This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. The current version which supercedes this version is 5.2.0. For a full list of available versions, see the Directory of published versions

Adjudication Value Codes - XML Representation

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Raw xml

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="adjudication"/>
  <meta>
    <lastUpdated value="2020-04-09T17:10:28.568-04:00"/>
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
            
      <h2>Adjudication Value Codes</h2>
            
      <div>
              
        <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>

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