Healthcare Financial Services IG Edition 1
0.4.0 - STU-Ballot with Updates
Healthcare Financial Services IG Edition 1
0.4.0 - STU-Ballot with Updates
Healthcare Financial Services IG Edition 1 - Local Development build (v0.4.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/payment-reconciliation | Version: 0.4.0 | |||
| Draft as of 2025-10-12 | Computable Name: NphiesPaymentReconciliation | |||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
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Nphies Payment Reconciliation Profile
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  PaymentReconciliation |
C | 0..* | PaymentReconciliation | PaymentReconciliation resource Constraints: BV-00053, BV-00191, BV-00194, BV-00337, BV-00338, BV-00361 |
  id |
Σ | 1..1 | id | Logical id of this artifact Max Length:64 |
  meta |
Σ | 1..1 | Meta | Metadata about the resource |
  profile |
Σ | 1..* | DP_canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier |
1..1 | DP_Identifier_A | Business Identifier for a payment reconciliation | |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active |
| period |
Σ | 1..1 | DP_Period_2 | Period covered |
| created |
Σ | 1..1 | DP_dateTime | Creation date |
 paymentIssuer |
Σ | 1..1 | DP_Reference_1or2a(Nphies Insurer Organization) | Party generating payment |
| requestor |
1..1 | DP_Reference_1or2a(Nphies Provider Organization) | Responsible practitioner | |
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | |
| disposition |
0..1 | DP_string | Disposition message | |
| paymentDate |
Σ | 1..1 | DP_date | When payment issued |
| paymentAmount |
ΣC | 1..1 | DP_Money_SAR | Total amount of Payment Constraints: BV-00083 |
| paymentIdentifier |
0..1 | DP_Identifier_C | Business identifier for the payment | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
Σ | 1..1 | DP_CodeableConcept | Description of identifier Binding: Payment Method (required) |
| system |
SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 Max Length:50 |
 detail |
1..* | BackboneElement | Settlement particulars | |
  Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
  extension:component-payment |
S | 1..1 | DP_Money_SAR | Component - Payment URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment |
| extension:component-early-fee |
S | 0..1 | DP_Money_SAR | Component - Early Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee |
 extension:component-nphies-fee |
S | 0..1 | DP_Money_SAR | Component - nphies Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier |
S | 0..1 | DP_Identifier_A | Business identifier of the payment detail |
| predecessor |
S | 0..1 | DP_Identifier_A | Business identifier of the prior payment detail |
| type |
1..1 | DP_CodeableConcept | Category of payment Binding: PaymentTypeCodes (required) | |
| request |
S | 0..1 | DP_Reference_3a(Nphies Claim Institutional | Nphies Claim Oral | Nphies Claim Pharmacy | Nphies Claim Professional | Nphies Claim Vision) | Request giving rise to the payment |
| submitter |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Submitter of the request |
| response |
S | 0..1 | DP_Reference_3a(Nphies Claim Response) | Response committing to a payment |
| date |
1..1 | DP_date | Date of commitment to pay | |
| payee |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Recipient of the payment |
| amount |
C | 1..1 | DP_Money_SAR | Amount allocated to this payable Constraints: BV-00082 |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| PaymentReconciliation.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.type | Base | required | Payment Method | 📦0.4.0 | This IG |
| PaymentReconciliation.detail.type | Base | required | Payment Type Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| BV-00053 | error | PaymentReconciliation | PaymentReconciliation period end date is after PaymentReconciliation created date. |
period.exists() implies created.exists() implies period.end >= created
|
| BV-00082 | error | PaymentReconciliation.detail.amount | PaymentReconciliation detail amount currency is not SAR. |
currency = 'SAR'
|
| BV-00083 | error | PaymentReconciliation.paymentAmount | PaymentReconciliation paymentAmount currency is not SAR. |
currency = 'SAR'
|
| BV-00191 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists()
|
| BV-00194 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists() implies identifier.value.exists()
|
| BV-00337 | error | PaymentReconciliation | PaymentReconciliation status is not using the specified value 'active'. |
status.exists() implies status='active'
|
| BV-00338 | error | PaymentReconciliation | PaymentReconciliation outcome is not using the specified value 'complete'. |
outcome.exists() implies outcome='complete'
|
| BV-00361 | error | PaymentReconciliation | PaymentReconciliation created date cannot be in the future. |
created.exists() implies created <= now()
|
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from PaymentReconciliation
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| PaymentReconciliation |
C | 0..* | PaymentReconciliation | PaymentReconciliation resource Constraints: BV-00053, BV-00191, BV-00194, BV-00337, BV-00338, BV-00361 |
 id |
1..1 | id | Logical id of this artifact Max Length:64 | |
| meta |
1..1 | Meta | Metadata about the resource | |
| profile |
1..* | DP_canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| identifier |
1..1 | DP_Identifier_A | Business Identifier for a payment reconciliation | |
| status |
1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
| period |
1..1 | DP_Period_2 | Period covered | |
| created |
1..1 | DP_dateTime | Creation date | |
| paymentIssuer |
1..1 | DP_Reference_1or2a(Nphies Insurer Organization) | Party generating payment | |
| requestor |
1..1 | DP_Reference_1or2a(Nphies Provider Organization) | Responsible practitioner | |
| outcome |
1..1 | code | queued | complete | error | partial Required Pattern: complete | |
| disposition |
0..1 | DP_string | Disposition message | |
| paymentDate |
1..1 | DP_date | When payment issued | |
| paymentAmount |
C | 1..1 | DP_Money_SAR | Total amount of Payment Constraints: BV-00083 |
| paymentIdentifier |
0..1 | DP_Identifier_C | Business identifier for the payment | |
| type |
1..1 | DP_CodeableConcept | Description of identifier Binding: Payment Method (required) | |
| detail |
1..* | BackboneElement | Settlement particulars | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:component-payment |
S | 1..1 | DP_Money_SAR | Component - Payment URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment |
| extension:component-early-fee |
S | 0..1 | DP_Money_SAR | Component - Early Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee |
| extension:component-nphies-fee |
S | 0..1 | DP_Money_SAR | Component - nphies Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee |
| identifier |
S | 0..1 | DP_Identifier_A | Business identifier of the payment detail |
| predecessor |
S | 0..1 | DP_Identifier_A | Business identifier of the prior payment detail |
| type |
1..1 | DP_CodeableConcept | Category of payment Binding: PaymentTypeCodes (required) | |
| request |
S | 0..1 | DP_Reference_3a(Nphies Claim Institutional | Nphies Claim Oral | Nphies Claim Pharmacy | Nphies Claim Professional | Nphies Claim Vision) | Request giving rise to the payment |
| submitter |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Submitter of the request |
| response |
S | 0..1 | DP_Reference_3a(Nphies Claim Response) | Response committing to a payment |
| date |
1..1 | DP_date | Date of commitment to pay | |
| payee |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Recipient of the payment |
| amount |
C | 1..1 | DP_Money_SAR | Amount allocated to this payable Constraints: BV-00082 |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| PaymentReconciliation.paymentIdentifier.type | Base | required | Payment Method | 📦0.4.0 | This IG |
| PaymentReconciliation.detail.type | Base | required | Payment Type Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| BV-00053 | error | PaymentReconciliation | PaymentReconciliation period end date is after PaymentReconciliation created date. |
period.exists() implies created.exists() implies period.end >= created
|
| BV-00082 | error | PaymentReconciliation.detail.amount | PaymentReconciliation detail amount currency is not SAR. |
currency = 'SAR'
|
| BV-00083 | error | PaymentReconciliation.paymentAmount | PaymentReconciliation paymentAmount currency is not SAR. |
currency = 'SAR'
|
| BV-00191 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists()
|
| BV-00194 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists() implies identifier.value.exists()
|
| BV-00337 | error | PaymentReconciliation | PaymentReconciliation status is not using the specified value 'active'. |
status.exists() implies status='active'
|
| BV-00338 | error | PaymentReconciliation | PaymentReconciliation outcome is not using the specified value 'complete'. |
outcome.exists() implies outcome='complete'
|
| BV-00361 | error | PaymentReconciliation | PaymentReconciliation created date cannot be in the future. |
created.exists() implies created <= now()
|
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| PaymentReconciliation |
C | 0..* | PaymentReconciliation | PaymentReconciliation resource Constraints: BV-00053, BV-00191, BV-00194, BV-00337, BV-00338, BV-00361 | ||||
| id |
Σ | 1..1 | id | Logical id of this artifact Max Length:64 | ||||
| meta |
Σ | 1..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
Σ | 0..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
Σ | 1..* | DP_canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
1..1 | DP_Identifier_A | Business Identifier for a payment reconciliation | |||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
| period |
Σ | 1..1 | DP_Period_2 | Period covered | ||||
| created |
Σ | 1..1 | DP_dateTime | Creation date | ||||
| paymentIssuer |
Σ | 1..1 | DP_Reference_1or2a(Nphies Insurer Organization) | Party generating payment | ||||
| request |
0..1 | Reference(Task) | Reference to requesting resource | |||||
| requestor |
1..1 | DP_Reference_1or2a(Nphies Provider Organization) | Responsible practitioner | |||||
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | |||||
| disposition |
0..1 | DP_string | Disposition message | |||||
| paymentDate |
Σ | 1..1 | DP_date | When payment issued | ||||
| paymentAmount |
ΣC | 1..1 | DP_Money_SAR | Total amount of Payment Constraints: BV-00083 | ||||
| paymentIdentifier |
0..1 | DP_Identifier_C | Business identifier for the payment | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 1..1 | DP_CodeableConcept | Description of identifier Binding: Payment Method (required) | ||||
| system |
SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 Max Length:50 | ||||
| period |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| detail |
1..* | BackboneElement | Settlement particulars | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:component-payment |
S | 1..1 | DP_Money_SAR | Component - Payment URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment | ||||
| extension:component-early-fee |
S | 0..1 | DP_Money_SAR | Component - Early Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee | ||||
| extension:component-nphies-fee |
S | 0..1 | DP_Money_SAR | Component - nphies Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier |
S | 0..1 | DP_Identifier_A | Business identifier of the payment detail | ||||
| predecessor |
S | 0..1 | DP_Identifier_A | Business identifier of the prior payment detail | ||||
| type |
1..1 | DP_CodeableConcept | Category of payment Binding: PaymentTypeCodes (required) | |||||
| request |
S | 0..1 | DP_Reference_3a(Nphies Claim Institutional | Nphies Claim Oral | Nphies Claim Pharmacy | Nphies Claim Professional | Nphies Claim Vision) | Request giving rise to the payment | ||||
| submitter |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Submitter of the request | ||||
| response |
S | 0..1 | DP_Reference_3a(Nphies Claim Response) | Response committing to a payment | ||||
| date |
1..1 | DP_date | Date of commitment to pay | |||||
| responsible |
0..1 | Reference(PractitionerRole) | Contact for the response | |||||
| payee |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Recipient of the payment | ||||
| amount |
C | 1..1 | DP_Money_SAR | Amount allocated to this payable Constraints: BV-00082 | ||||
| formCode |
0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| processNote |
0..* | BackboneElement | Note concerning processing | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanatory text | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| PaymentReconciliation.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.type | Base | required | Payment Method | 📦0.4.0 | This IG |
| PaymentReconciliation.detail.type | Base | required | Payment Type Codes | 📦4.0.1 | FHIR Std. |
| PaymentReconciliation.formCode | Base | example | Forms | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.processNote.type | Base | required | NoteType | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| BV-00053 | error | PaymentReconciliation | PaymentReconciliation period end date is after PaymentReconciliation created date. |
period.exists() implies created.exists() implies period.end >= created
|
| BV-00082 | error | PaymentReconciliation.detail.amount | PaymentReconciliation detail amount currency is not SAR. |
currency = 'SAR'
|
| BV-00083 | error | PaymentReconciliation.paymentAmount | PaymentReconciliation paymentAmount currency is not SAR. |
currency = 'SAR'
|
| BV-00191 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists()
|
| BV-00194 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists() implies identifier.value.exists()
|
| BV-00337 | error | PaymentReconciliation | PaymentReconciliation status is not using the specified value 'active'. |
status.exists() implies status='active'
|
| BV-00338 | error | PaymentReconciliation | PaymentReconciliation outcome is not using the specified value 'complete'. |
outcome.exists() implies outcome='complete'
|
| BV-00361 | error | PaymentReconciliation | PaymentReconciliation created date cannot be in the future. |
created.exists() implies created <= now()
|
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from PaymentReconciliation
Summary
Mandatory: 13 elements
Must-Support: 9 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| PaymentReconciliation |
C | 0..* | PaymentReconciliation | PaymentReconciliation resource Constraints: BV-00053, BV-00191, BV-00194, BV-00337, BV-00338, BV-00361 |
| id |
Σ | 1..1 | id | Logical id of this artifact Max Length:64 |
| meta |
Σ | 1..1 | Meta | Metadata about the resource |
| profile |
Σ | 1..* | DP_canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier |
1..1 | DP_Identifier_A | Business Identifier for a payment reconciliation | |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active |
| period |
Σ | 1..1 | DP_Period_2 | Period covered |
| created |
Σ | 1..1 | DP_dateTime | Creation date |
| paymentIssuer |
Σ | 1..1 | DP_Reference_1or2a(Nphies Insurer Organization) | Party generating payment |
| requestor |
1..1 | DP_Reference_1or2a(Nphies Provider Organization) | Responsible practitioner | |
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | |
| disposition |
0..1 | DP_string | Disposition message | |
| paymentDate |
Σ | 1..1 | DP_date | When payment issued |
| paymentAmount |
ΣC | 1..1 | DP_Money_SAR | Total amount of Payment Constraints: BV-00083 |
| paymentIdentifier |
0..1 | DP_Identifier_C | Business identifier for the payment | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
Σ | 1..1 | DP_CodeableConcept | Description of identifier Binding: Payment Method (required) |
| system |
SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 Max Length:50 |
| detail |
1..* | BackboneElement | Settlement particulars | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:component-payment |
S | 1..1 | DP_Money_SAR | Component - Payment URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment |
| extension:component-early-fee |
S | 0..1 | DP_Money_SAR | Component - Early Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee |
| extension:component-nphies-fee |
S | 0..1 | DP_Money_SAR | Component - nphies Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| identifier |
S | 0..1 | DP_Identifier_A | Business identifier of the payment detail |
| predecessor |
S | 0..1 | DP_Identifier_A | Business identifier of the prior payment detail |
| type |
1..1 | DP_CodeableConcept | Category of payment Binding: PaymentTypeCodes (required) | |
| request |
S | 0..1 | DP_Reference_3a(Nphies Claim Institutional | Nphies Claim Oral | Nphies Claim Pharmacy | Nphies Claim Professional | Nphies Claim Vision) | Request giving rise to the payment |
| submitter |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Submitter of the request |
| response |
S | 0..1 | DP_Reference_3a(Nphies Claim Response) | Response committing to a payment |
| date |
1..1 | DP_date | Date of commitment to pay | |
| payee |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Recipient of the payment |
| amount |
C | 1..1 | DP_Money_SAR | Amount allocated to this payable Constraints: BV-00082 |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| PaymentReconciliation.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.type | Base | required | Payment Method | 📦0.4.0 | This IG |
| PaymentReconciliation.detail.type | Base | required | Payment Type Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| BV-00053 | error | PaymentReconciliation | PaymentReconciliation period end date is after PaymentReconciliation created date. |
period.exists() implies created.exists() implies period.end >= created
|
| BV-00082 | error | PaymentReconciliation.detail.amount | PaymentReconciliation detail amount currency is not SAR. |
currency = 'SAR'
|
| BV-00083 | error | PaymentReconciliation.paymentAmount | PaymentReconciliation paymentAmount currency is not SAR. |
currency = 'SAR'
|
| BV-00191 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists()
|
| BV-00194 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists() implies identifier.value.exists()
|
| BV-00337 | error | PaymentReconciliation | PaymentReconciliation status is not using the specified value 'active'. |
status.exists() implies status='active'
|
| BV-00338 | error | PaymentReconciliation | PaymentReconciliation outcome is not using the specified value 'complete'. |
outcome.exists() implies outcome='complete'
|
| BV-00361 | error | PaymentReconciliation | PaymentReconciliation created date cannot be in the future. |
created.exists() implies created <= now()
|
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from PaymentReconciliation
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| PaymentReconciliation |
C | 0..* | PaymentReconciliation | PaymentReconciliation resource Constraints: BV-00053, BV-00191, BV-00194, BV-00337, BV-00338, BV-00361 |
| id |
1..1 | id | Logical id of this artifact Max Length:64 | |
| meta |
1..1 | Meta | Metadata about the resource | |
| profile |
1..* | DP_canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| identifier |
1..1 | DP_Identifier_A | Business Identifier for a payment reconciliation | |
| status |
1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
| period |
1..1 | DP_Period_2 | Period covered | |
| created |
1..1 | DP_dateTime | Creation date | |
| paymentIssuer |
1..1 | DP_Reference_1or2a(Nphies Insurer Organization) | Party generating payment | |
| requestor |
1..1 | DP_Reference_1or2a(Nphies Provider Organization) | Responsible practitioner | |
| outcome |
1..1 | code | queued | complete | error | partial Required Pattern: complete | |
| disposition |
0..1 | DP_string | Disposition message | |
| paymentDate |
1..1 | DP_date | When payment issued | |
| paymentAmount |
C | 1..1 | DP_Money_SAR | Total amount of Payment Constraints: BV-00083 |
| paymentIdentifier |
0..1 | DP_Identifier_C | Business identifier for the payment | |
| type |
1..1 | DP_CodeableConcept | Description of identifier Binding: Payment Method (required) | |
| detail |
1..* | BackboneElement | Settlement particulars | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:component-payment |
S | 1..1 | DP_Money_SAR | Component - Payment URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment |
| extension:component-early-fee |
S | 0..1 | DP_Money_SAR | Component - Early Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee |
| extension:component-nphies-fee |
S | 0..1 | DP_Money_SAR | Component - nphies Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee |
| identifier |
S | 0..1 | DP_Identifier_A | Business identifier of the payment detail |
| predecessor |
S | 0..1 | DP_Identifier_A | Business identifier of the prior payment detail |
| type |
1..1 | DP_CodeableConcept | Category of payment Binding: PaymentTypeCodes (required) | |
| request |
S | 0..1 | DP_Reference_3a(Nphies Claim Institutional | Nphies Claim Oral | Nphies Claim Pharmacy | Nphies Claim Professional | Nphies Claim Vision) | Request giving rise to the payment |
| submitter |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Submitter of the request |
| response |
S | 0..1 | DP_Reference_3a(Nphies Claim Response) | Response committing to a payment |
| date |
1..1 | DP_date | Date of commitment to pay | |
| payee |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Recipient of the payment |
| amount |
C | 1..1 | DP_Money_SAR | Amount allocated to this payable Constraints: BV-00082 |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| PaymentReconciliation.paymentIdentifier.type | Base | required | Payment Method | 📦0.4.0 | This IG |
| PaymentReconciliation.detail.type | Base | required | Payment Type Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| BV-00053 | error | PaymentReconciliation | PaymentReconciliation period end date is after PaymentReconciliation created date. |
period.exists() implies created.exists() implies period.end >= created
|
| BV-00082 | error | PaymentReconciliation.detail.amount | PaymentReconciliation detail amount currency is not SAR. |
currency = 'SAR'
|
| BV-00083 | error | PaymentReconciliation.paymentAmount | PaymentReconciliation paymentAmount currency is not SAR. |
currency = 'SAR'
|
| BV-00191 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists()
|
| BV-00194 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists() implies identifier.value.exists()
|
| BV-00337 | error | PaymentReconciliation | PaymentReconciliation status is not using the specified value 'active'. |
status.exists() implies status='active'
|
| BV-00338 | error | PaymentReconciliation | PaymentReconciliation outcome is not using the specified value 'complete'. |
outcome.exists() implies outcome='complete'
|
| BV-00361 | error | PaymentReconciliation | PaymentReconciliation created date cannot be in the future. |
created.exists() implies created <= now()
|
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| PaymentReconciliation |
C | 0..* | PaymentReconciliation | PaymentReconciliation resource Constraints: BV-00053, BV-00191, BV-00194, BV-00337, BV-00338, BV-00361 | ||||
| id |
Σ | 1..1 | id | Logical id of this artifact Max Length:64 | ||||
| meta |
Σ | 1..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
Σ | 0..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
Σ | 1..* | DP_canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
1..1 | DP_Identifier_A | Business Identifier for a payment reconciliation | |||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
| period |
Σ | 1..1 | DP_Period_2 | Period covered | ||||
| created |
Σ | 1..1 | DP_dateTime | Creation date | ||||
| paymentIssuer |
Σ | 1..1 | DP_Reference_1or2a(Nphies Insurer Organization) | Party generating payment | ||||
| request |
0..1 | Reference(Task) | Reference to requesting resource | |||||
| requestor |
1..1 | DP_Reference_1or2a(Nphies Provider Organization) | Responsible practitioner | |||||
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | |||||
| disposition |
0..1 | DP_string | Disposition message | |||||
| paymentDate |
Σ | 1..1 | DP_date | When payment issued | ||||
| paymentAmount |
ΣC | 1..1 | DP_Money_SAR | Total amount of Payment Constraints: BV-00083 | ||||
| paymentIdentifier |
0..1 | DP_Identifier_C | Business identifier for the payment | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 1..1 | DP_CodeableConcept | Description of identifier Binding: Payment Method (required) | ||||
| system |
SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 Max Length:50 | ||||
| period |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| detail |
1..* | BackboneElement | Settlement particulars | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:component-payment |
S | 1..1 | DP_Money_SAR | Component - Payment URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-payment | ||||
| extension:component-early-fee |
S | 0..1 | DP_Money_SAR | Component - Early Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-early-fee | ||||
| extension:component-nphies-fee |
S | 0..1 | DP_Money_SAR | Component - nphies Fee URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-component-nphies-fee | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier |
S | 0..1 | DP_Identifier_A | Business identifier of the payment detail | ||||
| predecessor |
S | 0..1 | DP_Identifier_A | Business identifier of the prior payment detail | ||||
| type |
1..1 | DP_CodeableConcept | Category of payment Binding: PaymentTypeCodes (required) | |||||
| request |
S | 0..1 | DP_Reference_3a(Nphies Claim Institutional | Nphies Claim Oral | Nphies Claim Pharmacy | Nphies Claim Professional | Nphies Claim Vision) | Request giving rise to the payment | ||||
| submitter |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Submitter of the request | ||||
| response |
S | 0..1 | DP_Reference_3a(Nphies Claim Response) | Response committing to a payment | ||||
| date |
1..1 | DP_date | Date of commitment to pay | |||||
| responsible |
0..1 | Reference(PractitionerRole) | Contact for the response | |||||
| payee |
S | 0..1 | DP_Reference_1or2a(Nphies Provider Organization) | Recipient of the payment | ||||
| amount |
C | 1..1 | DP_Money_SAR | Amount allocated to this payable Constraints: BV-00082 | ||||
| formCode |
0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| processNote |
0..* | BackboneElement | Note concerning processing | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanatory text | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| PaymentReconciliation.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.paymentIdentifier.type | Base | required | Payment Method | 📦0.4.0 | This IG |
| PaymentReconciliation.detail.type | Base | required | Payment Type Codes | 📦4.0.1 | FHIR Std. |
| PaymentReconciliation.formCode | Base | example | Forms | 📍4.0.1 | FHIR Std. |
| PaymentReconciliation.processNote.type | Base | required | NoteType | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| BV-00053 | error | PaymentReconciliation | PaymentReconciliation period end date is after PaymentReconciliation created date. |
period.exists() implies created.exists() implies period.end >= created
|
| BV-00082 | error | PaymentReconciliation.detail.amount | PaymentReconciliation detail amount currency is not SAR. |
currency = 'SAR'
|
| BV-00083 | error | PaymentReconciliation.paymentAmount | PaymentReconciliation paymentAmount currency is not SAR. |
currency = 'SAR'
|
| BV-00191 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists()
|
| BV-00194 | error | PaymentReconciliation | The PaymentReconciliation identifier does not exist. |
identifier.exists() implies identifier.value.exists()
|
| BV-00337 | error | PaymentReconciliation | PaymentReconciliation status is not using the specified value 'active'. |
status.exists() implies status='active'
|
| BV-00338 | error | PaymentReconciliation | PaymentReconciliation outcome is not using the specified value 'complete'. |
outcome.exists() implies outcome='complete'
|
| BV-00361 | error | PaymentReconciliation | PaymentReconciliation created date cannot be in the future. |
created.exists() implies created <= now()
|
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from PaymentReconciliation
Summary
Mandatory: 13 elements
Must-Support: 9 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron