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

ActInvoiceAdjudicationPaymentCode

Summary

Defining URL:http://terminology.hl7.org/ValueSet/v3-ActInvoiceAdjudicationPaymentCode
Version:2.0.0
Name:ActInvoiceAdjudicationPaymentCode
Status:Active
Title:ActInvoiceAdjudicationPaymentCode
Definition:

Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

OID:2.16.840.1.113883.1.11.19412 (for OID based terminology systems)
Source Resource:XML / JSON / Turtle

References

Content Logical Definition

Logical Definition (CLD)

This value set includes codes based on the following rules:

 

Expansion

This value set contains 25 concepts

Expansion based on ActCode v2.0.0 (CodeSystem)

All codes from system http://terminology.hl7.org/CodeSystem/v3-ActCode

CodeDisplayDefinition
_ActInvoiceAdjudicationPaymentGroupCodeActInvoiceAdjudicationPaymentGroupCodeCodes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.
ALECalternate electronicPayment initiated by the payor as the result of adjudicating a submitted invoice that arrived to the payor from an electronic source that did not provide a conformant set of HL7 messages (e.g. web claim submission).
BONUSbonusBonus payments based on performance, volume, etc. as agreed to by the payor.
CFWDcarry forward adjusmentAn amount still owing to the payor but the payment is 0$ and this cannot be settled until a future payment is made.
EDUeducation feesFees deducted on behalf of a payee for tuition and continuing education.
EPYMTearly payment feeFees deducted on behalf of a payee for charges based on a shorter payment frequency (i.e. next day versus biweekly payments.
GARNgarnisheeFees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.
INVOICEsubmitted invoicePayment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results..
PINVpaper invoicePayment initiated by the payor as the result of adjudicating a paper (original, may have been faxed) invoice.
PPRDprior period adjustmentAn amount that was owed to the payor as indicated, by a carry forward adjusment, in a previous payment advice
PROAprofessional association deductionProfessional association fee that is collected by the payor from the practitioner/provider on behalf of the association
RECOVrecoveryRetroactive adjustment such as fee rate adjustment due to contract negotiations.
RETROretro adjustmentBonus payments based on performance, volume, etc. as agreed to by the payor.
TRANtransaction feeFees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.
_ActInvoicePaymentCodeActInvoiceAdjudicationPaymentGroupCodeCodes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.
_ActInvoiceAdjudicationPaymentSummaryCodeActInvoiceAdjudicationPaymentSummaryCodeCodes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee, etc.
CONTcontractTransaction counts and value totals by Contract Identifier.
DAYdayTransaction counts and value totals for each calendar day within the date range specified.
LOClocationTransaction counts and value totals by service location (e.g clinic).
MONTHmonthTransaction counts and value totals for each calendar month within the date range specified.
PERIODperiodTransaction counts and value totals for the date range specified.
PROVproviderTransaction counts and value totals by Provider Identifier.
WEEKweekTransaction counts and value totals for each calendar week within the date range specified.
YEARyearTransaction counts and value totals for each calendar year within the date range specified.
INVTYPEinvoice typeTransaction counts and value totals by invoice type (e.g. RXDINV - Pharmacy Dispense)
PAYEEpayeeTransaction counts and value totals by each instance of an invoice payee.
PAYORpayorTransaction counts and value totals by each instance of an invoice payor.
SENDAPPsending applicationTransaction counts and value totals by each instance of a messaging application on a single processor. It is a registered identifier known to the receivers.

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

DateActionAuthorCustodianComment
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.
2014-03-26reviseVocabulary (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