FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM
6.5.0 - active
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
| Official URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/PaymentReconciliation | Version: 6.5.0 | |||
| Draft as of 2025-03-18 | Computable Name: PaymentReconciliation | |||
This profile provides the bulk payment details associated with a payment for goods and services rendered by a provider to patients covered by insurance plans offered by that payor.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  PaymentReconciliation |
0..* | PaymentReconciliation | PaymentReconciliation resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
  implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
| created |
Σ | 1..1 | dateTime | Creation date ele-1: All FHIR elements must have a @value or children |
 paymentIssuer |
Σ | 0..1 | Reference(Organization) | Party generating payment ele-1: All FHIR elements must have a @value or children |
| request |
0..1 | Reference(Task) | Reference to requesting resource ele-1: All FHIR elements must have a @value or children | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner ele-1: All FHIR elements must have a @value or children | |
| paymentDate |
Σ | 1..1 | date | When payment issued ele-1: All FHIR elements must have a @value or children |
  paymentAmount |
Σ | 1..1 | Money | Total amount of Payment ele-1: All FHIR elements must have a @value or children |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from PaymentReconciliation
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PaymentReconciliation |
PaymentReconciliation | |||
| paymentIssuer |
0..1 | Reference(Organization) | Party generating payment | |
| request |
0..1 | Reference(Task) | Reference to requesting resource | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |
  detail |
||||
 type |
1..1 | CodeableConcept | Category of payment Binding: Payment Type (example): The reason for the amount: payment, adjustment, advance,tds. | |
| submitter |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |
| responsible |
0..1 | Reference(PractitionerRole) | Contact for the response | |
| payee |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| PaymentReconciliation.detail.type | example | PaymentTypehttps://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-payment-typefrom this IG |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| PaymentReconciliation |
0..* | PaymentReconciliation | PaymentReconciliation resource | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
 extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier for a payment reconciliation | |||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| period |
Σ | 0..1 | Period | Period covered | ||||
| created |
Σ | 1..1 | dateTime | Creation date | ||||
| paymentIssuer |
Σ | 0..1 | Reference(Organization) | Party generating payment | ||||
| request |
0..1 | Reference(Task) | Reference to requesting resource | |||||
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |||||
| outcome |
0..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. | |||||
| disposition |
0..1 | string | Disposition message | |||||
| paymentDate |
Σ | 1..1 | date | When payment issued | ||||
| paymentAmount |
Σ | 1..1 | Money | Total amount of Payment | ||||
| paymentIdentifier |
0..1 | Identifier | Business identifier for the payment | |||||
 detail |
0..* | BackboneElement | Settlement particulars | |||||
 id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier |
0..1 | Identifier | Business identifier of the payment detail | |||||
| predecessor |
0..1 | Identifier | Business identifier of the prior payment detail | |||||
| type |
1..1 | CodeableConcept | Category of payment Binding: Payment Type (example): The reason for the amount: payment, adjustment, advance,tds. | |||||
| request |
0..1 | Reference(Resource) | Request giving rise to the payment | |||||
| submitter |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |||||
| response |
0..1 | Reference(Resource) | Response committing to a payment | |||||
| date |
0..1 | date | Date of commitment to pay | |||||
| responsible |
0..1 | Reference(PractitionerRole) | Contact for the response | |||||
| payee |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |||||
| amount |
0..1 | Money | Amount allocated to this payable | |||||
| formCode |
0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| processNote |
0..* | BackboneElement | Note concerning processing | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanatory text | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| PaymentReconciliation.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.detail.type | example | PaymentTypehttps://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-payment-typefrom this IG | ||||
| PaymentReconciliation.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/formsfrom the FHIR Standard | ||||
| PaymentReconciliation.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from PaymentReconciliation
Summary
Structures
This structure refers to these other structures:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PaymentReconciliation |
0..* | PaymentReconciliation | PaymentReconciliation resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
| created |
Σ | 1..1 | dateTime | Creation date ele-1: All FHIR elements must have a @value or children |
| paymentIssuer |
Σ | 0..1 | Reference(Organization) | Party generating payment ele-1: All FHIR elements must have a @value or children |
| request |
0..1 | Reference(Task) | Reference to requesting resource ele-1: All FHIR elements must have a @value or children | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner ele-1: All FHIR elements must have a @value or children | |
| paymentDate |
Σ | 1..1 | date | When payment issued ele-1: All FHIR elements must have a @value or children |
| paymentAmount |
Σ | 1..1 | Money | Total amount of Payment ele-1: All FHIR elements must have a @value or children |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Differential View
This structure is derived from PaymentReconciliation
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PaymentReconciliation |
PaymentReconciliation | |||
| paymentIssuer |
0..1 | Reference(Organization) | Party generating payment | |
| request |
0..1 | Reference(Task) | Reference to requesting resource | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |
| detail |
||||
| type |
1..1 | CodeableConcept | Category of payment Binding: Payment Type (example): The reason for the amount: payment, adjustment, advance,tds. | |
| submitter |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |
| responsible |
0..1 | Reference(PractitionerRole) | Contact for the response | |
| payee |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| PaymentReconciliation.detail.type | example | PaymentTypehttps://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-payment-typefrom this IG |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| PaymentReconciliation |
0..* | PaymentReconciliation | PaymentReconciliation resource | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier for a payment reconciliation | |||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| period |
Σ | 0..1 | Period | Period covered | ||||
| created |
Σ | 1..1 | dateTime | Creation date | ||||
| paymentIssuer |
Σ | 0..1 | Reference(Organization) | Party generating payment | ||||
| request |
0..1 | Reference(Task) | Reference to requesting resource | |||||
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Responsible practitioner | |||||
| outcome |
0..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. | |||||
| disposition |
0..1 | string | Disposition message | |||||
| paymentDate |
Σ | 1..1 | date | When payment issued | ||||
| paymentAmount |
Σ | 1..1 | Money | Total amount of Payment | ||||
| paymentIdentifier |
0..1 | Identifier | Business identifier for the payment | |||||
| detail |
0..* | BackboneElement | Settlement particulars | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier |
0..1 | Identifier | Business identifier of the payment detail | |||||
| predecessor |
0..1 | Identifier | Business identifier of the prior payment detail | |||||
| type |
1..1 | CodeableConcept | Category of payment Binding: Payment Type (example): The reason for the amount: payment, adjustment, advance,tds. | |||||
| request |
0..1 | Reference(Resource) | Request giving rise to the payment | |||||
| submitter |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Submitter of the request | |||||
| response |
0..1 | Reference(Resource) | Response committing to a payment | |||||
| date |
0..1 | date | Date of commitment to pay | |||||
| responsible |
0..1 | Reference(PractitionerRole) | Contact for the response | |||||
| payee |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Recipient of the payment | |||||
| amount |
0..1 | Money | Amount allocated to this payable | |||||
| formCode |
0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| processNote |
0..* | BackboneElement | Note concerning processing | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanatory text | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| PaymentReconciliation.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| PaymentReconciliation.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1from the FHIR Standard | ||||
| PaymentReconciliation.detail.type | example | PaymentTypehttps://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-payment-typefrom this IG | ||||
| PaymentReconciliation.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/formsfrom the FHIR Standard | ||||
| PaymentReconciliation.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | PaymentReconciliation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | PaymentReconciliation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | PaymentReconciliation | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from PaymentReconciliation
Summary
Structures
This structure refers to these other structures:
Other representations of profile: CSV, Excel, Schematron