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	This concept aligns with the FHIR [<nowiki/>https://build.fhir.org/paymentreconciliation.html PaymentReconciliation] resource, which records the outcome of payment processing against accounts and invoices.		This concept aligns with the FHIR [<nowiki/>https://build.fhir.org/paymentreconciliation.html PaymentReconciliation] resource, which records the outcome of payment processing against accounts and invoices.

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{{Doc header
|type=concept
|domain=billing
|title=Payment Reconciliation
|order=5
|introduced=3.0
|concept=Concepts/Charge Item
|reference=References/Payment Reconciliation
}}

A '''payment reconciliation''' in Care is the record of a single payment made toward a patient's account — how much was paid, how, when, and by whom. It is how money received at the counter, online, or as a deposit becomes a traceable entry against what the patient owes.

== What it represents ==

In Care's FHIR-aligned model, a payment reconciliation maps to the '''PaymentReconciliation''' resource. It captures:

* '''Who paid and how''' — whether the payer is the patient or an insurer, and the payment method (cash, card, cheque, direct deposit, and similar)
* '''What it applies to''' — the account being paid against, and optionally the single invoice this payment settles
* '''How much''' — the amount tendered, any amount returned as change, and the net amount that lands on the account
* '''Context''' — when the payment happened, where it was taken (e.g. a billing counter), and references such as a cheque or authorization number

A payment reconciliation is not a bill. The [[Concepts/Invoice|invoice]] states what is owed; the payment reconciliation records what was actually paid. Several payments can be recorded against one account over time, and a payment can also be a refund or credit note rather than money coming in.

== How money is calculated ==

Care does not simply trust a single "amount" field. Each payment carries two figures, and the net is derived from them:

* '''Tendered amount''' — what the payer handed over
* '''Returned amount''' — what was given back (typically change)
* '''Amount''' — the net that posts to the account, always computed as <code>tendered − returned</code>

This keeps cash handling honest: the returned amount must be smaller than the tendered amount, and the net is calculated server-side rather than taken at face value. A record can also be flagged as a '''credit note''', which inverts the meaning — money owed back to the payer rather than money received.

== Classification ==

Each payment is tagged so it can be reported and audited consistently. The tags answer a few plain questions:

* '''Why''' — its <code>type</code>: a normal <code>payment</code>, an <code>adjustment</code> (a correction), or an <code>advance</code> (paid ahead of charges)
* '''How it arrived''' — its <code>kind</code>: <code>deposit</code>, <code>periodic_payment</code>, <code>online</code>, or <code>kiosk</code>
* '''Who is paying''' — its <code>issuer_type</code>: the <code>patient</code> or an <code>insurer</code>
* '''What instrument''' — its <code>method</code>: cash, credit card, cheque, debit card, direct deposit, and similar, drawn from standard HL7 payment-method codes
* '''Where processing landed''' — its <code>outcome</code>: <code>queued</code>, <code>complete</code>, <code>partial</code>, or <code>error</code>

== Lifecycle ==

A payment moves through a small set of states that mirror real-world handling:

<syntaxhighlight lang="text">draft → active → cancelled / entered_in_error</syntaxhighlight>
* '''draft''' — being prepared, not yet a final record of money received
* '''active''' — a confirmed payment that counts against the account
* '''cancelled''' — a once-valid payment that has been voided
* '''entered_in_error''' — recorded by mistake; kept for audit but excluded from balances

== How it connects ==

A payment reconciliation always sits inside the billing picture for one patient:

* It is recorded against an '''[[Concepts/Account|account]]''' — the running ledger for a patient, which is always required.
* It may optionally be allocated to one '''[[Concepts/Invoice|invoice]]''', settling that specific bill. With no invoice, the payment simply credits the account balance.
* It is anchored to a '''[[Concepts/Facility|facility]]''' and may record the location where the payment was taken (e.g. a billing counter).

Because it points at an account and, through that account, at the [[Concepts/Patient|patient]], a payment reconciliation ties financial activity back to the same person whose [[Concepts/Encounter|encounters]] and orders drove the charges.

== Permissions ==

Access to payment records is governed by facility-scoped role-based permissions.

{| class="wikitable"
|-
! Permission
! Description
! System Roles
|-
| <code>can_write_payment_reconciliation</code>
| Create, update, cancel within the free-cancel window, or reassign payment records to another account
| Facility Admin, Admin, Staff, Doctor, Nurse, Pharmacist
|-
| <code>can_read_payment_reconciliation</code>
| List and view payment records
| Facility Admin, Administrator, Admin, Staff, Doctor, Nurse, Volunteer, Pharmacist
|-
| <code>can_destroy_payment_reconciliation</code>
| Cancel a payment record after the free-cancel window has passed
| Facility Admin, Admin
|}

Roles are granted through a user's facility and organization memberships, and permissions cascade down the organization tree, so a role held higher up applies to the facilities beneath it.

== FHIR reference ==

This concept aligns with the FHIR [<nowiki/>https://build.fhir.org/paymentreconciliation.html PaymentReconciliation] resource, which records the outcome of payment processing against accounts and invoices.

{{Related}}

Concepts/Payment Reconciliation - Revision history

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