HL7 Terminology (THO)
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This page is part of the HL7 Terminology (v6.1.0: 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 - XML Representation

Active as of 2024-11-17 Maturity Level: 1

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<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="2024-11-17T10:31:17-07:00"/>
  <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>