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

: PaymentReconciliation/example-01 - JSON Representation

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{
  "resourceType" : "PaymentReconciliation",
  "id" : "example-01",
  "meta" : {
    "profile" : [
      🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentReconciliation"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PaymentReconciliation example-01</b></p><a name=\"example-01\"> </a><a name=\"hcexample-01\"> </a><a name=\"example-01-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>: 2024-03-01 11:01:00+0500 --&gt; 2024-03-31 11:01:00+0500</p><p><b>created</b>: 2024-03-31</p><p><b>paymentIssuer</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><p><b>requestor</b>: <a href=\"Organization-example-03.html\">Organization XYZ Hospital Co. Ltd.</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: 2024 march month settlement.</p><p><b>paymentDate</b>: 2024-03-31</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" : "2024-03-01T11:01:00+05:00",
    "end" : "2024-03-31T11:01:00+05:00"
  },
  "created" : "2024-03-31",
  "paymentIssuer" : {
    🔗 "reference" : "Organization/example-02"
  },
  "requestor" : {
    🔗 "reference" : "Organization/example-03"
  },
  "outcome" : "complete",
  "disposition" : "2024 march month settlement.",
  "paymentDate" : "2024-03-31",
  "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"
      }
    }
  ]
}