HL7 Terminology
1.0.0 - Publication

This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

ActInvoiceOverrideCode

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

Content Logical Definition

Logical Definition (CLD)

This value set includes codes based on the following rules:

 

Expansion

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

CodeDisplayDefinition
COVGEcoverage problemInsurance coverage problems have been encountered. Additional explanation information to be supplied.
EFORMelectronic form to followElectronic form with supporting or additional information to follow.
FAXfax to followFax with supporting or additional information to follow.
GFTHgood faith indicatorThe 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.
LATElate invoiceKnowingly 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.
MANUALmanual reviewManual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.
OOJout of jurisdictionThe medical service and/or product was provided to a patient that has coverage in another jurisdiction.
ORTHOorthodontic serviceThe service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.
PAPERpaper documentation to followPaper documentation (or other physical format) with supporting or additional information to follow.
PIEpublic insurance exhaustedPublic 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.
PYRDELAYdelayed by a previous payorAllows provider to explain lateness of invoice to a subsequent payor.
REFNRreferral not requiredRules of practice do not require a physician's referral for the provider to perform a billable service.
REPSERVrepeated serviceThe 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.
UNRELATunrelated serviceThe 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.
VERBAUTHverbal authorizationThe 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

DateActionAuthorCustodianComment
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.
2014-03-26reviseVocabulary (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