HL7 Terminology
1.0.0 - Publication

This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Adjudication Value Codes

Summary

Defining URL:http://terminology.hl7.org/ValueSet/adjudication
Version:4.1.0
Name:AdjudicationValueCodes
Status:draft
Title:Adjudication Value Codes
Definition:

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.

Publisher:FHIR Project team
Committee:Financial Management
OID:2.16.840.1.113883.4.642.3.596 (for OID based terminology systems)
Copyright:

This is an example set.

Maturity:1
Source Resource:XML / JSON / Turtle

References

This value set is not used

Content Logical Definition

Logical Definition (CLD)

 

Expansion

This value set contains 8 concepts

Expansion based on Adjudication Value Codes v4.2.0 (CodeSystem)

All codes from system http://terminology.hl7.org/CodeSystem/adjudication

CodeDisplayDefinition
submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
copayCoPayPatient Co-Payment
eligibleEligible AmountAmount of the change which is considered for adjudication.
deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
unallocdeductUnallocated DeductibleThe amount of deductible which could not allocated to other line items.
eligpercentEligible %Eligible Percentage.
taxTaxThe amount of tax.
benefitBenefit AmountAmount payable under the coverage

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code

History

DateActionCustodianAuthorComment
2020-05-06reviseVocabulary WGTed KleinMigrated to the UTG maintenance environment and publishing tooling.