FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4.r4 |
| Resource Type | ValueSet |
| Id | ValueSet-R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4.json |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/xver-r5.r4/0.0.1-snapshot-2/ValueSet-R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4.html |
| URL | http://hl7.org/fhir/5.0/ValueSet/R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4 |
| Version | 0.0.1-snapshot-2 |
| Status | active |
| Date | 2025-09-01T22:37:04.900444+10:00 |
| Name | R5_v3_ActInvoiceDetailGenericAdjudicatorCode_for_R4 |
| Title | Cross-version VS for R5.ActInvoiceDetailGenericAdjudicatorCode for use in FHIR R4 |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4. |
No resources found
| CodeSystem | |
| v3-ActCode | ActCode |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4
This value set expansion contains 6 concepts.
| Code | System | Display | Definition |
| COIN | http://terminology.hl7.org/CodeSystem/v3-ActCode | coinsurance | That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results. |
| COPAYMENT | http://terminology.hl7.org/CodeSystem/v3-ActCode | patient co-pay | That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results. |
| DEDUCTIBLE | http://terminology.hl7.org/CodeSystem/v3-ActCode | deductible | That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results. |
| PAY | http://terminology.hl7.org/CodeSystem/v3-ActCode | payment | The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization. |
| SPEND | http://terminology.hl7.org/CodeSystem/v3-ActCode | spend down | That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results |
| COINS | http://terminology.hl7.org/CodeSystem/v3-ActCode | co-insurance | The covered party pays a percentage of the cost of covered services. |
FHIR
FHIRsmith{
"resourceType": "ValueSet",
"id": "R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fhir"
},
{
"extension": [
{
"url": "packageId",
"valueId": "hl7.fhir.uv.xver-r5.r4"
},
{
"url": "version",
"valueString": "0.0.1-snapshot-2"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/package-source"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
]
}
},
{
"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/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
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}
],
"url": "http://hl7.org/fhir/5.0/ValueSet/R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4",
"version": "0.0.1-snapshot-2",
"name": "R5_v3_ActInvoiceDetailGenericAdjudicatorCode_for_R4",
"title": "Cross-version VS for R5.ActInvoiceDetailGenericAdjudicatorCode for use in FHIR R4",
"status": "active",
"experimental": false,
"date": "2025-09-01T22:37:04.900444+10:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"concept": [
{
"code": "COIN",
"display": "coinsurance"
},
{
"code": "COPAYMENT",
"display": "patient co-pay"
},
{
"code": "DEDUCTIBLE",
"display": "deductible"
},
{
"code": "PAY",
"display": "payment"
},
{
"code": "SPEND",
"display": "spend down"
},
{
"code": "COINS",
"display": "co-insurance"
}
]
}
]
},
"expansion": {
"timestamp": "2025-09-01T22:37:04.900441+10:00",
"contains": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "COIN",
"display": "coinsurance"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "COPAYMENT",
"display": "patient co-pay"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "DEDUCTIBLE",
"display": "deductible"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "PAY",
"display": "payment"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "SPEND",
"display": "spend down"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "COINS",
"display": "co-insurance"
}
]
}
}