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

Payment Notification

Overview

This use case enables Healthcare Providers (HCPs) to notify nphies that a submitted Payment Reconciliation has been received and the corresponding payment has been processed by the HIC. The Payment Notice serves as a confirmation message from the HCP acknowledging receipt of the payment. The service also supports linking the notice to an existing Payment Reconciliation for traceability, reconciliation and regulatory purposes.

Workflow

1. Provider sends an Payment Notice Message to the nphies system.
2. nphies validates the message and if valid proceeds to Step 3 and return errors, otherwise proceeds to Step 2.
3. nphies stores the request message and returns an Acknowlegement Message indicating successful receipt of the Payment Notice Message or errors to the provider.

This is a REAL TIME use case. In addition to returning the aknowledgement, nphies will provide the Meta Tag: queued-messages should any messages remain in the queue.

Message Structures

Payment Notice Message

The key resources for the message are provided below and all require nphies-profiled resources as provided in the Artifacts. Note: the MessageHeader resource must be the first .entry in the bundle and any other resources may follow in any order.

Nphies Bundle (.type = message )
  Nphies MessageHeader (.eventCoding = payment-notice)
  Nphies PaymentNotice 
  Nphies Organization (Provider)
  Nphies Organization (nphies)
  [any additional resources]

Acknowledgement Message

See Acknowledgement Message.

Guidance

Providers SHALL submit a PaymentNotice message to nphies only after receiving the actual payment in their bank account regarding a Payment Reconciliation. This supports accurate tracking of payments made by insurers and supports identify missing payments.

See also: Information Guides.

Full Message Examples

Key Extensions

None to report.

Error Handling

If nphies detects errors in the request message such that the request cannot be processed then the response message will contain an OperationOutcome resource rather than a business-level Poll Response resource. Otherwise if nphies detects errors within the request it will return a Poll Response with errors (Task.output.type = 'error') and an extension indicating where the error occurred.

Like all other response messages the provider receives from nphies, if there are other messages queued at nphies which have not been delivered to the provider then this will be reflected in the presence of a MessageHeader.meta.tag.