HL7 Terminology (THO)
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This page is part of the HL7 Terminology (v6.0.1: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. 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

: Adjudication Value Codes - JSON Representation

Active as of 2024-07-18 Maturity Level: 1

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{
  "resourceType" : "CodeSystem",
  "id" : "adjudication",
  "meta" : {
    "lastUpdated" : "2024-04-24T00:00:00+00:00",
    "profile" : [
      🔗 "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem adjudication</b></p><a name=\"adjudication\"> </a><a name=\"hcadjudication\"> </a><a name=\"adjudication-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2024-04-24 00:00:00+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/R5/shareablecodesystem.html\">Shareable CodeSystem</a></p></div><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" : "1.0.1",
  "name" : "AdjudicationValueCodes",
  "title" : "Adjudication Value Codes",
  "status" : "active",
  "experimental" : false,
  "date" : "2024-07-18T15:46:48-06:00",
  "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"
    }
  ]
}