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FHIR IG Statistics: ValueSet/PCTAdjudication

Packagehl7.fhir.us.davinci-pct
TypeValueSet
IdPCTAdjudication
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-pct/https://build.fhir.org/ig/HL7/davinci-pct/ValueSet-PCTAdjudication.html
URLhttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudication
Version2.0.0-draft
Statusactive
Date2025-06-03T13:32:08+00:00
NamePCTAdjudication
TitlePCT Adjudication Value Set
Realmus
Authorityhl7
DescriptionDescribes 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.
CopyrightThis Valueset is not copyrighted.

Resources that use this resource

ValueSet
PCTTotalPCT Total Value Set

Resources that this resource uses

CodeSystem
PCTAdjudicationPCT Adjudication Code System
adjudicationAdjudication Value Codes
adjudicationAdjudication Value Codes

Narrative

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

Generated Narrative: ValueSet PCTAdjudication

This value set includes codes based on the following rules:

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/adjudication
    CodeDisplayDefinition
    submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
    copayCoPayPatient Co-Payment
    eligibleEligible AmountAmount of the change which is considered for adjudication.
    deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
    benefitBenefit AmountAmount payable under the coverage
  • Include these codes as defined in http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
    CodeDisplayDefinition
    coinsuranceCoinsuranceThe 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%.
    noncoveredNoncoveredThe 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.
    memberliabilityMember liabilityThe amount of the member's liability.
    discountDiscountThe 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"
          }
        ]
      }
    ]
  }
}