This case-sensitive code system http://terminology.hl7.org/CodeSystem/adjudication
defines the following codes:
Code | Display | Definition |
submitted | Submitted Amount | The total submitted amount for the claim or group or line item. |
copay | CoPay | Patient Co-Payment |
eligible | Eligible Amount | Amount of the change which is considered for adjudication. |
deductible | Deductible | Amount deducted from the eligible amount prior to adjudication. |
unallocdeduct | Unallocated Deductible | The amount of deductible which could not allocated to other line items. |
eligpercent | Eligible % | Eligible Percentage. |
tax | Tax | The amount of tax. |
benefit | Benefit Amount | Amount payable under the coverage |