Adjudication Value Codes - HL7 Terminology (THO) v5.3.0

HL7 Terminology (THO)
5.3.0 - Publication International flag

This page is part of the HL7 Terminology (v5.3.0: Release) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

CodeSystem: Adjudication Value Codes

Official URL: http://terminology.hl7.org/CodeSystem/adjudication			Version: 0.1.0
Draft as of 2023-09-08	Maturity Level: 1	Responsible: FHIR Project team	Computable Name: AdjudicationValueCodes
Other Identifiers: id: urn:oid:2.16.840.1.113883.4.642.1.1171
Copyright/Legal: This is an example set.

This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://terminology.hl7.org/CodeSystem/adjudication defines the following codes:

Code	Display	Definition
submitted	Submitted Amount	The total submitted amount for the claim or group or line item.
copay	CoPay	Patient Co-Payment
eligible	Eligible Amount	Amount of the change which is considered for adjudication.
deductible	Deductible	Amount deducted from the eligible amount prior to adjudication.
unallocdeduct	Unallocated Deductible	The amount of deductible which could not allocated to other line items.
eligpercent	Eligible %	Eligible Percentage.
tax	Tax	The amount of tax.
benefit	Benefit Amount	Amount payable under the coverage