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
Draft as of 2025-06-23 |
Definitions for the payment-reconciliation resource profile.
Guidance on how to interpret the contents of this table can be found here
0. PaymentReconciliation | |
2. PaymentReconciliation.id | |
Control | 1..? |
Max Length: | 64 |
4. PaymentReconciliation.meta | |
Control | 1..? |
6. PaymentReconciliation.meta.profile | |
Control | 1..? |
Type | canonical(DP_canonical)(StructureDefinition) |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
8. PaymentReconciliation.identifier | |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..? |
Type | Identifier(DP_Identifier_A) |
10. PaymentReconciliation.status | |
Pattern Value | active |
12. PaymentReconciliation.period | |
Control | 1..? |
Type | Period(DP_Period_2) |
14. PaymentReconciliation.created | |
Type | dateTime(DP_dateTime) |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
16. PaymentReconciliation.paymentIssuer | |
Control | 1..? |
Type | Reference(DP_Reference_1or2a)(Nphies Insurer Organization) |
18. PaymentReconciliation.requestor | |
Control | 1..? |
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization) |
20. PaymentReconciliation.outcome | |
Control | 1..? |
Pattern Value | complete |
22. PaymentReconciliation.disposition | |
Type | string(DP_string) |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
24. PaymentReconciliation.paymentDate | |
Type | date(DP_date) |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
26. PaymentReconciliation.paymentAmount | |
Type | Money(DP_Money_SAR) |
28. PaymentReconciliation.paymentIdentifier | |
Type | Identifier(DP_Identifier_C) |
30. PaymentReconciliation.paymentIdentifier.type | |
Binding | The codes SHALL be taken from Payment Method (required to http://nphies.sa/terminology/ValueSet/payment-method ) |
32. PaymentReconciliation.detail | |
Control | 1..? |
34. PaymentReconciliation.detail.extension | |
Control | 1..? |
Slicing | This element introduces a set of slices on PaymentReconciliation.detail.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
36. PaymentReconciliation.detail.extension:component-payment | |
Slice Name | component-payment |
Control | 1..1 |
Type | Extension(Component - Payment) (Extension Type: Money(DP_Money_SAR)) |
Must Support | true |
38. PaymentReconciliation.detail.extension:component-early-fee | |
Slice Name | component-early-fee |
Control | 0..1 |
Type | Extension(Component - Early Fee) (Extension Type: Money(DP_Money_SAR)) |
Must Support | true |
40. PaymentReconciliation.detail.extension:component-nphies-fee | |
Slice Name | component-nphies-fee |
Control | 0..1 |
Type | Extension(Component - Payment) (Extension Type: Money(DP_Money_SAR)) |
Must Support | true |
42. PaymentReconciliation.detail.identifier | |
Note | This is a business identifier, not a resource identifier (see discussion) |
Type | Identifier(DP_Identifier_A) |
Must Support | true |
44. PaymentReconciliation.detail.predecessor | |
Type | Identifier(DP_Identifier_A) |
Must Support | true |
46. PaymentReconciliation.detail.type | |
Binding | The codes SHALL be taken from PaymentTypeCodes (required to http://hl7.org/fhir/ValueSet/payment-type ) |
Type | CodeableConcept(DP_CodeableConcept) |
48. PaymentReconciliation.detail.request | |
Type | Reference(DP_Reference_3a)(Nphies Claim Institutional, Nphies Claim Oral, Nphies Claim Pharmacy, Nphies Claim Professional, Nphies Claim Vision) |
Must Support | true |
Must Support Types | No must-support rules about the choice of types/profiles |
50. PaymentReconciliation.detail.submitter | |
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization) |
Must Support | true |
52. PaymentReconciliation.detail.response | |
Type | Reference(DP_Reference_3a)(Nphies Claim Response) |
Must Support | true |
54. PaymentReconciliation.detail.date | |
Control | 1..? |
Type | date(DP_date) |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
56. PaymentReconciliation.detail.payee | |
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization) |
Must Support | true |
58. PaymentReconciliation.detail.amount | |
Control | 1..? |
Type | Money(DP_Money_SAR) |
Guidance on how to interpret the contents of this table can be found here
0. PaymentReconciliation | |
Definition | This resource provides the details including amount of a payment and allocates the payment items being paid. |
Short | PaymentReconciliation resource |
Control | 0..* |
Is Modifier | false |
Summary | false |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
2. PaymentReconciliation.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Short | Logical id of this artifact |
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
Control | 10..1 |
Type | idstring |
Is Modifier | false |
Summary | true |
Max Length: | 64 |
4. PaymentReconciliation.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Short | Metadata about the resource |
Control | 10..1 |
Type | Meta |
Is Modifier | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
6. PaymentReconciliation.meta.profile | |
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. |
Short | Profiles this resource claims to conform to |
Comments | It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. |
Control | 10..* |
Type | canonical(DP_canonical)(StructureDefinition) |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
8. PaymentReconciliation.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
10. PaymentReconciliation.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Summary | false |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
12. PaymentReconciliation.identifier | |
Definition | A unique identifier assigned to this payment reconciliation. |
Short | Business Identifier for a payment reconciliation |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 10..* |
Type | Identifier(DP_Identifier_A) |
Is Modifier | false |
Summary | false |
Requirements | Allows payment reconciliations to be distinguished and referenced. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
14. PaymentReconciliation.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Pattern Value | active |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
16. PaymentReconciliation.period | |
Definition | The period of time for which payments have been gathered into this bulk payment for settlement. |
Short | Period covered |
Control | 10..1 |
Type | Period(DP_Period_2) |
Is Modifier | false |
Summary | true |
Requirements | Needed to allow receivers to monitor and reconcile payment issuer schedules. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
18. PaymentReconciliation.created | |
Definition | The date when the resource was created. |
Short | Creation date |
Control | 1..1 |
Type | dateTime(DP_dateTime) |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
20. PaymentReconciliation.paymentIssuer | |
Definition | The party who generated the payment. |
Short | Party generating payment |
Comments | This party is also responsible for the reconciliation. |
Control | 10..1 |
Type | Reference(DP_Reference_1or2a)(Nphies Insurer Organization, Organization) |
Is Modifier | false |
Summary | true |
Requirements | Need to identify the party resonsible for the payment and this resource. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
22. PaymentReconciliation.requestor | |
Definition | The practitioner who is responsible for the services rendered to the patient. |
Short | Responsible practitioner |
Control | 10..1 |
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | false |
Requirements | Need to identify the party responsible for the request. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
24. PaymentReconciliation.outcome | |
Definition | The outcome of a request for a reconciliation. |
Short | queued | complete | error | partial |
Comments | The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). |
Control | 10..1 |
Binding | The codes SHALL be taken from ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 )The outcome of the processing. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | To advise the requestor of an overall processing outcome. |
Pattern Value | complete |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
26. PaymentReconciliation.disposition | |
Definition | A human readable description of the status of the request for the reconciliation. |
Short | Disposition message |
Control | 0..1 |
Type | string(DP_string) |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Provided for user display. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
28. PaymentReconciliation.paymentDate | |
Definition | The date of payment as indicated on the financial instrument. |
Short | When payment issued |
Control | 1..1 |
Type | date(DP_date) |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | To advise the payee when payment can be expected. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
30. PaymentReconciliation.paymentAmount | |
Definition | Total payment amount as indicated on the financial instrument. |
Short | Total amount of Payment |
Control | 1..1 |
Type | Money(DP_Money_SAR) |
Is Modifier | false |
Summary | true |
Requirements | Needed to provide the actual payment amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
32. PaymentReconciliation.paymentIdentifier | |
Definition | Issuer's unique identifier for the payment instrument. |
Short | Business identifier for the payment |
Comments | For example: EFT number or check number. |
Control | 0..1 |
Type | Identifier(DP_Identifier_C) |
Is Modifier | false |
Summary | false |
Requirements | Enable the receiver to reconcile when payment is received. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
34. PaymentReconciliation.paymentIdentifier.use | |
Definition | The purpose of this identifier. |
Short | usual | official | temp | secondary | old (If known) |
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 )Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
36. PaymentReconciliation.paymentIdentifier.type | |
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
Short | Description of identifier |
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
Control | 10..1 |
Binding | The codes SHALL be taken from Unless not suitable, these codes SHALL be taken from Payment Methodhttp://hl7.org/fhir/ValueSet/identifier-type (required to http://nphies.sa/terminology/ValueSet/payment-method ) |
Type | CodeableConcept(DP_CodeableConcept) |
Is Modifier | false |
Summary | true |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
38. PaymentReconciliation.paymentIdentifier.system | |
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. |
Short | The namespace for the identifier value |
Comments | Identifier.system is always case sensitive. |
Control | 0..1 |
Type | uri |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. |
Example | <br/><b>General</b>:http://www.acme.com/identifiers/patient |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
40. PaymentReconciliation.paymentIdentifier.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Short | The value that is unique |
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. |
Control | 10..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Max Length: | 50 |
Example | <br/><b>General</b>:123456 |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. PaymentReconciliation.detail | |
Definition | Distribution of the payment amount for a previously acknowledged payable. |
Short | Settlement particulars |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Needed to show how the payment amount is distributed across the payables. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
44. PaymentReconciliation.detail.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 10..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on PaymentReconciliation.detail.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
46. PaymentReconciliation.detail.extension:component-payment | |
Slice Name | component-payment |
Definition | The amount of the payment. |
Short | Component - Payment |
Control | 1..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Component - Payment) (Extension Type: Money(DP_Money_SAR)) |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
48. PaymentReconciliation.detail.extension:component-early-fee | |
Slice Name | component-early-fee |
Definition | The charge for early settlemnt of the payment. |
Short | Component - Early Fee |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Component - Early Fee) (Extension Type: Money(DP_Money_SAR)) |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
50. PaymentReconciliation.detail.extension:component-nphies-fee | |
Slice Name | component-nphies-fee |
Definition | The charge for nphies services. |
Short | Component - Payment |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Component - Payment) (Extension Type: Money(DP_Money_SAR)) |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
52. PaymentReconciliation.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
54. PaymentReconciliation.detail.identifier | |
Definition | Unique identifier for the current payment item for the referenced payable. |
Short | Business identifier of the payment detail |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..1 |
Type | Identifier(DP_Identifier_A) |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Needed for reconciliation of payments. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
56. PaymentReconciliation.detail.predecessor | |
Definition | Unique identifier for the prior payment item for the referenced payable. |
Short | Business identifier of the prior payment detail |
Control | 0..1 |
Type | Identifier(DP_Identifier_A) |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Needed for reconciliation of payments. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
58. PaymentReconciliation.detail.type | |
Definition | Code to indicate the nature of the payment. |
Short | Category of payment |
Comments | For example: payment, adjustment, funds advance, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PaymentTypeCodeshttp://hl7.org/fhir/ValueSet/payment-type (required to http://hl7.org/fhir/ValueSet/payment-type ) |
Type | CodeableConcept(DP_CodeableConcept) |
Is Modifier | false |
Summary | false |
Requirements | Needed to provide context for the amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
60. PaymentReconciliation.detail.request | |
Definition | A resource, such as a Claim, the evaluation of which could lead to payment. |
Short | Request giving rise to the payment |
Control | 0..1 |
Type | Reference(DP_Reference_3a)(Nphies Claim Institutional, Nphies Claim Oral, Nphies Claim Pharmacy, Nphies Claim Professional, Nphies Claim Vision, Resource) |
Is Modifier | false |
Must Support | true |
Must Support Types | No must-support rules about the choice of types/profiles |
Summary | false |
Requirements | Needed to provide a linkage to the original request. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
62. PaymentReconciliation.detail.submitter | |
Definition | The party which submitted the claim or financial transaction. |
Short | Submitter of the request |
Control | 0..1 |
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Needed for audit and validation. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
64. PaymentReconciliation.detail.response | |
Definition | A resource, such as a ClaimResponse, which contains a commitment to payment. |
Short | Response committing to a payment |
Control | 0..1 |
Type | Reference(DP_Reference_3a)(Nphies Claim Response, Resource) |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Needed to provide a linkage to the payment commitment. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
66. PaymentReconciliation.detail.date | |
Definition | The date from the response resource containing a commitment to pay. |
Short | Date of commitment to pay |
Control | 10..1 |
Type | date(DP_date) |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Needed for audit and validation. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
68. PaymentReconciliation.detail.payee | |
Definition | The party which is receiving the payment. |
Short | Recipient of the payment |
Control | 0..1 |
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Needed for audit and validation. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
70. PaymentReconciliation.detail.amount | |
Definition | The monetary amount allocated from the total payment to the payable. |
Short | Amount allocated to this payable |
Control | 10..1 |
Type | Money(DP_Money_SAR) |
Is Modifier | false |
Summary | false |
Requirements | Needed to explain the distribution of the payment to the payables. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. PaymentReconciliation | |||||
Definition | This resource provides the details including amount of a payment and allocates the payment items being paid. | ||||
Short | PaymentReconciliation resource | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) | ||||
2. PaymentReconciliation.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Short | Logical id of this artifact | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
Control | 1..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Summary | true | ||||
Max Length: | 64 | ||||
4. PaymentReconciliation.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
Short | Metadata about the resource | ||||
Control | 1..1 | ||||
Type | Meta | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
6. PaymentReconciliation.meta.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
8. PaymentReconciliation.meta.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on PaymentReconciliation.meta.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
10. PaymentReconciliation.meta.versionId | |||||
Definition | The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. | ||||
Short | Version specific identifier | ||||
Comments | The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
12. PaymentReconciliation.meta.lastUpdated | |||||
Definition | When the resource last changed - e.g. when the version changed. | ||||
Short | When the resource version last changed | ||||
Comments | This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. | ||||
Control | 0..1 | ||||
Type | instant | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
14. PaymentReconciliation.meta.source | |||||
Definition | A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. | ||||
Short | Identifies where the resource comes from | ||||
Comments | In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
16. PaymentReconciliation.meta.profile | |||||
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. | ||||
Short | Profiles this resource claims to conform to | ||||
Comments | It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. | ||||
Control | 1..* | ||||
Type | canonical(DP_canonical)(StructureDefinition) | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
18. PaymentReconciliation.meta.security | |||||
Definition | Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. | ||||
Short | Security Labels applied to this resource | ||||
Comments | The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Control | 0..* | ||||
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to http://hl7.org/fhir/ValueSet/security-labels )Security Labels from the Healthcare Privacy and Security Classification System. | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
20. PaymentReconciliation.meta.tag | |||||
Definition | Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. | ||||
Short | Tags applied to this resource | ||||
Comments | The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Control | 0..* | ||||
Binding | For example codes, see CommonTags (example to http://hl7.org/fhir/ValueSet/common-tags )Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
22. PaymentReconciliation.implicitRules | |||||
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
Short | A set of rules under which this content was created | ||||
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
24. PaymentReconciliation.language | |||||
Definition | The base language in which the resource is written. | ||||
Short | Language of the resource content | ||||
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages )A human language.
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
26. PaymentReconciliation.text | |||||
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Short | Text summary of the resource, for human interpretation | ||||
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
28. PaymentReconciliation.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Short | Contained, inline Resources | ||||
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
30. PaymentReconciliation.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
32. PaymentReconciliation.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Summary | false | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
34. PaymentReconciliation.identifier | |||||
Definition | A unique identifier assigned to this payment reconciliation. | ||||
Short | Business Identifier for a payment reconciliation | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..* | ||||
Type | Identifier(DP_Identifier_A) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Allows payment reconciliations to be distinguished and referenced. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
36. PaymentReconciliation.status | |||||
Definition | The status of the resource instance. | ||||
Short | active | cancelled | draft | entered-in-error | ||||
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from FinancialResourceStatusCodes (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1 )A code specifying the state of the resource instance. | ||||
Type | code | ||||
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. | ||||
Pattern Value | active | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
38. PaymentReconciliation.period | |||||
Definition | The period of time for which payments have been gathered into this bulk payment for settlement. | ||||
Short | Period covered | ||||
Control | 1..1 | ||||
Type | Period(DP_Period_2) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Needed to allow receivers to monitor and reconcile payment issuer schedules. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
40. PaymentReconciliation.created | |||||
Definition | The date when the resource was created. | ||||
Short | Creation date | ||||
Control | 1..1 | ||||
Type | dateTime(DP_dateTime) | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to record a timestamp for use by both the recipient and the issuer. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
42. PaymentReconciliation.paymentIssuer | |||||
Definition | The party who generated the payment. | ||||
Short | Party generating payment | ||||
Comments | This party is also responsible for the reconciliation. | ||||
Control | 1..1 | ||||
Type | Reference(DP_Reference_1or2a)(Nphies Insurer Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Need to identify the party resonsible for the payment and this resource. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
44. PaymentReconciliation.request | |||||
Definition | Original request resource reference. | ||||
Short | Reference to requesting resource | ||||
Control | 0..1 | ||||
Type | Reference(Task) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed to allow the response to be linked to the request. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
46. PaymentReconciliation.requestor | |||||
Definition | The practitioner who is responsible for the services rendered to the patient. | ||||
Short | Responsible practitioner | ||||
Control | 1..1 | ||||
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to identify the party responsible for the request. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
48. PaymentReconciliation.outcome | |||||
Definition | The outcome of a request for a reconciliation. | ||||
Short | queued | complete | error | partial | ||||
Comments | The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from ClaimProcessingCodes (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 )The outcome of the processing. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To advise the requestor of an overall processing outcome. | ||||
Pattern Value | complete | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
50. PaymentReconciliation.disposition | |||||
Definition | A human readable description of the status of the request for the reconciliation. | ||||
Short | Disposition message | ||||
Control | 0..1 | ||||
Type | string(DP_string) | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Provided for user display. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
52. PaymentReconciliation.paymentDate | |||||
Definition | The date of payment as indicated on the financial instrument. | ||||
Short | When payment issued | ||||
Control | 1..1 | ||||
Type | date(DP_date) | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | To advise the payee when payment can be expected. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
54. PaymentReconciliation.paymentAmount | |||||
Definition | Total payment amount as indicated on the financial instrument. | ||||
Short | Total amount of Payment | ||||
Control | 1..1 | ||||
Type | Money(DP_Money_SAR) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Needed to provide the actual payment amount. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
56. PaymentReconciliation.paymentIdentifier | |||||
Definition | Issuer's unique identifier for the payment instrument. | ||||
Short | Business identifier for the payment | ||||
Comments | For example: EFT number or check number. | ||||
Control | 0..1 | ||||
Type | Identifier(DP_Identifier_C) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Enable the receiver to reconcile when payment is received. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
58. PaymentReconciliation.paymentIdentifier.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
60. PaymentReconciliation.paymentIdentifier.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on PaymentReconciliation.paymentIdentifier.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
62. PaymentReconciliation.paymentIdentifier.use | |||||
Definition | The purpose of this identifier. | ||||
Short | usual | official | temp | secondary | old (If known) | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 )Identifies the purpose for this identifier, if known . | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
64. PaymentReconciliation.paymentIdentifier.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Short | Description of identifier | ||||
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from Payment Method (required to http://nphies.sa/terminology/ValueSet/payment-method ) | ||||
Type | CodeableConcept(DP_CodeableConcept) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
66. PaymentReconciliation.paymentIdentifier.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Short | The namespace for the identifier value | ||||
Comments | Identifier.system is always case sensitive. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Example | <br/><b>General</b>:http://www.acme.com/identifiers/patient | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
68. PaymentReconciliation.paymentIdentifier.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Short | The value that is unique | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Control | 1..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Max Length: | 50 | ||||
Example | <br/><b>General</b>:123456 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
70. PaymentReconciliation.paymentIdentifier.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Short | Time period when id is/was valid for use | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
72. PaymentReconciliation.paymentIdentifier.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Short | Organization that issued id (may be just text) | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Control | 0..1 | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
74. PaymentReconciliation.detail | |||||
Definition | Distribution of the payment amount for a previously acknowledged payable. | ||||
Short | Settlement particulars | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed to show how the payment amount is distributed across the payables. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
76. PaymentReconciliation.detail.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
78. PaymentReconciliation.detail.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on PaymentReconciliation.detail.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
80. PaymentReconciliation.detail.extension:component-payment | |||||
Slice Name | component-payment | ||||
Definition | The amount of the payment. | ||||
Short | Component - Payment | ||||
Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Component - Payment) (Extension Type: Money(DP_Money_SAR)) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
82. PaymentReconciliation.detail.extension:component-early-fee | |||||
Slice Name | component-early-fee | ||||
Definition | The charge for early settlemnt of the payment. | ||||
Short | Component - Early Fee | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Component - Early Fee) (Extension Type: Money(DP_Money_SAR)) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
84. PaymentReconciliation.detail.extension:component-nphies-fee | |||||
Slice Name | component-nphies-fee | ||||
Definition | The charge for nphies services. | ||||
Short | Component - Payment | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Component - Payment) (Extension Type: Money(DP_Money_SAR)) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
86. PaymentReconciliation.detail.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
88. PaymentReconciliation.detail.identifier | |||||
Definition | Unique identifier for the current payment item for the referenced payable. | ||||
Short | Business identifier of the payment detail | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier(DP_Identifier_A) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Needed for reconciliation of payments. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
90. PaymentReconciliation.detail.predecessor | |||||
Definition | Unique identifier for the prior payment item for the referenced payable. | ||||
Short | Business identifier of the prior payment detail | ||||
Control | 0..1 | ||||
Type | Identifier(DP_Identifier_A) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Needed for reconciliation of payments. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
92. PaymentReconciliation.detail.type | |||||
Definition | Code to indicate the nature of the payment. | ||||
Short | Category of payment | ||||
Comments | For example: payment, adjustment, funds advance, etc. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PaymentTypeCodes (required to http://hl7.org/fhir/ValueSet/payment-type ) | ||||
Type | CodeableConcept(DP_CodeableConcept) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed to provide context for the amount. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
94. PaymentReconciliation.detail.request | |||||
Definition | A resource, such as a Claim, the evaluation of which could lead to payment. | ||||
Short | Request giving rise to the payment | ||||
Control | 0..1 | ||||
Type | Reference(DP_Reference_3a)(Nphies Claim Institutional, Nphies Claim Oral, Nphies Claim Pharmacy, Nphies Claim Professional, Nphies Claim Vision) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Must Support Types | No must-support rules about the choice of types/profiles | ||||
Summary | false | ||||
Requirements | Needed to provide a linkage to the original request. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
96. PaymentReconciliation.detail.submitter | |||||
Definition | The party which submitted the claim or financial transaction. | ||||
Short | Submitter of the request | ||||
Control | 0..1 | ||||
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Needed for audit and validation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
98. PaymentReconciliation.detail.response | |||||
Definition | A resource, such as a ClaimResponse, which contains a commitment to payment. | ||||
Short | Response committing to a payment | ||||
Control | 0..1 | ||||
Type | Reference(DP_Reference_3a)(Nphies Claim Response) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Needed to provide a linkage to the payment commitment. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
100. PaymentReconciliation.detail.date | |||||
Definition | The date from the response resource containing a commitment to pay. | ||||
Short | Date of commitment to pay | ||||
Control | 1..1 | ||||
Type | date(DP_date) | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Needed for audit and validation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
102. PaymentReconciliation.detail.responsible | |||||
Definition | A reference to the individual who is responsible for inquiries regarding the response and its payment. | ||||
Short | Contact for the response | ||||
Control | 0..1 | ||||
Type | Reference(PractitionerRole) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | To provide contact information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
104. PaymentReconciliation.detail.payee | |||||
Definition | The party which is receiving the payment. | ||||
Short | Recipient of the payment | ||||
Control | 0..1 | ||||
Type | Reference(DP_Reference_1or2a)(Nphies Provider Organization) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Needed for audit and validation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
106. PaymentReconciliation.detail.amount | |||||
Definition | The monetary amount allocated from the total payment to the payable. | ||||
Short | Amount allocated to this payable | ||||
Control | 1..1 | ||||
Type | Money(DP_Money_SAR) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed to explain the distribution of the payment to the payables. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
108. PaymentReconciliation.formCode | |||||
Definition | A code for the form to be used for printing the content. | ||||
Short | Printed form identifier | ||||
Comments | May be needed to identify specific jurisdictional forms. | ||||
Control | 0..1 | ||||
Binding | For example codes, see Form Codes (example to http://hl7.org/fhir/ValueSet/forms )The forms codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed to specify the specific form used for producing output for this response. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
110. PaymentReconciliation.processNote | |||||
Definition | A note that describes or explains the processing in a human readable form. | ||||
Short | Note concerning processing | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides the specific textual explanations associated with the processing. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
112. PaymentReconciliation.processNote.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
114. PaymentReconciliation.processNote.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
116. PaymentReconciliation.processNote.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
118. PaymentReconciliation.processNote.type | |||||
Definition | The business purpose of the note text. | ||||
Short | display | print | printoper | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from NoteType (required to http://hl7.org/fhir/ValueSet/note-type|4.0.1 )The presentation types of notes. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To convey the expectation for when the text is used. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
120. PaymentReconciliation.processNote.text | |||||
Definition | The explanation or description associated with the processing. | ||||
Short | Note explanatory text | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Required to provide human readable explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |