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Reconciliation

Owning committee name

Financial Management

Contributing or Reviewing Work Groups

  • Patient Administration

FHIR Resource Development Project Insight ID

994

Scope of coverage

The Reconciliation resource provides application level error information or the bulk payment details associated with a payment by the payor for goods and services rendered by a provider to patients covered by insurance plans offered by that payor. These are the payment reconciliation details which align to the individual payment amounts indicated on discrete ClaimResponses.


RIM scope

Payment (classClode=XACT, moodCode=EVN))

Resource appropriateness

Bulk payments need to provide a means to associate the amounts paid again specific Claims to the bulk payment itself in order to reconcile provider accounts receivable.

Expected implementations

This is a key resource expected by most Healthcare billing implementations where Health care products and services are provided.

Content sources

Existing normative V3 and V2 specifications, Canadian Specifications, X12, NCPDP

Example Scenarios

Resource Relationships

Refers to a ReconciliationRequest.

Timelines

Ready for DSTU 2

gForge Users

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