<?xml version="1.0" encoding="UTF-8"?><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="2025-01-22T18:33:38-07:00"/><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>