Payment Reconciliations
Payment Reconciliations (FHIRPaymentReconciliation) provide detailed payment settlement information from payers to providers. They include line-item breakdowns showing how individual claims were settled.
Record a Payment Settlement
const { data: reconciliation } = await clinik.paymentReconciliations.create({
status: 'active',
paymentDate: '2024-03-15',
paymentAmount: { value: 4750.00, currency: 'USD' },
paymentIssuerId: 'org_blueShield',
outcome: 'complete',
disposition: 'Monthly settlement — March 2024',
period: { start: '2024-03-01', end: '2024-03-31' },
detail: [
{
type: 'payment',
date: '2024-03-15',
amount: { value: 2500.00, currency: 'USD' },
payeeId: 'Practitioner/prac_drSmith',
requestId: 'Claim/clm_visit001',
},
{
type: 'payment',
date: '2024-03-15',
amount: { value: 1800.00, currency: 'USD' },
payeeId: 'Practitioner/prac_drJones',
requestId: 'Claim/clm_visit002',
},
{
type: 'adjustment',
date: '2024-03-15',
amount: { value: 450.00, currency: 'USD' },
},
],
processNote: [
{ type: 'display', text: 'All claims for March settled. Adjustment for overpayment on CLM-2024-002.' },
],
});
Partial Payment
const { data: partial } = await clinik.paymentReconciliations.create({
status: 'active',
paymentDate: '2024-03-20',
paymentAmount: { value: 800.00, currency: 'USD' },
paymentIssuerId: 'org_aetna',
outcome: 'partial',
disposition: 'Partial payment — pending additional documentation',
detail: [
{
type: 'payment',
amount: { value: 800.00, currency: 'USD' },
requestId: 'Claim/clm_surgery456',
},
],
processNote: [
{ text: 'Remaining $2,200 pending operative report submission' },
],
});
Search Payment Reconciliations
// All reconciliations by outcome
const { data } = await clinik.paymentReconciliations.search({
outcome: 'complete',
});
// Filter by date range
const { data: q1 } = await clinik.paymentReconciliations.search({
dateFrom: '2024-01-01',
dateTo: '2024-03-31',
status: 'active',
});
Outcome Values
| Outcome | Description |
|---|---|
queued | Payment is queued for processing |
complete | Payment fully processed |
error | Error during processing |
partial | Partial payment issued |