HL7.TERMINOLOGY\ActInvoiceOverrideCode

This page is part of the HL7 Terminology (v2.1.0: 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

ValueSet: ActInvoiceOverrideCode

Summary

Defining URL:

http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode

Version:

2.0.0

Name:

ActInvoiceOverrideCode

Status:

Active as of 2014-03-26

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 here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

This value set includes codes based on the following rules:

Include codes from http://terminology.hl7.org/CodeSystem/v3-ActCode where concept is-a _ActInvoiceOverrideCode

This value set excludes codes based on the following rules:

Exclude these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActCode

Code	Display	Definition
_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.

Expansion

This value set contains 15 concepts

Expansion based on ActCode v5.0.0 (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

Custodian

Author

Comment

2020-05-06

revise