.0)</a></p></div><p><b>identifier</b>: <code>http://sni.com.sa/identifiers/paymentreconciliation</code>/90581</p><p><b>status</b>: Active</p><p><b>period</b>: 2023-12-01 --&gt; 2023-12-06</p><p><b>created</b>: 2023-12-06</p><p><b>paymentIssuer</b>: <a href="Bundle-16b80922-b538-4ab3-0176-a80b33242163.html#http-//sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db">Bundle: type = message; timestamp = 2024-12-02 19:36:29+0000</a></p><p><b>requestor</b>: <a href="Bundle-96b80922-b538-4ab3-0176-a80b51242161.html#http-//sni.com.sa/Organization/215">Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Payment made for the month of December, 2023</p><p><b>paymentDate</b>: 2023-12-06</p><h3>PaymentAmounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>239.55</td><td>Saudi riyal</td></tr></table><p><b>paymentIdentifier</b>: EFT/URN-987590432322</p><blockquote><p><b>detail</b></p><p><b>Component - Payment</b>: <span title="Saudi Riyal">SAR241.50</span> (SAR)</p><p><b>Component - Early Fee</b>: <span title="Saudi Riyal">SAR0.00</span> (SAR)</p><p><b>Component - nphies Fee</b>: <span title="Saudi Riyal">SAR-1.95</span> (SAR)</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/payment-type payment}">Payment</span></p><p><b>request</b>: Identifier: <code>http://saudidentalclinic.com.sa/identifiers/claim</code>/req_29309905401</p><p><b>submitter</b>: <a href="Bundle-96b80922-b538-4ab3-0176-a80b51242161.html#http-//sni.com.sa/Organization/215">Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000</a></p><p><b>response</b>: Identifier: <code>http://sni.com.sa/identifiers/claimresponse</code>/res_10411448401</p><p><b>date</b>: 2023-12-06</p><p><b>payee</b>: <a href="Bundle-96b80922-b538-4ab3-0176-a80b51242161.html#http-//sni.com.sa/Organization/215">Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000</a></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>239.55</td><td>Saudi riyal</td></tr></table></blockquote></div>
        </text>
        <identifier>
          <system
                  value="http://sni.com.sa/identifiers/paymentreconciliation"/>
          <value value="90581"/>
        </identifier>
        <status value="active"/>
        <period>
          <start value="2023-12-01"/>
          <end value="2023-12-06"/>
        </period>
        <created value="2023-12-06"/>
        <paymentIssuer>
          <reference
                     value="http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db"/>
        </paymentIssuer>
        <requestor>
          <reference value="http://sni.com.sa/Organization/215"/>
        </requestor>
        <outcome value="complete"/>
        <disposition value="Payment made for the month of December, 2023"/>
        <paymentDate value="2023-12-06"/>
        <paymentAmount>
          <value value="239.55"/>
          <currency value="SAR"/>
        </paymentAmount>
        <paymentIdentifier>
          <type>
            <coding>
              <system
                      value="http://nphies.sa/terminology/CodeSystem/payment-method"/>
              <code value="eft"/>
            </coding>
          </type>
          <system
                  value="http://saudinationalbank.com.sa/identifiers/payment-45908"/>
          <value value="URN-987590432322"/>
        </paymentIdentifier>
        <detail>
          <extension
                     url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment">
            <valueMoney>
              <value value="241.5"/>
              <currency value="SAR"/>
            </valueMoney>
          </extension>
          <extension
                     url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee">
            <valueMoney>
              <value value="0"/>
              <currency value="SAR"/>
            </valueMoney>
          </extension>
          <extension
                     url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee">
            <valueMoney>
              <value value="-1.95"/>
              <currency value="SAR"/>
            </valueMoney>
          </extension>
          <type>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/payment-type"/>
              <code value="payment"/>
            </coding>
          </type>
          <request>
            <identifier>
              <system
                      value="http://saudidentalclinic.com.sa/identifiers/claim"/>
              <value value="req_29309905401"/>
            </identifier>
          </request>
          <submitter>
            <reference value="http://sni.com.sa/Organization/215"/>
          </submitter>
          <response>
            <identifier>
              <system value="http://sni.com.sa/identifiers/claimresponse"/>
              <value value="res_10411448401"/>
            </identifier>
          </response>
          <date value="2023-12-06"/>
          <payee>
            <reference value="http://sni.com.sa/Organization/215"/>
          </payee>
          <amount>
            <value value="239.55"/>
            <currency value="SAR"/>
          </amount>
        </detail>
      </PaymentReconciliation>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://sni.com.sa/Organization/215"/>
    <resource>
      <Organization>
        <id value="215"/>
        <meta>
          <profile
                   value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|0.3.0"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_215"> </a><p class="res-header-id"><b>Generated Narrative: Organization 215</b></p><a name="215"> </a><a name="hc215"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-provider-organization.html">Nphies Provider Organizationversion: null0.3.0)</a></p></div><p><b>Provider Type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/provider-type 5}">Clinic</span></p><p><b>identifier</b>: <code>http://nphies.sa/license/provider-license</code>/DC-FHIR</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/organization-type prov}">Healthcare Provider</span></p><p><b>name</b>: Saudi Dental Clinic</p><p><b>address</b>: Hajar Valley, Building 104, Riyadh Saudi Arabia(work)</p></div>
        </text>
        <extension
                   url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://nphies.sa/terminology/CodeSystem/provider-type"/>
              <code value="5"/>
              <display value="Clinic"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <identifier>
          <system value="http://nphies.sa/license/provider-license"/>
          <value value="DC-FHIR"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://nphies.sa/terminology/CodeSystem/organization-type"/>
            <code value="prov"/>
          </coding>
        </type>
        <name value="Saudi Dental Clinic"/>
        <address>
          <use value="work"/>
          <text value="Hajar Valley, Building 104, Riyadh Saudi Arabia"/>
          <line value="Hajar Valley, Building 104"/>
          <line value="Al Malga District"/>
          <city value="Riyadh"/>
          <country value="Saudi Arabia"/>
        </address>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db"/>
    <resource>
      <Organization>
        <id value="bff3aa1fbd3648619ac082357bf135db"/>
        <meta>
          <profile
                   value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|0.3.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_bff3aa1fbd3648619ac082357bf135db"> </a><p class="res-header-id"><b>Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db</b></p><a name="bff3aa1fbd3648619ac082357bf135db"> </a><a name="hcbff3aa1fbd3648619ac082357bf135db"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-insurer-organization.html">Nphies Insurer Organizationversion: null0.3.0)</a></p></div><p><b>identifier</b>: National Insurance Organization Identifier/INS-FHIR (use: official, )</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/organization-type ins}">Insurance Company</span></p><p><b>name</b>: Saudi National Insurance</p><p><b>address</b>: Olaya Street, Building 70, Riyadh Saudi Arabia(work)</p></div>
        </text>
        <identifier>
          <use value="official"/>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NII"/>
            </coding>
          </type>
          <system value="http://nphies.sa/license/payer-license"/>
          <value value="INS-FHIR"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://nphies.sa/terminology/CodeSystem/organization-type"/>
            <code value="ins"/>
          </coding>
        </type>
        <name value="Saudi National Insurance"/>
        <address>
          <use value="work"/>
          <text value="Olaya Street, Building 70, Riyadh Saudi Arabia"/>
          <line value="Olaya Street, Building 70"/>
          <line value="Al Olaya District"/>
          <city value="Riyadh"/>
          <country value="Saudi Arabia"/>
        </address>
      </Organization>
    </resource>
  </entry>
</Bundle>