HL7 Terminology (THO)
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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

ValueSet: Adjudication Value Codes

Official URL: http://terminology.hl7.org/ValueSet/adjudication Version: 1.0.0
Draft as of 2020-02-24 Maturity Level: 1 Responsible: Health Level Seven International Computable Name: AdjudicationValueCodes
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:oid:2.16.840.1.113883.4.642.3.596

Copyright/Legal: 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

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.

References

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)

 

Expansion

Expansion based on codesystem Adjudication Value Codes v1.0.0 (CodeSystem)

This value set contains 8 concepts.

CodeSystemDisplayDefinition
  submittedhttp://terminology.hl7.org/CodeSystem/adjudicationSubmitted Amount

The total submitted amount for the claim or group or line item.

  copayhttp://terminology.hl7.org/CodeSystem/adjudicationCoPay

Patient Co-Payment

  eligiblehttp://terminology.hl7.org/CodeSystem/adjudicationEligible Amount

Amount of the change which is considered for adjudication.

  deductiblehttp://terminology.hl7.org/CodeSystem/adjudicationDeductible

Amount deducted from the eligible amount prior to adjudication.

  unallocdeducthttp://terminology.hl7.org/CodeSystem/adjudicationUnallocated Deductible

The amount of deductible which could not allocated to other line items.

  eligpercenthttp://terminology.hl7.org/CodeSystem/adjudicationEligible %

Eligible Percentage.

  taxhttp://terminology.hl7.org/CodeSystem/adjudicationTax

The amount of tax.

  benefithttp://terminology.hl7.org/CodeSystem/adjudicationBenefit Amount

Amount payable under the coverage

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

DateActionCustodianAuthorComment
2023-11-14reviseTSMGMarc DuteauAdd standard copyright and contact to internal content; up-476
2020-10-14reviseVocabulary WGGrahame GrieveReset Version after migration to UTG
2020-05-06reviseVocabulary WGTed KleinMigrated to the UTG maintenance environment and publishing tooling.