Packages

ISO/HL7 FHIR Application Server

Current section

Files

Jump to
hl7 priv samples PaymentReconciliation PaymentReconciliation-ER2500.json
Raw

priv/samples/PaymentReconciliation/PaymentReconciliation-ER2500.json

{"resourceType":"PaymentReconciliation","id":"ER2500","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the PaymentReconciliation\u003c/div\u003e"},"identifier":[{"system":"http://www.BenefitsInc.com/fhir/enrollmentresponse","value":"781234"}],"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payment-type","code":"payment"}]},"status":"active","period":{"start":"2014-08-16","end":"2014-08-31"},"created":"2014-08-16","paymentIssuer":{"reference":"Organization/2"},"request":{"reference":"http://www.BenefitsInc.com/fhir/eligibility/225476332402"},"requestor":{"reference":"Organization/1"},"outcome":"complete","disposition":"2014 August mid-month settlement.","date":"2014-08-01","amount":{"value":7000.00,"currency":"USD"},"paymentIdentifier":{"system":"http://www.BenefitsInc.com/payment/2018","value":"10-12345"},"allocation":[{"identifier":{"system":"http://www.BenefitsInc.com/payment/2018/detail","value":"10-12345-001"},"target":{"identifier":{"system":"http://happyvalleyclinic.com/claim","value":"AB12345"}},"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payment-type","code":"payment"}]},"submitter":{"reference":"Organization/1"},"response":{"identifier":{"system":"http://www.BenefitsInc.com/fhir/claimresponse","value":"CR20140815-AB12345"}},"date":"2014-08-16","payee":{"reference":"Organization/1"},"amount":{"value":3500.00,"currency":"USD"}},{"identifier":{"system":"http://www.BenefitsInc.com/payment/2018/detail","value":"10-12345-002"},"target":{"reference":"http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699"},"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payment-type","code":"payment"}]},"date":"2014-08-12","amount":{"value":4000.00,"currency":"USD"}},{"identifier":{"system":"http://www.BenefitsInc.com/payment/2018/detail","value":"10-12345-003"},"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payment-type","code":"advance"}]},"date":"2014-08-16","amount":{"value":-1500.00,"currency":"USD"}}],"formCode":{"coding":[{"system":"http://ncforms.org/formid","code":"PAYREC/2016/01B"}]},"processNote":[{"type":"display","text":"Due to the year end holiday the cutoff for submissions for December will be the 28th."}],"meta":{"tag":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActReason","code":"HTEST","display":"test health data"}]}}