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FHIR IG Statistics: CodeSystem/PCTFinancialType

Packagehl7.fhir.us.davinci-pct
TypeCodeSystem
IdPCTFinancialType
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-pct/https://build.fhir.org/ig/HL7/davinci-pct/CodeSystem-PCTFinancialType.html
URLhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType
Version2.0.0-draft
Statusactive
Date2025-06-03T13:32:08+00:00
NamePCTFinancialType
TitlePCT Financial Type Code System
Realmus
Authorityhl7
DescriptionFinancial Type codes for benefitBalance.financial.type. 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
PCTFinancialTypeVSPCT Financial Type Value Set

Resources that this resource uses

No resources found


Narrative

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

Generated Narrative: CodeSystem PCTFinancialType

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

CodeDisplayDefinition
allowed AllowedThe maximum amount a plan will pay for a covered health care service. May also be called "payment allowance", or "negotiated rate".
coinsurance Co-InsuranceThe amount the insured individual pays, as a set percentage of the cost of covered services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.
copay CoPayA fixed amount ($20, for example) the insured individual pays for a covered health care service after the deductible is paid.
deductible DeductibleThe amount the insured individual pays for covered health care services before the insurance plan starts to pay.
eligible Eligible AmountAmount of the charge which is considered for adjudication.
memberliability Member LiabilityThe amount of the member's liability.
noncovered NoncoveredThe portion of the cost of the service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract.
out-of-pocket-maximum Out-of-Pocket MaximumThe most the insured individual has to pay for covered services in a plan year. After this amount is spent on deductibles, copayments, and coinsurance for in-network care and services, the health plan pays 100% of the costs of covered benefits.
visit VisitA medical visit means diagnostic, therapeutic, or consultative services provided to a client by a healthcare professional in an outpatient setting.
penalty PenaltyBenefit penalty is an approach used by the insurance company to reduce their payment on a claim when the patient or medical provider does not satisfy the rules of the health plan. Benefit penalties may occur when a pre-authorization is not obtained, for example.

Source

{
  "resourceType": "CodeSystem",
  "id": "PCTFinancialType",
  "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/PCTFinancialType",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.4.16.8"
    }
  ],
  "version": "2.0.0-draft",
  "name": "PCTFinancialType",
  "title": "PCT Financial Type 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": "Financial Type codes for benefitBalance.financial.type. 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": 10,
  "concept": [
    {
      "code": "allowed",
      "display": "Allowed",
      "definition": "The maximum amount a plan will pay for a covered health care service. May also be called \"payment allowance\", or \"negotiated rate\"."
    },
    {
      "code": "coinsurance",
      "display": "Co-Insurance",
      "definition": "The amount the insured individual pays, as a set percentage of the cost of covered services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%."
    },
    {
      "code": "copay",
      "display": "CoPay",
      "definition": "A fixed amount ($20, for example) the insured individual pays for a covered health care service after the deductible is paid."
    },
    {
      "code": "deductible",
      "display": "Deductible",
      "definition": "The amount the insured individual pays for covered health care services before the insurance plan starts to pay."
    },
    {
      "code": "eligible",
      "display": "Eligible Amount",
      "definition": "Amount of the charge which is considered for adjudication."
    },
    {
      "code": "memberliability",
      "display": "Member Liability",
      "definition": "The amount of the member's liability."
    },
    {
      "code": "noncovered",
      "display": "Noncovered",
      "definition": "The portion of the cost of the service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract."
    },
    {
      "code": "out-of-pocket-maximum",
      "display": "Out-of-Pocket Maximum",
      "definition": "The most the insured individual has to pay for covered services in a plan year. After this amount is spent on deductibles, copayments, and coinsurance for in-network care and services, the health plan pays 100% of the costs of covered benefits."
    },
    {
      "code": "visit",
      "display": "Visit",
      "definition": "A medical visit means diagnostic, therapeutic, or consultative services provided to a client by a healthcare professional in an outpatient setting."
    },
    {
      "code": "penalty",
      "display": "Penalty",
      "definition": "Benefit penalty is an approach used by the insurance company to reduce their payment on a claim when the patient or medical provider does not satisfy the rules of the health plan. Benefit penalties may occur when a pre-authorization is not obtained, for example."
    }
  ]
}