FHIR Implementation Guide for ABDM
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This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: TaskBundleForPaymentNoticeRequest-example-01 - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "TaskBundleForPaymentNoticeRequest-example-01",
  "meta" : {
    "profile" : [
      🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/TaskBundle"
    ],
    "security" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
        "code" : "V",
        "display" : "very restricted"
      }
    ]
  },
  "identifier" : {
    "value" : "bc3c6c57-2053-4d0e-ac40-139ccccff645"
  },
  "type" : "collection",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:c147ae4a-f6c1-4375-a5bb-cedf69235521",
      "resource" : {
        "resourceType" : "Task",
        "id" : "c147ae4a-f6c1-4375-a5bb-cedf69235521",
        "meta" : {
          "profile" : [
            🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Task"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Task_c147ae4a-f6c1-4375-a5bb-cedf69235521\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Task c147ae4a-f6c1-4375-a5bb-cedf69235521</b></p><a name=\"c147ae4a-f6c1-4375-a5bb-cedf69235521\"> </a><a name=\"hcc147ae4a-f6c1-4375-a5bb-cedf69235521\"> </a><a name=\"c147ae4a-f6c1-4375-a5bb-cedf69235521-hi-IN\"> </a><p><b>status</b>: Requested</p><p><b>intent</b>: order</p><p><b>code</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-task-codes deliver}\">deliver</span></p><p><b>description</b>: payment status Check</p><p><b>authoredOn</b>: 2025-03-07</p><p><b>requester</b>: <a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-a5b973a0-7274-4158-9f47-398be057b8e1\">Organization-insurance-company</a></p><p><b>owner</b>: <a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-5adfff18-d900-4016-bfa1-987af186bf8f\">Organization-hospital</a></p><h3>Inputs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/financialtaskinputtype status}\">Status code</span></td><td><a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-dd6916d4-485d-45d3-bcc9-f067cab42a70\">PaymentNotice</a></td></tr></table></div>"
        },
        "status" : "requested",
        "intent" : "order",
        "code" : {
          "coding" : [
            {
              "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-task-codes",
              "code" : "deliver"
            }
          ]
        },
        "description" : "payment status Check",
        "authoredOn" : "2025-03-07",
        "requester" : {
          "reference" : "urn:uuid:a5b973a0-7274-4158-9f47-398be057b8e1",
          "display" : "Organization-insurance-company"
        },
        "owner" : {
          "reference" : "urn:uuid:5adfff18-d900-4016-bfa1-987af186bf8f",
          "display" : "Organization-hospital"
        },
        "input" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/financialtaskinputtype",
                  "code" : "status"
                }
              ]
            },
            "valueReference" : {
              "reference" : "urn:uuid:dd6916d4-485d-45d3-bcc9-f067cab42a70",
              "display" : "PaymentNotice"
            }
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:dd6916d4-485d-45d3-bcc9-f067cab42a70",
      "resource" : {
        "resourceType" : "PaymentNotice",
        "id" : "dd6916d4-485d-45d3-bcc9-f067cab42a70",
        "meta" : {
          "profile" : [
            🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentNotice"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"PaymentNotice_dd6916d4-485d-45d3-bcc9-f067cab42a70\"> </a><p class=\"res-header-id\"><b>Generated Narrative: PaymentNotice dd6916d4-485d-45d3-bcc9-f067cab42a70</b></p><a name=\"dd6916d4-485d-45d3-bcc9-f067cab42a70\"> </a><a name=\"hcdd6916d4-485d-45d3-bcc9-f067cab42a70\"> </a><a name=\"dd6916d4-485d-45d3-bcc9-f067cab42a70-hi-IN\"> </a><p><b>identifier</b>: <code>http://benefitsinc.com/paymentnotice</code>/776543</p><p><b>status</b>: Active</p><p><b>created</b>: 2025-03-07 14:58:58+0530</p><p><b>payment</b>: <a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-498c0785-7cb6-4e18-9848-e61f515ca257\">PaymentReconciliation</a></p><p><b>paymentDate</b>: 2025-03-07</p><p><b>recipient</b>: <a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-5adfff18-d900-4016-bfa1-987af186bf8f\">Organization-hospital</a></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>180000</td><td>Indian rupee</td></tr></table><p><b>paymentStatus</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/paymentstatus paid}\">Paid</span></p></div>"
        },
        "identifier" : [
          {
            "system" : "http://benefitsinc.com/paymentnotice",
            "value" : "776543"
          }
        ],
        "status" : "active",
        "created" : "2025-03-07T14:58:58.181+05:30",
        "payment" : {
          "reference" : "urn:uuid:498c0785-7cb6-4e18-9848-e61f515ca257",
          "display" : "PaymentReconciliation"
        },
        "paymentDate" : "2025-03-07",
        "recipient" : {
          "reference" : "urn:uuid:5adfff18-d900-4016-bfa1-987af186bf8f",
          "display" : "Organization-hospital"
        },
        "amount" : {
          "value" : 180000,
          "currency" : "INR"
        },
        "paymentStatus" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/paymentstatus",
              "code" : "paid"
            }
          ]
        }
      }
    },
    {
      "fullUrl" : "urn:uuid:a5b973a0-7274-4158-9f47-398be057b8e1",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "a5b973a0-7274-4158-9f47-398be057b8e1",
        "meta" : {
          "profile" : [
            🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_a5b973a0-7274-4158-9f47-398be057b8e1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization a5b973a0-7274-4158-9f47-398be057b8e1</b></p><a name=\"a5b973a0-7274-4158-9f47-398be057b8e1\"> </a><a name=\"hca5b973a0-7274-4158-9f47-398be057b8e1\"> </a><a name=\"a5b973a0-7274-4158-9f47-398be057b8e1-hi-IN\"> </a><p><b>identifier</b>: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: XYZ Insurance Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
                  "code" : "ROHINI",
                  "display" : "Registry of Hospitals in Network of Insurance (ROHINI) ID"
                }
              ]
            },
            "system" : "https://rohini.iib.gov.in/",
            "value" : "4567878"
          }
        ],
        "type" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "ins",
                "display" : "Insurance Company"
              }
            ]
          }
        ],
        "name" : "XYZ Insurance Co. Ltd.",
        "telecom" : [
          {
            "system" : "phone",
            "value" : "+91 243 2634 1234",
            "use" : "work"
          },
          {
            "system" : "email",
            "value" : "contact@xyz.org",
            "use" : "work"
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:5adfff18-d900-4016-bfa1-987af186bf8f",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "5adfff18-d900-4016-bfa1-987af186bf8f",
        "meta" : {
          "profile" : [
            🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_5adfff18-d900-4016-bfa1-987af186bf8f\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 5adfff18-d900-4016-bfa1-987af186bf8f</b></p><a name=\"5adfff18-d900-4016-bfa1-987af186bf8f\"> </a><a name=\"hc5adfff18-d900-4016-bfa1-987af186bf8f\"> </a><a name=\"5adfff18-d900-4016-bfa1-987af186bf8f-hi-IN\"> </a><p><b>identifier</b>: Provider number/45675454</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: XYZ Hospital Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341278\">+91 243 2634 1278</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "PRN",
                  "display" : "Provider number"
                }
              ]
            },
            "system" : "https://facility.ndhm.gov.in",
            "value" : "45675454"
          }
        ],
        "type" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "prov",
                "display" : "Healthcare Provider"
              }
            ]
          }
        ],
        "name" : "XYZ Hospital Co. Ltd.",
        "telecom" : [
          {
            "system" : "phone",
            "value" : "+91 243 2634 1278",
            "use" : "work"
          },
          {
            "system" : "email",
            "value" : "contact@xyz.org",
            "use" : "work"
          }
        ]
      }
    },
    {
      "fullUrl" : "urn:uuid:498c0785-7cb6-4e18-9848-e61f515ca257",
      "resource" : {
        "resourceType" : "PaymentReconciliation",
        "id" : "498c0785-7cb6-4e18-9848-e61f515ca257",
        "meta" : {
          "profile" : [
            🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentReconciliation"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"PaymentReconciliation_498c0785-7cb6-4e18-9848-e61f515ca257\"> </a><p class=\"res-header-id\"><b>Generated Narrative: PaymentReconciliation 498c0785-7cb6-4e18-9848-e61f515ca257</b></p><a name=\"498c0785-7cb6-4e18-9848-e61f515ca257\"> </a><a name=\"hc498c0785-7cb6-4e18-9848-e61f515ca257\"> </a><a name=\"498c0785-7cb6-4e18-9848-e61f515ca257-hi-IN\"> </a><p><b>identifier</b>: <code>http://www.BenefitsInc.com/fhir/enrollmentresponse</code>/781234</p><p><b>status</b>: Active</p><p><b>period</b>: 2025-03-01 11:01:00+0500 --&gt; 2025-03-07 11:01:00+0500</p><p><b>created</b>: 2025-03-07</p><p><b>paymentIssuer</b>: <a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-a5b973a0-7274-4158-9f47-398be057b8e1\">Organization-Insurance-Company</a></p><p><b>requestor</b>: <a href=\"Bundle-TaskBundleForPaymentNoticeRequest-example-01.html#urn-uuid-5adfff18-d900-4016-bfa1-987af186bf8f\">Organization-hospital</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: 2025 march month settlement.</p><p><b>paymentDate</b>: 2025-03-07</p><h3>PaymentAmounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>180000</td><td>Indian rupee</td></tr></table><p><b>paymentIdentifier</b>: UTRNUMBER2920287229</p><blockquote><p><b>detail</b></p><p><b>identifier</b>: CLAIMREFNUM7612345</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type approvedAmount}\">Approved Amount</span></p><p><b>date</b>: 2024-03-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>90000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>identifier</b>: CLAIMREFNUM7612345</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type tds}\">TDS Deduction</span></p><p><b>date</b>: 2024-03-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>9000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>identifier</b>: CLAIMREFNUM6789054</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type approvedAmount}\">Approved Amount</span></p><p><b>date</b>: 2024-03-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>110000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>identifier</b>: CLAIMREFNUM6789054</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type tds}\">TDS Deduction</span></p><p><b>date</b>: 2024-03-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>11000</td><td>Indian rupee</td></tr></table></blockquote></div>"
        },
        "identifier" : [
          {
            "system" : "http://www.BenefitsInc.com/fhir/enrollmentresponse",
            "value" : "781234"
          }
        ],
        "status" : "active",
        "period" : {
          "start" : "2025-03-01T11:01:00+05:00",
          "end" : "2025-03-07T11:01:00+05:00"
        },
        "created" : "2025-03-07",
        "paymentIssuer" : {
          "reference" : "urn:uuid:a5b973a0-7274-4158-9f47-398be057b8e1",
          "display" : "Organization-Insurance-Company"
        },
        "requestor" : {
          "reference" : "urn:uuid:5adfff18-d900-4016-bfa1-987af186bf8f",
          "display" : "Organization-hospital"
        },
        "outcome" : "complete",
        "disposition" : "2025 march month settlement.",
        "paymentDate" : "2025-03-07",
        "paymentAmount" : {
          "value" : 180000,
          "currency" : "INR"
        },
        "paymentIdentifier" : {
          "value" : "UTRNUMBER2920287229"
        },
        "detail" : [
          {
            "identifier" : {
              "value" : "CLAIMREFNUM7612345"
            },
            "type" : {
              "coding" : [
                {
                  "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type",
                  "code" : "approvedAmount",
                  "display" : "Approved Amount"
                }
              ]
            },
            "date" : "2024-03-31",
            "amount" : {
              "value" : 90000,
              "currency" : "INR"
            }
          },
          {
            "identifier" : {
              "value" : "CLAIMREFNUM7612345"
            },
            "type" : {
              "coding" : [
                {
                  "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type",
                  "code" : "tds",
                  "display" : "TDS Deduction"
                }
              ]
            },
            "date" : "2024-03-31",
            "amount" : {
              "value" : 9000,
              "currency" : "INR"
            }
          },
          {
            "identifier" : {
              "value" : "CLAIMREFNUM6789054"
            },
            "type" : {
              "coding" : [
                {
                  "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type",
                  "code" : "approvedAmount",
                  "display" : "Approved Amount"
                }
              ]
            },
            "date" : "2024-03-31",
            "amount" : {
              "value" : 110000,
              "currency" : "INR"
            }
          },
          {
            "identifier" : {
              "value" : "CLAIMREFNUM6789054"
            },
            "type" : {
              "coding" : [
                {
                  "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type",
                  "code" : "tds",
                  "display" : "TDS Deduction"
                }
              ]
            },
            "date" : "2024-03-31",
            "amount" : {
              "value" : 11000,
              "currency" : "INR"
            }
          }
        ]
      }
    }
  ]
}