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
Summary
Defining URL: | http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode |
Version: | 2.0.0 |
Name: | ActInvoiceOverrideCode |
Status: | Active |
Title: | ActInvoiceOverrideCode |
Definition: | Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results. |
OID: | 2.16.840.1.113883.1.11.17590 (for OID based terminology systems) |
Source Resource: | XML / JSON / Turtle |
References
This value set is not used
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/v3-ActCode
where concept is-a _ActInvoiceOverrideCodehttp://terminology.hl7.org/CodeSystem/v3-ActCode
Code | Display | |
_ActInvoiceOverrideCode | ActInvoiceOverrideCode | Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results. |
This value set contains 15 concepts
Expansion based on ActCode v2.0.0 (CodeSystem)
All codes from system http://terminology.hl7.org/CodeSystem/v3-ActCode
Code | Display | Definition |
COVGE | coverage problem | Insurance coverage problems have been encountered. Additional explanation information to be supplied. |
EFORM | electronic form to follow | Electronic form with supporting or additional information to follow. |
FAX | fax to follow | Fax with supporting or additional information to follow. |
GFTH | good faith indicator | The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered. |
LATE | late invoice | Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied. |
MANUAL | manual review | Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal. |
OOJ | out of jurisdiction | The medical service and/or product was provided to a patient that has coverage in another jurisdiction. |
ORTHO | orthodontic service | The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid. |
PAPER | paper documentation to follow | Paper documentation (or other physical format) with supporting or additional information to follow. |
PIE | public insurance exhausted | Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission. |
PYRDELAY | delayed by a previous payor | Allows provider to explain lateness of invoice to a subsequent payor. |
REFNR | referral not required | Rules of practice do not require a physician's referral for the provider to perform a billable service. |
REPSERV | repeated service | The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate. |
UNRELAT | unrelated service | The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items. |
VERBAUTH | verbal authorization | The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced. |
Explanation of the columns that may appear on this page:
Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
Source | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
Code | The code (used as the code in the resource instance) |
Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
Definition | An explanation of the meaning of the concept |
Comments | Additional notes about how to use the code |
History
Date | Action | Author | Custodian | Comment |
2020-05-06 | revise | Ted Klein | Vocabulary WG | Migrated to the UTG maintenance environment and publishing tooling. |
2014-03-26 | revise | Vocabulary (Woody Beeler) (no record of original request) | 2014T1_2014-03-26_001283 (RIM release ID) | Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26 |