HL7 Terminology (THO)
5.5.0 - Publication
This page is part of the HL7 Terminology (v5.5.0: Release) based on FHIR (HL7® FHIR® Standard) 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
Draft as of 2024-03-09 | Maturity Level: 1 |
{
"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 case-sensitive 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-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" : "1.0.0",
"name" : "AdjudicationValueCodes",
"title" : "Adjudication Value Codes",
"status" : "draft",
"experimental" : false,
"date" : "2024-03-09T11:11:30-07:00",
"publisher" : "Health Level Seven International",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "http://hl7.org"
},
{
"system" : "email",
"value" : "hq@HL7.org"
}
]
}
],
"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 material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license",
"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"
}
]
}