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: ActInvoiceOverrideCode

Official URL: http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode Version: 2.0.0
Active as of 2014-03-26 Computable Name: ActInvoiceOverrideCode
Other Identifiers: id: urn:oid:2.16.840.1.113883.1.11.17590

Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.


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)

This value set includes codes based on the following rules:

This value set excludes codes based on the following rules:



This value set contains 15 concepts

Expansion based on ActCode v8.0.0 (CodeSystem)

  COVGEhttp://terminology.hl7.org/CodeSystem/v3-ActCodecoverage problem

Insurance coverage problems have been encountered. Additional explanation information to be supplied.

  EFORMhttp://terminology.hl7.org/CodeSystem/v3-ActCodeelectronic form to follow

Electronic form with supporting or additional information to follow.

  FAXhttp://terminology.hl7.org/CodeSystem/v3-ActCodefax to follow

Fax with supporting or additional information to follow.

  GFTHhttp://terminology.hl7.org/CodeSystem/v3-ActCodegood faith indicator

The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered.

  LATEhttp://terminology.hl7.org/CodeSystem/v3-ActCodelate invoice

Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied.

  MANUALhttp://terminology.hl7.org/CodeSystem/v3-ActCodemanual review

Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.

  OOJhttp://terminology.hl7.org/CodeSystem/v3-ActCodeout of jurisdiction

The medical service and/or product was provided to a patient that has coverage in another jurisdiction.

  ORTHOhttp://terminology.hl7.org/CodeSystem/v3-ActCodeorthodontic service

The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.

  PAPERhttp://terminology.hl7.org/CodeSystem/v3-ActCodepaper documentation to follow

Paper documentation (or other physical format) with supporting or additional information to follow.

  PIEhttp://terminology.hl7.org/CodeSystem/v3-ActCodepublic insurance exhausted

Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission.

  PYRDELAYhttp://terminology.hl7.org/CodeSystem/v3-ActCodedelayed by a previous payor

Allows provider to explain lateness of invoice to a subsequent payor.

  REFNRhttp://terminology.hl7.org/CodeSystem/v3-ActCodereferral not required

Rules of practice do not require a physician's referral for the provider to perform a billable service.

  REPSERVhttp://terminology.hl7.org/CodeSystem/v3-ActCoderepeated service

The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate.

  UNRELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeunrelated service

The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items.

  VERBAUTHhttp://terminology.hl7.org/CodeSystem/v3-ActCodeverbal authorization

The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.

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


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