FHIR IG Statistics: ValueSet/PDexAdjudication
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/carin-bb/CodeSystem/C4BBAdjudication| 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. |
| priorpayerpaid | Prior payer paid | The reduction in the payment amount to reflect the carrier as a secondary payer. |
| paidbypatient | Paid by patient | The total amount paid by the patient without specifying the source. |
| paidtopatient | Paid to patient | paid to patient |
| paidtoprovider | Paid to provider | The amount paid to the provider. |
| memberliability | Member liability | The amount of the member's liability. |
| discount | Discount | The amount of the discount |
| drugcost | Drug cost | Price paid for the drug excluding mfr or other discounts. It typically is the sum of the following components: ingredient cost, dispensing fee, sales tax, and vaccine administration |
Source
{
"resourceType": "ValueSet",
"id": "PDexAdjudication",
"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": "informative",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pdex/ValueSet/PDexAdjudication",
"version": "2.1.0",
"name": "PDexAdjudication",
"title": "PDex Adjudication",
"status": "active",
"experimental": true,
"date": "2025-06-16T14:46:24+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": "fm@lists.HL7.org"
}
]
},
{
"name": "Mark Scrimshire (mark.scrimshire@onyxhealth.io)",
"telecom": [
{
"system": "email",
"value": "mailto:mark.scrimshire@onyxhealth.io"
}
]
},
{
"name": "HL7 International - Financial Management",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fm"
}
]
}
],
"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",
"display": "United States of America"
}
]
}
],
"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/carin-bb/CodeSystem/C4BBAdjudication",
"concept": [
{
"code": "coinsurance",
"display": "Coinsurance"
},
{
"code": "noncovered",
"display": "Noncovered"
},
{
"code": "priorpayerpaid",
"display": "Prior payer paid"
},
{
"code": "paidbypatient",
"display": "Paid by patient"
},
{
"code": "paidtopatient",
"display": "Paid to patient"
},
{
"code": "paidtoprovider",
"display": "Paid to provider"
},
{
"code": "memberliability",
"display": "Member liability"
},
{
"code": "discount",
"display": "Discount"
},
{
"code": "drugcost",
"display": "Drug cost"
}
]
}
]
}
}
FHIR