HL7 Terminology (THO)
6.0.1 - Publication
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
Active as of 2024-07-18 | Maturity Level: 1 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="adjudication"/>
<meta>
<lastUpdated value="2024-04-24T00:00:00+00:00"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="1"/>
</extension>
<url value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.4.642.1.1171"/>
</identifier>
<version value="1.0.1"/>
<name value="AdjudicationValueCodes"/>
<title value="Adjudication Value Codes"/>
<status value="active"/>
<experimental value="false"/>
<date value="2024-07-18T15:46:48-06:00"/>
<publisher value="Health Level Seven International"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://hl7.org"/>
</telecom>
<telecom>
<system value="email"/>
<value value="hq@HL7.org"/>
</telecom>
</contact>
<description
value="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
value="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 value="true"/>
<valueSet value="http://terminology.hl7.org/ValueSet/adjudication"/>
<content value="complete"/>
<concept>
<code value="submitted"/>
<display value="Submitted Amount"/>
<definition
value="The total submitted amount for the claim or group or line item."/>
</concept>
<concept>
<code value="copay"/>
<display value="CoPay"/>
<definition value="Patient Co-Payment"/>
</concept>
<concept>
<code value="eligible"/>
<display value="Eligible Amount"/>
<definition
value="Amount of the change which is considered for adjudication."/>
</concept>
<concept>
<code value="deductible"/>
<display value="Deductible"/>
<definition
value="Amount deducted from the eligible amount prior to adjudication."/>
</concept>
<concept>
<code value="unallocdeduct"/>
<display value="Unallocated Deductible"/>
<definition
value="The amount of deductible which could not allocated to other line items."/>
</concept>
<concept>
<code value="eligpercent"/>
<display value="Eligible %"/>
<definition value="Eligible Percentage."/>
</concept>
<concept>
<code value="tax"/>
<display value="Tax"/>
<definition value="The amount of tax."/>
</concept>
<concept>
<code value="benefit"/>
<display value="Benefit Amount"/>
<definition value="Amount payable under the coverage"/>
</concept>
</CodeSystem>