xCaliber healthCare Data Mesh

PaymentNotice

Overview

The PaymentNotice API allows creating, managing, and reconciling electronic insurance payment notices. Healthcare developers can use it to build solutions to consolidate explanation of benefits data from multiple payers and track patient financials.

Use Cases

  • Claims Management - Receive and process electronic remittance advice and explanation of benefits.
  • Patient Billing - Post payments to patient accounts automatically based on payment notices.
  • Denials Management - Identify denied claims and determine reasons to guide resubmission.
  • Payment Reconciliation - Match payments to claims and remittances to automate reconciliation.
  • Analytics - Analyze notice data to gain insights into payer behavior, reimbursement trends.
  • Reporting - Generate reports on payment volumes, cycles, denials by payer and service.
  • Eligibility Checking - Leverage payment data to verify patient coverage and benefits eligibility.
  • Workflow Integration - Incorporate notice information into billing and revenue cycle workflows.
  • Audit Trails - Maintain comprehensive audit trails linking notices to claims and payments.
  • Compliance Tracking - Ensure adherence to timely filing, appeals, and reporting requirements.

EHR Data Model

EHRSupported?Mapped Source Object
AthenaPayment History, Record Payment
ElationN/A
EpicN/A

Object Definition

{
  "resourceType": "PaymentNotice",
  "id": "77654",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentNotice</div>"
  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/paymentnotice",
      "value": "776543"
    }
  ],
  "status": "active",
  "request": {
    "reference": "http://benefitsinc.com/fhir/claim/12345"
  },
  "response": {
    "reference": "http://benefitsinc.com/fhir/claimresponse/CR12345"
  },
  "created": "2014-08-16",
  "provider": {
    "reference": "Organization/1"
  },
  "payment": {
    "reference": "PaymentReconciliation/ER2500"
  },
  "paymentDate": "2014-08-15",
  "payee": {
    "reference": "Organization/1"
  },
  "recipient": {
    "identifier": {
      "system": "http://regulators.gov",
      "value": "AB123"
    }
  },
  "amount": {
    "value": 12500,
    "currency": "USD"
  },
  "paymentStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/paymentstatus",
        "code": "paid"
      }
    ]
  },
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}

Data Fields

Data FieldTypeDescription
resourceTypePaymentNoticeThis is a PaymentNotice resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedBackboneElementThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionExtensionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionExtensionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierIdentifierA unique identifier assigned to this payment notice.
statuscodeThe status of the resource instance.
requestReferenceReference of resource for which payment is being made.
responseReferenceReference of response to resource for which payment is being made.
createddateTimeThe date when this resource was created.
providerReferenceThe practitioner who is responsible for the services rendered to the patient.
paymentReferenceA reference to the payment which is the subject of this notice.
paymentDatedateThe date when the above payment action occurred.
payeeReferenceThe party who will receive or has received payment that is the subject of this notification.
recipientReferenceThe party who is notified of the payment status.
amountMoneyThe amount sent to the payee.
paymentStatusCodeableConceptA code indicating whether payment has been sent or cleared.

Extensions

NameURL

Operations & APIs

PaymentNotice-GET

PaymentNotice-POST

PaymentNotice ID-GET

PaymentNotice ID-PUT

PaymentNotice ID-DELETE