HL7 Terminology (THO)
3.1.0 - Publication International flag

This page is part of the HL7 Terminology (v3.1.0: 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: Adjudication Value Codes

Official URL: http://terminology.hl7.org/ValueSet/adjudication Version: 0.3.0
Standards status: Draft Maturity Level: 1 Responsible: FHIR Project team Computable Name: AdjudicationValueCodes
Other Identifiers: : urn:oid:2.16.840.1.113883.4.642.3.596

Copyright/Legal: This is an example set.

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.

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)

 

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

CodeDisplayDefinition
submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
copayCoPayPatient Co-Payment
eligibleEligible AmountAmount of the change which is considered for adjudication.
deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
unallocdeductUnallocated DeductibleThe amount of deductible which could not allocated to other line items.
eligpercentEligible %Eligible Percentage.
taxTaxThe amount of tax.
benefitBenefit AmountAmount 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
System 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

DateActionAuthorCustodianComment
2020-10-14reviseGrahame GrieveVocabulary WGReset Version after migration to UTG
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.