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 - XML Representation

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<PaymentReconciliation xmlns="http://hl7.org/fhir">
  <id value="90581"/>
  <meta>
    <profile
             value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/payment-reconciliation"/>
  </meta>
  <text>
    <status value="extensions"/>
    <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>
  </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>