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

• Narrative Content
• XML
• JSON
• TTL

: PaymentReconciliation/example-01 - XML Representation

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<PaymentReconciliation xmlns="http://hl7.org/fhir">
  <id value="example-01"/>
  <meta>
    <profile
             value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentReconciliation"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <system value="http://www.BenefitsInc.com/fhir/enrollmentresponse"/>
    <value value="781234"/>
  </identifier>
  <status value="active"/>
  <period>
    <start value="2024-03-01T11:01:00+05:00"/>
    <end value="2024-03-31T11:01:00+05:00"/>
  </period>
  <created value="2024-03-31"/>
  <paymentIssuer>🔗 
    <reference value="Organization/example-02"/>
  </paymentIssuer>
  <requestor>🔗 
    <reference value="Organization/example-03"/>
  </requestor>
  <outcome value="complete"/>
  <disposition value="2024 march month settlement."/>
  <paymentDate value="2024-03-31"/>
  <paymentAmount>
    <value value="180000"/>
    <currency value="INR"/>
  </paymentAmount>
  <paymentIdentifier>
    <value value="UTRNUMBER2920287229"/>
  </paymentIdentifier>
  <detail>
    <identifier>
      <value value="CLAIMREFNUM7612345"/>
    </identifier>
    <type>
      <coding>
        <system
                value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type"/>
        <code value="approvedAmount"/>
        <display value="Approved Amount"/>
      </coding>
    </type>
    <date value="2024-03-31"/>
    <amount>
      <value value="90000"/>
      <currency value="INR"/>
    </amount>
  </detail>
  <detail>
    <identifier>
      <value value="CLAIMREFNUM7612345"/>
    </identifier>
    <type>
      <coding>
        <system
                value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type"/>
        <code value="tds"/>
        <display value="TDS Deduction"/>
      </coding>
    </type>
    <date value="2024-03-31"/>
    <amount>
      <value value="9000"/>
      <currency value="INR"/>
    </amount>
  </detail>
  <detail>
    <identifier>
      <value value="CLAIMREFNUM6789054"/>
    </identifier>
    <type>
      <coding>
        <system
                value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type"/>
        <code value="approvedAmount"/>
        <display value="Approved Amount"/>
      </coding>
    </type>
    <date value="2024-03-31"/>
    <amount>
      <value value="110000"/>
      <currency value="INR"/>
    </amount>
  </detail>
  <detail>
    <identifier>
      <value value="CLAIMREFNUM6789054"/>
    </identifier>
    <type>
      <coding>
        <system
                value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-payment-type"/>
        <code value="tds"/>
        <display value="TDS Deduction"/>
      </coding>
    </type>
    <date value="2024-03-31"/>
    <amount>
      <value value="11000"/>
      <currency value="INR"/>
    </amount>
  </detail>
</PaymentReconciliation>