FHIR IG Statistics: ValueSet/PCTAdjudication
Package | hl7.fhir.us.davinci-pct |
Type | ValueSet |
Id | PCTAdjudication |
FHIR Version | R4 |
Source | http://hl7.org/fhir/us/davinci-pct/https://build.fhir.org/ig/HL7/davinci-pct/ValueSet-PCTAdjudication.html |
URL | http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudication |
Version | 2.0.0-draft |
Status | active |
Date | 2025-06-03T13:32:08+00:00 |
Name | PCTAdjudication |
Title | PCT Adjudication Value Set |
Realm | us |
Authority | hl7 |
Description | Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values
defined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem. |
Copyright | This Valueset is not copyrighted. |
Resources that use this resource
Resources that this resource uses
Narrative
Note: links and images are rebased to the (stated) source
This value set includes codes based on the following rules:
- Include these codes as defined in
http://terminology.hl7.org/CodeSystem/adjudication
Code | Display | Definition |
submitted | Submitted Amount | The total submitted amount for the claim or group or line item. |
copay | CoPay | Patient Co-Payment |
eligible | Eligible Amount | Amount of the change which is considered for adjudication. |
deductible | Deductible | Amount deducted from the eligible amount prior to adjudication. |
benefit | Benefit Amount | Amount payable under the coverage |
- Include these codes as defined in
http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
Code | Display | Definition |
coinsurance | Coinsurance | 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%. |
noncovered | Noncovered | 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. |
memberliability | Member liability | The amount of the member's liability. |
discount | Discount | The amount of the discount |
Source
{
"resourceType": "ValueSet",
"id": "PCTAdjudication",
"text": {
"status": "extensions",
"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/ValueSet/PCTAdjudication",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.40.4.48.6"
}
],
"version": "2.0.0-draft",
"name": "PCTAdjudication",
"title": "PCT Adjudication Value Set",
"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 includes the values \ndefined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US"
}
]
}
],
"copyright": "This Valueset is not copyrighted.",
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"concept": [
{
"code": "submitted"
},
{
"code": "copay"
},
{
"code": "eligible"
},
{
"code": "deductible"
},
{
"code": "benefit"
}
]
},
{
"system": "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication",
"concept": [
{
"code": "coinsurance",
"display": "Coinsurance"
},
{
"code": "noncovered",
"display": "Noncovered"
},
{
"code": "memberliability",
"display": "Member liability"
},
{
"code": "discount",
"display": "Discount"
}
]
}
]
}
}