HL7 Terminology (THO)
3.0.0 - Publication

This page is part of the HL7 Terminology (v3.0.0: 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 - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "adjudication",
  "meta" : {
    "lastUpdated" : "2020-04-09T15:10:28.568-06:00",
    "profile" : [
      "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><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>"
  },
  "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" : "0.1.0",
  "name" : "AdjudicationValueCodes",
  "title" : "Adjudication Value Codes",
  "status" : "draft",
  "experimental" : false,
  "date" : "2021-12-02T19:54:18-07:00",
  "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"
    }
  ]
}