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FHIR IG Statistics: CodeSystem/PCTAdjudication

Packagehl7.fhir.us.davinci-pct
TypeCodeSystem
IdPCTAdjudication
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-pct/https://build.fhir.org/ig/HL7/davinci-pct/CodeSystem-PCTAdjudication.html
URLhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
Version2.0.0-draft
Statusactive
Date2025-06-03T13:32:08+00:00
NamePCTAdjudication
TitlePCT Adjudication Code System
Realmus
Authorityhl7
DescriptionDescribes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions.
CopyrightThis CodeSystem is not copyrighted.
Contentcomplete

Resources that use this resource

ValueSet
PCTAdjudicationPCT Adjudication Value Set

Resources that this resource uses

No resources found


Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CodeSystem PCTAdjudication

This case-sensitive code system http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication defines the following codes:

CodeDisplayDefinition
coinsurance Co-insuranceThe amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.
noncovered NoncoveredThe portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract.
memberliability Member liabilityThe amount of the member's liability.
discount DiscountThe amount of the discount

Source

{
  "resourceType": "CodeSystem",
  "id": "PCTAdjudication",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.4.16.2"
    }
  ],
  "version": "2.0.0-draft",
  "name": "PCTAdjudication",
  "title": "PCT Adjudication Code System",
  "status": "active",
  "experimental": false,
  "date": "2025-06-03T13:32:08+00:00",
  "publisher": "HL7 International / Financial Management",
  "contact": [
    {
      "name": "HL7 International / Financial Management",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        },
        {
          "system": "email",
          "value": "fmlists@lists.hl7.org"
        }
      ]
    }
  ],
  "description": "Describes the various amount fields used when payers receive and adjudicate a claim.  It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "copyright": "This CodeSystem is not copyrighted.",
  "caseSensitive": true,
  "content": "complete",
  "count": 4,
  "concept": [
    {
      "code": "coinsurance",
      "display": "Co-insurance",
      "definition": "The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%."
    },
    {
      "code": "noncovered",
      "display": "Noncovered",
      "definition": "The portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract."
    },
    {
      "code": "memberliability",
      "display": "Member liability",
      "definition": "The amount of the member's liability."
    },
    {
      "code": "discount",
      "display": "Discount",
      "definition": "The amount of the discount"
    }
  ]
}