HL7 Terminology (THO)
5.1.0 - Publication International flag

This page is part of the HL7 Terminology (v5.1.0: 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: ActInvoiceAdjudicationPaymentCode

Official URL: http://terminology.hl7.org/ValueSet/v3-ActInvoiceAdjudicationPaymentCode Version: 2.0.0
Active as of 2014-03-26 Computable Name: ActInvoiceAdjudicationPaymentCode
Other Identifiers: id: urn:oid:2.16.840.1.113883.1.11.19412

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.

References

Logical Definition (CLD)

This value set includes codes based on the following rules:

This value set excludes codes based on the following rules:

  • Exclude these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActCode
    CodeDisplayDefinition
    _ActInvoiceAdjudicationPaymentCodeActInvoiceAdjudicationPaymentCodeCodes 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 v8.0.0 (CodeSystem)

CodeSystemDisplayDefinition
  _ActInvoiceAdjudicationPaymentGroupCodehttp://terminology.hl7.org/CodeSystem/v3-ActCodeActInvoiceAdjudicationPaymentGroupCode

Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.

  ALEChttp://terminology.hl7.org/CodeSystem/v3-ActCodealternate 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).

  BONUShttp://terminology.hl7.org/CodeSystem/v3-ActCodebonus

Bonus payments based on performance, volume, etc. as agreed to by the payor.

  CFWDhttp://terminology.hl7.org/CodeSystem/v3-ActCodecarry 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.

  EDUhttp://terminology.hl7.org/CodeSystem/v3-ActCodeeducation fees

Fees deducted on behalf of a payee for tuition and continuing education.

  EPYMThttp://terminology.hl7.org/CodeSystem/v3-ActCodeearly payment fee

Fees deducted on behalf of a payee for charges based on a shorter payment frequency (i.e. next day versus biweekly payments.

  GARNhttp://terminology.hl7.org/CodeSystem/v3-ActCodegarnishee

Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

  INVOICEhttp://terminology.hl7.org/CodeSystem/v3-ActCodesubmitted invoice

Payment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results..

  PINVhttp://terminology.hl7.org/CodeSystem/v3-ActCodepaper invoice

Payment initiated by the payor as the result of adjudicating a paper (original, may have been faxed) invoice.

  PPRDhttp://terminology.hl7.org/CodeSystem/v3-ActCodeprior period adjustment

An amount that was owed to the payor as indicated, by a carry forward adjusment, in a previous payment advice

  PROAhttp://terminology.hl7.org/CodeSystem/v3-ActCodeprofessional association deduction

Professional association fee that is collected by the payor from the practitioner/provider on behalf of the association

  RECOVhttp://terminology.hl7.org/CodeSystem/v3-ActCoderecovery

Retroactive adjustment such as fee rate adjustment due to contract negotiations.

  RETROhttp://terminology.hl7.org/CodeSystem/v3-ActCoderetro adjustment

Bonus payments based on performance, volume, etc. as agreed to by the payor.

  TRANhttp://terminology.hl7.org/CodeSystem/v3-ActCodetransaction fee

Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

  _ActInvoicePaymentCodehttp://terminology.hl7.org/CodeSystem/v3-ActCodeActInvoiceAdjudicationPaymentGroupCode

Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.

  _ActInvoiceAdjudicationPaymentSummaryCodehttp://terminology.hl7.org/CodeSystem/v3-ActCodeActInvoiceAdjudicationPaymentSummaryCode

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.

  CONThttp://terminology.hl7.org/CodeSystem/v3-ActCodecontract

Transaction counts and value totals by Contract Identifier.

  DAYhttp://terminology.hl7.org/CodeSystem/v3-ActCodeday

Transaction counts and value totals for each calendar day within the date range specified.

  LOChttp://terminology.hl7.org/CodeSystem/v3-ActCodelocation

Transaction counts and value totals by service location (e.g clinic).

  MONTHhttp://terminology.hl7.org/CodeSystem/v3-ActCodemonth

Transaction counts and value totals for each calendar month within the date range specified.

  PERIODhttp://terminology.hl7.org/CodeSystem/v3-ActCodeperiod

Transaction counts and value totals for the date range specified.

  PROVhttp://terminology.hl7.org/CodeSystem/v3-ActCodeprovider

Transaction counts and value totals by Provider Identifier.

  WEEKhttp://terminology.hl7.org/CodeSystem/v3-ActCodeweek

Transaction counts and value totals for each calendar week within the date range specified.

  YEARhttp://terminology.hl7.org/CodeSystem/v3-ActCodeyear

Transaction counts and value totals for each calendar year within the date range specified.

  INVTYPEhttp://terminology.hl7.org/CodeSystem/v3-ActCodeinvoice type

Transaction counts and value totals by invoice type (e.g. RXDINV - Pharmacy Dispense)

  PAYEEhttp://terminology.hl7.org/CodeSystem/v3-ActCodepayee

Transaction counts and value totals by each instance of an invoice payee.

  PAYORhttp://terminology.hl7.org/CodeSystem/v3-ActCodepayor

Transaction counts and value totals by each instance of an invoice payor.

  SENDAPPhttp://terminology.hl7.org/CodeSystem/v3-ActCodesending 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
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
2022-10-18reviseMarc DuteauTSMGFixing missing metadata; up-349
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.
2014-03-26reviseVocabulary (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