Concepts/Payment Reconciliation

conceptbillingCARE 3.0+

Billing

Concepts

Account

Charge Item Invoice

Payment Reconciliation

References

Account

Charge Item Invoice

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 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 tendered − returned

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

Lifecycle

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

draft → active → cancelled / entered_in_error

• 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 account — the running ledger for a patient, which is always required.
• It may optionally be allocated to one invoice, settling that specific bill. With no invoice, the payment simply credits the account balance.
• It is anchored to a 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 patient, a payment reconciliation ties financial activity back to the same person whose encounters and orders drove the charges.

Permissions

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

Permission	Description	System Roles
can_write_payment_reconciliation	Create, update, cancel within the free-cancel window, or reassign payment records to another account	Facility Admin, Admin, Staff, Doctor, Nurse, Pharmacist
can_read_payment_reconciliation	List and view payment records	Facility Admin, Administrator, Admin, Staff, Doctor, Nurse, Volunteer, Pharmacist
can_destroy_payment_reconciliation	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 [https://build.fhir.org/paymentreconciliation.html PaymentReconciliation] resource, which records the outcome of payment processing against accounts and invoices.

Billing

Concepts

Account · Charge Item · Invoice · Payment Reconciliation

References

Account · Charge Item · Invoice · Payment Reconciliation

Related

• Concept: Concepts/Charge Item
• Reference: References/Payment Reconciliation

Wiki: ohcnwiki.tellmey.fyi

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Fast Healthcare Interoperability Resources — an HL7 standard for exchanging healthcare data. CARE is built on FHIR R5.