HL7 Terminology (THO)
5.2.0 - Publication
This page is part of the HL7 Terminology (v5.2.0: Release) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
Official URL: http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode | Version: 2.0.0 | |||
Active as of 2014-03-26 | Computable Name: ActInvoiceDetailGenericAdjudicatorCode | |||
Other Identifiers: id: urn:oid:2.16.840.1.113883.1.11.19411 |
The billable item codes to identify adjudicator specified components to the total billing of a claim.
References
This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/v3-ActCode
where concept is-a _ActInvoiceDetailGenericAdjudicatorCodeThis value set excludes codes based on the following rules:
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. |
This value set contains 6 concepts
Expansion based on ActCode v8.0.1 (CodeSystem)
Code | System | Display | Definition |
COIN | http://terminology.hl7.org/CodeSystem/v3-ActCode | 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 | http://terminology.hl7.org/CodeSystem/v3-ActCode | 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 | http://terminology.hl7.org/CodeSystem/v3-ActCode | 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 | http://terminology.hl7.org/CodeSystem/v3-ActCode | 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 | http://terminology.hl7.org/CodeSystem/v3-ActCode | 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 | http://terminology.hl7.org/CodeSystem/v3-ActCode | co-insurance | The covered party pays a percentage of the cost of covered services. |
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 |
2022-10-18 | revise | Marc Duteau | TSMG | Fixing missing metadata; up-349 |
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 |