This case-sensitive code system http://terminology.hl7.org/CodeSystem/adjudication
defines the following codes:
Code | Display | Definition |
submitted | Submitted Amount | The total submitted amount for the claim or group or line item. |
copay | CoPay | Patient Co-Payment |
eligible | Eligible Amount | Amount of the change which is considered for adjudication. |
deductible | Deductible | Amount deducted from the eligible amount prior to adjudication. |
unallocdeduct | Unallocated Deductible | The amount of deductible which could not allocated to other line items. |
eligpercent | Eligible % | Eligible Percentage. |
tax | Tax | The amount of tax. |
benefit | Benefit Amount | Amount payable under the coverage |
"
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "fm" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1"^^xsd:integer ]
] ) ; #
fhir:url [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI] ; #
fhir:identifier ( [
fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.1.1171" ]
] ) ; #
fhir:version [ fhir:v "1.0.0"] ; #
fhir:name [ fhir:v "AdjudicationValueCodes"] ; #
fhir:title [ fhir:v "Adjudication Value Codes"] ; #
fhir:status [ fhir:v "draft"] ; #
fhir:experimental [ fhir:v "false"^^xsd:boolean] ; #
fhir:date [ fhir:v "2024-03-09T11:11:30-07:00"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "Health Level Seven International"] ; #
fhir:contact ( [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org" ]
] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "hq@HL7.org" ]
] )
] ) ; #
fhir:description [ fhir:v "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."] ; #
fhir:copyright [ fhir:v "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"] ; #
fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; #
fhir:valueSet [
fhir:v "http://terminology.hl7.org/ValueSet/adjudication"^^xsd:anyURI ;
fhir:link