HL7.TERMINOLOGY\ActInvoiceAdjudicationPaymentCode

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: ActInvoiceAdjudicationPaymentCode

Summary

Defining URL:

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

Version:

2.0.0

Name:

ActInvoiceAdjudicationPaymentCode

Status:

Active as of 3/26/14

Definition:

Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

OID:

2.16.840.1.113883.1.11.19412 (for OID based terminology systems)

Source Resource:

XML / JSON / Turtle

References

Included into ActInvoiceElementCode

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 _ActInvoiceAdjudicationPaymentCode

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
_ActInvoiceAdjudicationPaymentCode	ActInvoiceAdjudicationPaymentCode	Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

Expansion

This value set contains 25 concepts

Expansion based on ActCode v6.0.0 (CodeSystem)

All codes in this table are from the system http://terminology.hl7.org/CodeSystem/v3-ActCode

Code	Display	Definition
_ActInvoiceAdjudicationPaymentGroupCode	ActInvoiceAdjudicationPaymentGroupCode	Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.
ALEC	alternate electronic	Payment initiated by the payor as the result of adjudicating a submitted invoice that arrived to the payor from an electronic source that did not provide a conformant set of HL7 messages (e.g. web claim submission).
BONUS	bonus	Bonus payments based on performance, volume, etc. as agreed to by the payor.
CFWD	carry forward adjusment	An amount still owing to the payor but the payment is 0$ and this cannot be settled until a future payment is made.
EDU	education fees	Fees deducted on behalf of a payee for tuition and continuing education.
EPYMT	early payment fee	Fees deducted on behalf of a payee for charges based on a shorter payment frequency (i.e. next day versus biweekly payments.
GARN	garnishee	Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.
INVOICE	submitted invoice	Payment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results..
PINV	paper invoice	Payment initiated by the payor as the result of adjudicating a paper (original, may have been faxed) invoice.
PPRD	prior period adjustment	An amount that was owed to the payor as indicated, by a carry forward adjusment, in a previous payment advice
PROA	professional association deduction	Professional association fee that is collected by the payor from the practitioner/provider on behalf of the association
RECOV	recovery	Retroactive adjustment such as fee rate adjustment due to contract negotiations.
RETRO	retro adjustment	Bonus payments based on performance, volume, etc. as agreed to by the payor.
TRAN	transaction fee	Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.
_ActInvoicePaymentCode	ActInvoiceAdjudicationPaymentGroupCode	Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.
_ActInvoiceAdjudicationPaymentSummaryCode	ActInvoiceAdjudicationPaymentSummaryCode	Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee, etc.
CONT	contract	Transaction counts and value totals by Contract Identifier.
DAY	day	Transaction counts and value totals for each calendar day within the date range specified.
LOC	location	Transaction counts and value totals by service location (e.g clinic).
MONTH	month	Transaction counts and value totals for each calendar month within the date range specified.
PERIOD	period	Transaction counts and value totals for the date range specified.
PROV	provider	Transaction counts and value totals by Provider Identifier.
WEEK	week	Transaction counts and value totals for each calendar week within the date range specified.
YEAR	year	Transaction counts and value totals for each calendar year within the date range specified.
INVTYPE	invoice type	Transaction counts and value totals by invoice type (e.g. RXDINV - Pharmacy Dispense)
PAYEE	payee	Transaction counts and value totals by each instance of an invoice payee.
PAYOR	payor	Transaction counts and value totals by each instance of an invoice payor.
SENDAPP	sending application	Transaction counts and value totals by each instance of a messaging application on a single processor. It is a registered identifier known to the receivers.

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