HL7 Terminology (THO)
6.0.2 - Publication
This page is part of the HL7 Terminology (v6.0.2: 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
Official URL: http://terminology.hl7.org/ValueSet/v3-ActAdjudicationCode | Version: 3.0.0 | |||
Active as of 2014-03-26 | Responsible: Health Level Seven International | Computable Name: ActAdjudicationCode | ||
Other Identifiers: OID:2.16.840.1.113883.1.11.17616 | ||||
Copyright/Legal: 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.html |
Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.
References
This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)
Generated Narrative: ValueSet v3-ActAdjudicationCode
Language: en
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/v3-ActCode
where concept is-a _ActAdjudicationCodeThis value set excludes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/v3-ActCode
Code | Display | Definition |
_ActAdjudicationCode | ActAdjudicationCode | Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results. |
Generated Narrative: ValueSet
Language: en
Expansion based on codesystem ActCode v9.0.0 (CodeSystem)
This value set contains 13 concepts
Code | System | Display | Definition |
_ActAdjudicationGroupCode | http://terminology.hl7.org/CodeSystem/v3-ActCode | ActAdjudicationGroupCode | Catagorization of grouping criteria for the associated transactions and/or summary (totals, subtotals). |
CONT | http://terminology.hl7.org/CodeSystem/v3-ActCode | contract | Transaction counts and value totals by Contract Identifier. |
DAY | http://terminology.hl7.org/CodeSystem/v3-ActCode | day | Transaction counts and value totals for each calendar day within the date range specified. |
LOC | http://terminology.hl7.org/CodeSystem/v3-ActCode | location | Transaction counts and value totals by service location (e.g clinic). |
MONTH | http://terminology.hl7.org/CodeSystem/v3-ActCode | month | Transaction counts and value totals for each calendar month within the date range specified. |
PERIOD | http://terminology.hl7.org/CodeSystem/v3-ActCode | period | Transaction counts and value totals for the date range specified. |
PROV | http://terminology.hl7.org/CodeSystem/v3-ActCode | provider | Transaction counts and value totals by Provider Identifier. |
WEEK | http://terminology.hl7.org/CodeSystem/v3-ActCode | week | Transaction counts and value totals for each calendar week within the date range specified. |
YEAR | http://terminology.hl7.org/CodeSystem/v3-ActCode | year | Transaction counts and value totals for each calendar year within the date range specified. |
AA | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated with adjustments | The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges). Also includes the concept 'Adjudicate as zero' and items not covered under a particular Policy. Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting). |
ANF | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated with adjustments and no financial impact | The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges) without changing the amount. Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting). |
AR | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated as refused | The invoice element has passed through the adjudication process but payment is refused due to one or more reasons. Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late'). If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected. A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer. Invoice element cannot be reversed (nullified) as there is nothing to reverse. Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting). |
AS | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated as submitted | The invoice element was/will be paid exactly as submitted, without financial adjustment(s). If the dollar amount stays the same, but the billing codes have been amended or financial adjustments have been applied through the adjudication process, the invoice element is treated as "Adjudicated with Adjustment". If information items are included in the adjudication results that do not affect the monetary amounts paid, then this is still Adjudicated as Submitted (e.g. 'reached Plan Maximum on this Claim'). Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting). |
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 |
System | 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
Date | Action | Author | Custodian | Comment |
2023-11-14 | revise | Marc Duteau | TSMG | Add standard copyright and contact to internal content; up-476 |
2022-10-18 | revise | Marc Duteau | TSMG | Fixing missing metadata; up-349 |
2020-05-06 | revise | Ted Klein | Vocabulary WG | Migrated to the UTG maintenance environment and publishing tooling. |
2014-03-26 | revise | Vocabulary (Woody Beeler) (no record of original request) | 2014T1_2014-03-26_001283 (RIM release ID) | Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26 |