{
  "resourceType": "CodeSystem",
  "id": "adjudication",
  "meta": {
    "lastUpdated": "2020-04-09T21:10:28.568+00:00",
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system <code>http://terminology.hl7.org/CodeSystem/adjudication</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">submitted<a name=\"adjudication-submitted\"> </a></td><td>Submitted Amount</td><td>The total submitted amount for the claim or group or line item.</td></tr><tr><td style=\"white-space:nowrap\">copay<a name=\"adjudication-copay\"> </a></td><td>CoPay</td><td>Patient Co-Payment</td></tr><tr><td style=\"white-space:nowrap\">eligible<a name=\"adjudication-eligible\"> </a></td><td>Eligible Amount</td><td>Amount of the change which is considered for adjudication.</td></tr><tr><td style=\"white-space:nowrap\">deductible<a name=\"adjudication-deductible\"> </a></td><td>Deductible</td><td>Amount deducted from the eligible amount prior to adjudication.</td></tr><tr><td style=\"white-space:nowrap\">unallocdeduct<a name=\"adjudication-unallocdeduct\"> </a></td><td>Unallocated Deductible</td><td>The amount of deductible which could not allocated to other line items.</td></tr><tr><td style=\"white-space:nowrap\">eligpercent<a name=\"adjudication-eligpercent\"> </a></td><td>Eligible %</td><td>Eligible Percentage.</td></tr><tr><td style=\"white-space:nowrap\">tax<a name=\"adjudication-tax\"> </a></td><td>Tax</td><td>The amount of tax.</td></tr><tr><td style=\"white-space:nowrap\">benefit<a name=\"adjudication-benefit\"> </a></td><td>Benefit Amount</td><td>Amount payable under the coverage</td></tr></table></div>"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "draft"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1
    }
  ],
  "url": "http://terminology.hl7.org/CodeSystem/adjudication",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.1.1171"
    }
  ],
  "version": "0.1.0",
  "name": "AdjudicationValueCodes",
  "title": "Adjudication Value Codes",
  "status": "draft",
  "experimental": false,
  "date": "2022-09-14T03:23:03-06:00",
  "publisher": "FHIR Project team",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org/fhir"
        }
      ]
    }
  ],
  "description": "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.",
  "copyright": "This is an example set.",
  "caseSensitive": true,
  "valueSet": "http://terminology.hl7.org/ValueSet/adjudication",
  "content": "complete",
  "concept": [
    {
      "code": "submitted",
      "display": "Submitted Amount",
      "definition": "The total submitted amount for the claim or group or line item."
    },
    {
      "code": "copay",
      "display": "CoPay",
      "definition": "Patient Co-Payment"
    },
    {
      "code": "eligible",
      "display": "Eligible Amount",
      "definition": "Amount of the change which is considered for adjudication."
    },
    {
      "code": "deductible",
      "display": "Deductible",
      "definition": "Amount deducted from the eligible amount prior to adjudication."
    },
    {
      "code": "unallocdeduct",
      "display": "Unallocated Deductible",
      "definition": "The amount of deductible which could not allocated to other line items."
    },
    {
      "code": "eligpercent",
      "display": "Eligible %",
      "definition": "Eligible Percentage."
    },
    {
      "code": "tax",
      "display": "Tax",
      "definition": "The amount of tax."
    },
    {
      "code": "benefit",
      "display": "Benefit Amount",
      "definition": "Amount payable under the coverage"
    }
  ]
}