HL7.TERMINOLOGY\ActInvoiceDetailGenericCode

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: ActInvoiceDetailGenericCode

Summary

Defining URL:

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

Version:

2.0.0

Name:

ActInvoiceDetailGenericCode

Status:

Active as of 3/26/14

Definition:

The detail item codes to identify charges or changes to the total billing of a claim due to insurance rules and payments.

OID:

2.16.840.1.113883.1.11.19407 (for OID based terminology systems)

Source Resource:

XML / JSON / Turtle

References

Included into ActInvoiceDetailCode
Included into XActInvoiceDetailPharmacyCode

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 _ActInvoiceDetailGenericCode

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
_ActInvoiceDetailGenericCode ActInvoiceDetailGenericCode The detail item codes to identify charges or changes to the total billing of a claim due to insurance rules and payments.

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
_ActInvoiceDetailGenericAdjudicatorCode	ActInvoiceDetailGenericAdjudicatorCode	The billable item codes to identify adjudicator specified components to the total billing of a claim.
COIN	coinsurance	That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.
COPAYMENT	patient co-pay	That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.
DEDUCTIBLE	deductible	That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.
PAY	payment	The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.
SPEND	spend down	That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results
COINS	co-insurance	The covered party pays a percentage of the cost of covered services.
_ActInvoiceDetailGenericModifierCode	ActInvoiceDetailGenericModifierCode	The billable item codes to identify modifications to a billable item charge. As for example after hours increase in the office visit fee.
AFTHRS	non-normal hours	Premium paid on service fees in compensation for practicing outside of normal working hours.
ISOL	isolation allowance	Premium paid on service fees in compensation for practicing in a remote location.
OOO	out of office	Premium paid on service fees in compensation for practicing at a location other than normal working location.
_ActInvoiceDetailGenericProviderCode	ActInvoiceDetailGenericProviderCode	The billable item codes to identify provider supplied charges or changes to the total billing of a claim.
CANCAPT	cancelled appointment	A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.
DSC	discount	A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.
ESA	extraordinary service assessment	A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.
FFSTOP	fee for service top off	Under agreement between the parties (payor and provider), a guaranteed level of income is established for the provider over a specific, pre-determined period of time. The normal course of business for the provider is submission of fee-for-service claims. Should the fee-for-service income during the specified period of time be less than the agreed to amount, a top-up amount is paid to the provider equal to the difference between the fee-for-service total and the guaranteed income amount for that period of time. The details of the agreement may specify (or not) a requirement for repayment to the payor in the event that the fee-for-service income exceeds the guaranteed amount.
FNLFEE	final fee	Anticipated or actual final fee associated with treating a patient.
FRSTFEE	first fee	Anticipated or actual initial fee associated with treating a patient.
MARKUP	markup or up-charge	An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.
MISSAPT	missed appointment	A charge to compensate the provider when a patient does not show for an appointment.
PERFEE	periodic fee	Anticipated or actual periodic fee associated with treating a patient. For example, expected billing cycle such as monthly, quarterly. The actual period (e.g. monthly, quarterly) is specified in the unit quantity of the Invoice Element.
PERMBNS	performance bonus	The amount for a performance bonus that is being requested from a payor for the performance of certain services (childhood immunizations, influenza immunizations, mammograms, pap smears) on a sliding scale. That is, for 90% of childhood immunizations to a maximum of $2200/yr. An invoice is created at the end of the service period (one year) and a code is submitted indicating the percentage achieved and the dollar amount claimed.
RESTOCK	restocking fee	A charge is requested because the patient failed to pick up the item and it took an amount of time to return it to stock for future use.
TRAVEL	travel	A charge to cover the cost of travel time and/or cost in conjuction with providing a service or product. It may be charged per kilometer or per hour based on the effective agreement.
URGENT	urgent	Premium paid on service fees in compensation for providing an expedited response to an urgent situation.
_ActInvoiceDetailTaxCode	ActInvoiceDetailTaxCode	The billable item codes to identify modifications to a billable item charge by a tax factor applied to the amount. As for example 7% provincial sales tax.
FST	federal sales tax	Federal tax on transactions such as the Goods and Services Tax (GST)
HST	harmonized sales Tax	Joint Federal/Provincial Sales Tax
PST	provincial/state sales tax	Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax

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

2020-05-06

revise