HL7.TERMINOLOGY\Adjudication Value Codes

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

ValueSet: Adjudication Value Codes

Summary

Defining URL:

http://terminology.hl7.org/ValueSet/adjudication

Version:

0.3.0

Name:

AdjudicationValueCodes

Title:

Adjudication Value Codes

Status:

Draft as of 2/24/20, 12:41 PM (Standards Status: Draft)

Definition:

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.

Publisher:

FHIR Project team

Committee:

Financial Management

Copyright:

This is an example set.

Maturity:

1

OID:

2.16.840.1.113883.4.642.3.596 (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)

Include all codes defined in http://terminology.hl7.org/CodeSystem/adjudication

Expansion

This value set contains 8 concepts

Expansion based on Adjudication Value Codes v0.1.0 (CodeSystem)

All codes in this table are from the system http://terminology.hl7.org/CodeSystem/adjudication

Code	Display	Definition
submitted	Submitted Amount	The total submitted amount for the claim or group or line item.
copay	CoPay	Patient Co-Payment
eligible	Eligible Amount	Amount of the change which is considered for adjudication.
deductible	Deductible	Amount deducted from the eligible amount prior to adjudication.
unallocdeduct	Unallocated Deductible	The amount of deductible which could not allocated to other line items.
eligpercent	Eligible %	Eligible Percentage.
tax	Tax	The amount of tax.
benefit	Benefit Amount	Amount payable under the coverage

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

2020-10-14

revise