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{ "resourceType" : "CodeSystem", "id" : "adjudication", "meta" : { "lastUpdated" : "2020-04-09T17:10:28.568-04:00", "profile" : [ "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ] }, "text" : { "status" : "generated", "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n \n <h2>Adjudication Value Codes</h2>\n \n <div>\n \n <p>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.</p>\n\n \n </div>\n \n <p>\n \n <b>Copyright Statement:</b> This is an example set.\n \n </p>\n \n <p>This code system http://terminology.hl7.org/CodeSystem/adjudication defines the following codes:</p>\n \n <table class=\"codes\">\n \n <tr>\n \n <td style=\"white-space:nowrap\">\n \n <b>Code</b>\n \n </td>\n \n <td>\n \n <b>Display</b>\n \n </td>\n \n <td>\n \n <b>Definition</b>\n \n </td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">submitted\n \n <a name=\"adjudication-submitted\"> </a>\n \n </td>\n \n <td>Submitted Amount</td>\n \n <td>The total submitted amount for the claim or group or line item.</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">copay\n \n <a name=\"adjudication-copay\"> </a>\n \n </td>\n \n <td>CoPay</td>\n \n <td>Patient Co-Payment</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">eligible\n \n <a name=\"adjudication-eligible\"> </a>\n \n </td>\n \n <td>Eligible Amount</td>\n \n <td>Amount of the change which is considered for adjudication.</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">deductible\n \n <a name=\"adjudication-deductible\"> </a>\n \n </td>\n \n <td>Deductible</td>\n \n <td>Amount deducted from the eligible amount prior to adjudication.</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">unallocdeduct\n \n <a name=\"adjudication-unallocdeduct\"> </a>\n \n </td>\n \n <td>Unallocated Deductible</td>\n \n <td>The amount of deductible which could not allocated to other line items.</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">eligpercent\n \n <a name=\"adjudication-eligpercent\"> </a>\n \n </td>\n \n <td>Eligible %</td>\n \n <td>Eligible Percentage.</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">tax\n \n <a name=\"adjudication-tax\"> </a>\n \n </td>\n \n <td>Tax</td>\n \n <td>The amount of tax.</td>\n \n </tr>\n \n <tr>\n \n <td style=\"white-space:nowrap\">benefit\n \n <a name=\"adjudication-benefit\"> </a>\n \n </td>\n \n <td>Benefit Amount</td>\n \n <td>Amount payable under the coverage</td>\n \n </tr>\n \n </table>\n \n </div>" }, "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "fm" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode" : "draft" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger" : 1 } ], "url" : "http://terminology.hl7.org/CodeSystem/adjudication", "identifier" : [ { "system" : "urn:ietf:rfc:3986", "value" : "urn:oid:2.16.840.1.113883.4.642.1.1171" } ], "version" : "4.2.0", "name" : "AdjudicationValueCodes", "title" : "Adjudication Value Codes", "status" : "draft", "experimental" : false, "date" : "2020-05-09T12:49:00-04:00", "publisher" : "FHIR Project team", "contact" : [ { "telecom" : [ { "system" : "url", "value" : "http://hl7.org/fhir" } ] } ], "description" : "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.", "copyright" : "This is an example set.", "caseSensitive" : true, "valueSet" : "http://terminology.hl7.org/ValueSet/adjudication", "content" : "complete", "concept" : [ { "code" : "submitted", "display" : "Submitted Amount", "definition" : "The total submitted amount for the claim or group or line item." }, { "code" : "copay", "display" : "CoPay", "definition" : "Patient Co-Payment" }, { "code" : "eligible", "display" : "Eligible Amount", "definition" : "Amount of the change which is considered for adjudication." }, { "code" : "deductible", "display" : "Deductible", "definition" : "Amount deducted from the eligible amount prior to adjudication." }, { "code" : "unallocdeduct", "display" : "Unallocated Deductible", "definition" : "The amount of deductible which could not allocated to other line items." }, { "code" : "eligpercent", "display" : "Eligible %", "definition" : "Eligible Percentage." }, { "code" : "tax", "display" : "Tax", "definition" : "The amount of tax." }, { "code" : "benefit", "display" : "Benefit Amount", "definition" : "Amount payable under the coverage" } ] }