Implementation Guide
23.1.0 - R4 APIs

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Logical Model: Profile - Athena Custom Payment

Official URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-payment-profile Version: 23.1.0
Active as of 2023-03-01 Computable Name: Payment

The Payment is used by providers and payors, insurers, to exchange the financial information, and supporting clinical information, regarding the provision of health care services. This is not a FHIR Conformant Resource.


This Payment profile is part of the custom resource profiles supported by the API server used with the Athena Practice product used with the athenaPractice 23.0.0. This is not a FHIR Conformant Resource. It further describes read and search capabilities of these products.
Note: Create and Update operations are NOT supported for this resource.

Overview

This resource is used to extract the Payment information of a patient.

Scope and Usage

The Payment resource provides the transaction details associated with a Payment by the payor for receivable amounts, such as for goods and services rendered by a provider to patients covered by insurance plans offered by that payor. All elements listed in the differential profile view are Supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

Source

The Payment information is extracted from PatientVisit, PatientProfile, VisitTransactions, PaymentMethod, Batch, Transactions, MedLists, TransactionDistributions, PatientVisitProcs, InsuranceCarriers, InsuranceGroup tables.

Example

Example for the athena-payment-profile Profile.

Payment Example

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-payment-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... pid Σ 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference 0..1 string Patient Reference
.... display 0..1 string display to the Patient name
... patientProfileId SΣ 0..1 integer Patient specific id for practice management data including financial information
... patientVisitId 0..1 string Patient visitId for facility
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure-code
... payer 0..1 string Payer information
... paymentSource 0..1 string Transaction type indentification
... batchName 0..1 string Transaction batch name
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Check Card Number for payment
... checkDate 0..1 dateTime Check date on card for payment
... notes 0..1 string The note associated with the transaction.
... insuranceCarrier 0..1 Reference(Organization) Insurance carrier Reference
.... reference 0..1 string Insurance Carrier Id refering to Organization
.... display 0..1 string Insurance carrier Name
... insurancePayment 0..1 Money The Payment amount distribution
.... value 0..1 decimal Insurance Payment amount
.... currency 0..1 code Currency
... patientPayment 0..1 Money The total amount of the distribution when the source is patient
.... value 0..1 decimal Patient payment amount.
.... currency 0..1 code Currency
... financialClass 0..1 string Financial class description
... lastModified 0..1 string Last modified date of transaction

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-payment-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... pid Σ 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference ΣC 0..1 string Patient Reference
.... display Σ 0..1 string display to the Patient name
... patientProfileId SΣ 0..1 integer Patient specific id for practice management data including financial information
... patientVisitId 0..1 string Patient visitId for facility
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure-code
... payer 0..1 string Payer information
... paymentSource 0..1 string Transaction type indentification
... batchName 0..1 string Transaction batch name
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Check Card Number for payment
... checkDate 0..1 dateTime Check date on card for payment
... notes 0..1 string The note associated with the transaction.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier Reference
ref-1: SHALL have a contained resource if a local reference is provided
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... display Σ 0..1 string Insurance carrier Name
... insurancePayment 0..1 Money The Payment amount distribution
.... value Σ 0..1 decimal Insurance Payment amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientPayment 0..1 Money The total amount of the distribution when the source is patient
.... value Σ 0..1 decimal Patient payment amount.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... financialClass 0..1 string Financial class description
... lastModified 0..1 string Last modified date of transaction

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-payment-profile.insurancePayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-payment-profile.patientPayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-payment-profile.patient, athena-payment-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-payment-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... pid Σ 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Patient Reference
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string display to the Patient name
... patientProfileId SΣ 0..1 integer Patient specific id for practice management data including financial information
... patientVisitId 0..1 string Patient visitId for facility
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure-code
... payer 0..1 string Payer information
... paymentSource 0..1 string Transaction type indentification
... batchName 0..1 string Transaction batch name
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Check Card Number for payment
... checkDate 0..1 dateTime Check date on card for payment
... notes 0..1 string The note associated with the transaction.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier Reference
ref-1: SHALL have a contained resource if a local reference is provided
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Insurance carrier Name
... insurancePayment 0..1 Money The Payment amount distribution
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Insurance Payment amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientPayment 0..1 Money The total amount of the distribution when the source is patient
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Patient payment amount.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... financialClass 0..1 string Financial class description
... lastModified 0..1 string Last modified date of transaction

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-payment-profile.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-payment-profile.insuranceCarrier.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-payment-profile.insurancePayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-payment-profile.patientPayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-payment-profile.patient, athena-payment-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from Base

Summary

Mandatory: 0 element(1 nested mandatory element)
Must-Support: 2 elements

Differential View

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-payment-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... pid Σ 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference 0..1 string Patient Reference
.... display 0..1 string display to the Patient name
... patientProfileId SΣ 0..1 integer Patient specific id for practice management data including financial information
... patientVisitId 0..1 string Patient visitId for facility
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure-code
... payer 0..1 string Payer information
... paymentSource 0..1 string Transaction type indentification
... batchName 0..1 string Transaction batch name
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Check Card Number for payment
... checkDate 0..1 dateTime Check date on card for payment
... notes 0..1 string The note associated with the transaction.
... insuranceCarrier 0..1 Reference(Organization) Insurance carrier Reference
.... reference 0..1 string Insurance Carrier Id refering to Organization
.... display 0..1 string Insurance carrier Name
... insurancePayment 0..1 Money The Payment amount distribution
.... value 0..1 decimal Insurance Payment amount
.... currency 0..1 code Currency
... patientPayment 0..1 Money The total amount of the distribution when the source is patient
.... value 0..1 decimal Patient payment amount.
.... currency 0..1 code Currency
... financialClass 0..1 string Financial class description
... lastModified 0..1 string Last modified date of transaction

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-payment-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... pid Σ 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... reference ΣC 0..1 string Patient Reference
.... display Σ 0..1 string display to the Patient name
... patientProfileId SΣ 0..1 integer Patient specific id for practice management data including financial information
... patientVisitId 0..1 string Patient visitId for facility
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure-code
... payer 0..1 string Payer information
... paymentSource 0..1 string Transaction type indentification
... batchName 0..1 string Transaction batch name
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Check Card Number for payment
... checkDate 0..1 dateTime Check date on card for payment
... notes 0..1 string The note associated with the transaction.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier Reference
ref-1: SHALL have a contained resource if a local reference is provided
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... display Σ 0..1 string Insurance carrier Name
... insurancePayment 0..1 Money The Payment amount distribution
.... value Σ 0..1 decimal Insurance Payment amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientPayment 0..1 Money The total amount of the distribution when the source is patient
.... value Σ 0..1 decimal Patient payment amount.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... financialClass 0..1 string Financial class description
... lastModified 0..1 string Last modified date of transaction

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-payment-profile.insurancePayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-payment-profile.patientPayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-payment-profile.patient, athena-payment-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. athena-payment-profile 0..* Base Instances of this logical model are not marked to be the target of a Reference
... id SΣ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... pid Σ 1..1 integer PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Patient Reference
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string display to the Patient name
... patientProfileId SΣ 0..1 integer Patient specific id for practice management data including financial information
... patientVisitId 0..1 string Patient visitId for facility
... ticketNumber 0..1 string The ticket number for this visit.
... procedureCode 0..1 string Procedure-code
... payer 0..1 string Payer information
... paymentSource 0..1 string Transaction type indentification
... batchName 0..1 string Transaction batch name
... dateOfEntry 0..1 dateTime The date of entry for the batch.
... dateOfServiceFrom 0..1 dateTime The start date of service for this procedure.
... dateOfServiceTo 0..1 dateTime The stop date of service for this procedure.
... checkNumber 0..1 string Check Card Number for payment
... checkDate 0..1 dateTime Check date on card for payment
... notes 0..1 string The note associated with the transaction.
... insuranceCarrier C 0..1 Reference(Organization) Insurance carrier Reference
ref-1: SHALL have a contained resource if a local reference is provided
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Insurance Carrier Id refering to Organization
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Insurance carrier Name
... insurancePayment 0..1 Money The Payment amount distribution
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Insurance Payment amount
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... patientPayment 0..1 Money The total amount of the distribution when the source is patient
.... @id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... value Σ 0..1 decimal Patient payment amount.
.... currency Σ 0..1 code Currency
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

... financialClass 0..1 string Financial class description
... lastModified 0..1 string Last modified date of transaction

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
athena-payment-profile.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-payment-profile.insuranceCarrier.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
athena-payment-profile.insurancePayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard
athena-payment-profile.patientPayment.currencyrequiredCurrencies (a valid code from urn:iso:std:iso:4217)
http://hl7.org/fhir/ValueSet/currencies|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ref-1errorathena-payment-profile.patient, athena-payment-profile.insuranceCarrierSHALL have a contained resource if a local reference is provided
: reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from Base

Summary

Mandatory: 0 element(1 nested mandatory element)
Must-Support: 2 elements

 

Other representations of profile: CSV, Excel

Notes:

Supported Interactions

The Interactions supported by this resource are listed below.

Search Parameters

Search parameters are executed as specified in the HL7 FHIR RESTful API implementation definition. To search for Payment resources, an application shall perform an HTTP GET, specifying the query parameters associated with the resource.

GET [base]/customresource/Payment?{search-parameters}

Where:

Name Description
[base] Specifies the base URL of the FHIR Server, e.g., https://ap22sandbox.athenahealth.com/demoAPIServer
_id (token) The ID of the resource
patientProfileId known id of the patient.
patient (reference) The patient this person is related to.
[_include] Specifies the supported HL7 resources include which are defined as reference in examples. Note: The Patient and Organization resources are supported via the _include parameter.
HTTP Response Codes

The following HTTP response codes are returned by this API call:

200 OK The query was performed and any results found are contained within the body of the HTTP response. Note: The search API will return 200 OK when the query itself is successful, regardless of whether or not any matching results were found.
401 Unauthorized Authorization is required for this request, and either the Authorization header is missing or the supplied user credentials in the Authorization header are not valid or have expired. The body of the HTTP response will contain an OperationOutcome resource that indicates that Authorization is required.
500 Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.