PaymentReconciliation — Payment reconciliation
14,500 USD received in the bank for 12 Claims from May 2026, broken down line by line: the FHIR equivalent of X12 835 (Healthcare Claim Payment / Advice).
Purpose
PaymentReconciliation is the detailed breakdown of a received payment: typically
a consolidated bank transfer for multiple Claims submitted over a period. Each
allocation[] identifies a target Claim, the allocated amount, and
any adjustment. It is the FHIR equivalent of the X12 835 transaction in HIPAA.
Key fields
| Field | Type | Cardinality | Role |
|---|---|---|---|
identifier | Identifier[] | 0..* | External identifiers. |
type | CodeableConcept | 1..1 | Mandatory. payment, adjustment, advance. |
status | code | 1..1 | Mandatory. active, cancelled, draft, entered-in-error. |
kind | CodeableConcept | 0..1 | deposit, periodic-payment, online, kiosk. |
period | Period | 0..1 | Covered period. |
created | dateTime | 1..1 | Mandatory. Creation date. |
enterer | Reference(...) | 0..1 | Enterer. |
issuerType | CodeableConcept | 0..1 | Issuer type. |
paymentIssuer | Reference(Organization | Patient | RelatedPerson) | 0..1 | Payment issuer. |
request | Reference(Task) | 0..1 | Originating request. |
requestor | Reference(...) | 0..1 | Request author. |
outcome | code | 0..1 | queued, complete, error, partial. |
disposition | string | 0..1 | Description. |
paymentDate | date | 1..1 | Mandatory. Effective date. |
amount | Money | 1..1 | Mandatory. Total amount. |
method | CodeableConcept | 0..1 | Method (check, EFT, card). |
cardBrand | string | 0..1 | Card brand if applicable. |
accountNumber | string | 0..1 | Account (masked). |
processor | string | 0..1 | Payment processor. |
referenceNumber | string | 0..1 | External reference. |
allocation | BackboneElement[] | 0..* | Line-by-line breakdown: target Claim/Account, amount, adjustment. |
formCode | CodeableConcept | 0..1 | Transmission form code. |
processNote | BackboneElement[] | 0..* | Process notes. |
JSON example
Reconciliation of 14,500 USD for 12 Claims, period May 2026:
{
"resourceType": "PaymentReconciliation",
"id": "pr-2026-005",
"identifier": [{
"system": "urn:oid:1.2.34",
"value": "PR-2026-005"
}],
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/payment-type",
"code": "payment"
}]
},
"status": "active",
"kind": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/payment-kind",
"code": "deposit"
}]
},
"period": {
"start": "2026-05-01",
"end": "2026-05-14"
},
"created": "2026-05-15T11:00:00+02:00",
"issuerType": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/payment-issuertype",
"code": "insurer"
}]
},
"paymentIssuer": { "reference": "Organization/insurer-x" },
"request": { "reference": "Task/task-payment-batch-001" },
"paymentDate": "2026-05-14",
"amount": {
"value": 14500.00,
"currency": "USD"
},
"outcome": "complete",
"disposition": "Consolidated reimbursement for 12 Claims, May 2026",
"method": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/v3-paymentTerms",
"code": "EFT"
}]
},
"allocation": [{
"identifier": { "system": "urn:oid:1.2.34", "value": "ALLOC-001" },
"target": { "reference": "Claim/claim-2026-001" },
"submitter": { "reference": "Organization/hospital-1" },
"response": { "reference": "ClaimResponse/claimresponse-2026-001" },
"date": "2026-05-14",
"type": {
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/payment-type",
"code": "payment"
}]
},
"amount": { "value": 1250.00, "currency": "USD" }
}]
}Common pitfalls
- Empty
allocation— without breakdown, reconciliation is unusable for accounting allocation. - Sum of allocations ≠
amount— the spec doesn't require consistency, but in practice it is mandatory for audit. - No
paymentIssuer— where does the money come from? Required for traceability. - Confusing with EOB — ExplanationOfBenefit explains why a reimbursement, PaymentReconciliation explains how a transfer was broken down.
- No encryption of
accountNumber— a clear-text IBAN in FHIR is a data leak.
Related resources
- Claim — paid claims.
- ClaimResponse — responses.
- PaymentNotice — associated notification.
- Account — credited account.
- ExplanationOfBenefit — EOB.