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

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: Payment Reconciliation Example - JSON Representation

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{
  "resourceType" : "PaymentReconciliation",
  "id" : "90581",
  "meta" : {
    "profile" : [
      🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/payment-reconciliation"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PaymentReconciliation 90581</b></p><a name=\"90581\"> </a><a name=\"hc90581\"> </a><a name=\"90581-en-US\"> </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 Reconciliation</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-43c68545-8e37-4744-b8ea-9a1e3c1ada84.html#http-//sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db\">Bundle: type = message; timestamp = 2023-12-19 08:20:29+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 - Payment</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>"
  },
  "identifier" : [
    {
      "system" : "http://sni.com.sa/identifiers/paymentreconciliation",
      "value" : "90581"
    }
  ],
  "status" : "active",
  "period" : {
    "start" : "2023-12-01",
    "end" : "2023-12-06"
  },
  "created" : "2023-12-06",
  "paymentIssuer" : {
    "reference" : "http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db"
  },
  "requestor" : {
    "reference" : "http://sni.com.sa/Organization/215"
  },
  "outcome" : "complete",
  "disposition" : "Payment made for the month of December, 2023",
  "paymentDate" : "2023-12-06",
  "paymentAmount" : {
    "value" : 239.55,
    "currency" : "SAR"
  },
  "paymentIdentifier" : {
    "type" : {
      "coding" : [
        {
          "system" : "http://nphies.sa/terminology/CodeSystem/payment-method",
          "code" : "eft"
        }
      ]
    },
    "system" : "http://saudinationalbank.com.sa/identifiers/payment-45908",
    "value" : "URN-987590432322"
  },
  "detail" : [
    {
      "extension" : [
        {
          "url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment",
          "valueMoney" : {
            "value" : 241.5,
            "currency" : "SAR"
          }
        },
        {
          "url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee",
          "valueMoney" : {
            "value" : 0,
            "currency" : "SAR"
          }
        },
        {
          "url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee",
          "valueMoney" : {
            "value" : -1.95,
            "currency" : "SAR"
          }
        }
      ],
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/payment-type",
            "code" : "payment"
          }
        ]
      },
      "request" : {
        "identifier" : {
          "system" : "http://saudidentalclinic.com.sa/identifiers/claim",
          "value" : "req_29309905401"
        }
      },
      "submitter" : {
        "reference" : "http://sni.com.sa/Organization/215"
      },
      "response" : {
        "identifier" : {
          "system" : "http://sni.com.sa/identifiers/claimresponse",
          "value" : "res_10411448401"
        }
      },
      "date" : "2023-12-06",
      "payee" : {
        "reference" : "http://sni.com.sa/Organization/215"
      },
      "amount" : {
        "value" : 239.55,
        "currency" : "SAR"
      }
    }
  ]
}