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. For a full list of available versions, see the Directory of published versions
: Adjudication Value Codes - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "adjudication"] ; #
fhir:meta [
fhir:lastUpdated [ fhir:v "2024-04-24T00:00:00+00:00"^^xsd:dateTime ] ;
( fhir:profile [
fhir:v "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/StructureDefinition/shareablecodesystem> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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>"
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "fm" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1"^^xsd:integer ]
] ) ; #
fhir:url [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI] ; #
fhir:identifier ( [
fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.1.1171" ]
] ) ; #
fhir:version [ fhir:v "1.0.1"] ; #
fhir:name [ fhir:v "AdjudicationValueCodes"] ; #
fhir:title [ fhir:v "Adjudication Value Codes"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v "false"^^xsd:boolean] ; #
fhir:date [ fhir:v "2024-11-17T12:23:22-07:00"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "Health Level Seven International"] ; #
fhir:contact ( [
( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org" ] ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "hq@HL7.org" ] ] )
] ) ; #
fhir:description [ fhir:v "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."] ; #
fhir:copyright [ fhir:v "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"] ; #
fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; #
fhir:valueSet [
fhir:v "http://terminology.hl7.org/ValueSet/adjudication"^^xsd:anyURI ;
fhir:link <http://terminology.hl7.org/ValueSet/adjudication>
] ; #
fhir:content [ fhir:v "complete"] ; #
fhir:concept ( [
fhir:code [ fhir:v "submitted" ] ;
fhir:display [ fhir:v "Submitted Amount" ] ;
fhir:definition [ fhir:v "The total submitted amount for the claim or group or line item." ]
] [
fhir:code [ fhir:v "copay" ] ;
fhir:display [ fhir:v "CoPay" ] ;
fhir:definition [ fhir:v "Patient Co-Payment" ]
] [
fhir:code [ fhir:v "eligible" ] ;
fhir:display [ fhir:v "Eligible Amount" ] ;
fhir:definition [ fhir:v "Amount of the change which is considered for adjudication." ]
] [
fhir:code [ fhir:v "deductible" ] ;
fhir:display [ fhir:v "Deductible" ] ;
fhir:definition [ fhir:v "Amount deducted from the eligible amount prior to adjudication." ]
] [
fhir:code [ fhir:v "unallocdeduct" ] ;
fhir:display [ fhir:v "Unallocated Deductible" ] ;
fhir:definition [ fhir:v "The amount of deductible which could not allocated to other line items." ]
] [
fhir:code [ fhir:v "eligpercent" ] ;
fhir:display [ fhir:v "Eligible %" ] ;
fhir:definition [ fhir:v "Eligible Percentage." ]
] [
fhir:code [ fhir:v "tax" ] ;
fhir:display [ fhir:v "Tax" ] ;
fhir:definition [ fhir:v "The amount of tax." ]
] [
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit Amount" ] ;
fhir:definition [ fhir:v "Amount payable under the coverage" ]
] ) . #
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