HL7 Terminology (THO)
3.1.0 - Publication
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
Official URL: http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericCode | Version: 2.0.0 | |||
Active as of 2014-03-26 | Computable Name: ActInvoiceDetailGenericCode | |||
Other Identifiers: : urn:oid:2.16.840.1.113883.1.11.19407 |
The detail item codes to identify charges or changes to the total billing of a claim due to insurance rules and payments.
References
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/v3-ActCode
where concept is-a _ActInvoiceDetailGenericCodeThis value set excludes codes based on the following rules:
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. |
This value set contains 25 concepts
Expansion based on ActCode v6.1.0 (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 |
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
Date | Action | Author | Custodian | Comment |
2020-05-06 | revise | Ted Klein | Vocabulary WG | Migrated to the UTG maintenance environment and publishing tooling. |
2014-03-26 | revise | Vocabulary (Woody Beeler) (no record of original request) | 2014T1_2014-03-26_001283 (RIM release ID) | Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26 |