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Packagehl7.fhir.uv.xver-r5.r4b
Resource TypeCodeSystem
IdCodeSystem-adjudication.json
FHIR VersionR4B

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Narrative

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

This code system http://terminology.hl7.org/CodeSystem/adjudication defines the following codes:

CodeDisplayDefinition
submitted Submitted AmountThe total submitted amount for the claim or group or line item.
copay CoPayPatient Co-Payment
eligible Eligible AmountAmount of the change which is considered for adjudication.
deductible DeductibleAmount deducted from the eligible amount prior to adjudication.
unallocdeduct Unallocated DeductibleThe amount of deductible which could not allocated to other line items.
eligpercent Eligible %Eligible Percentage.
tax TaxThe amount of tax.
benefit Benefit AmountAmount payable under the coverage

Source1

{
  "resourceType": "CodeSystem",
  "id": "adjudication",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1
    },
    {
      "extension": [
        {
          "url": "packageId",
          "valueId": "hl7.fhir.uv.xver-r5.r4b"
        },
        {
          "url": "version",
          "valueString": "0.0.1-snapshot-2"
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/package-source"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    }
  ],
  "url": "http://terminology.hl7.org/CodeSystem/adjudication",
  "version": "0.1.0",
  "name": "AdjudicationValueCodes",
  "title": "Adjudication Value Codes",
  "status": "draft",
  "experimental": false,
  "date": "2023-02-26T04:07:30+10:00",
  "publisher": "Financial Management",
  "contact": [
    {
      "name": "Financial Management",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description": "This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001",
          "display": "World"
        }
      ]
    }
  ],
  "copyright": "This is an example set.",
  "caseSensitive": true,
  "valueSet": "http://terminology.hl7.org/ValueSet/adjudication|1.0.1",
  "content": "complete",
  "concept": [
    {
      "code": "submitted",
      "display": "Submitted Amount",
      "definition": "The total submitted amount for the claim or group or line item."
    },
    {
      "code": "copay",
      "display": "CoPay",
      "definition": "Patient Co-Payment"
    },
    {
      "code": "eligible",
      "display": "Eligible Amount",
      "definition": "Amount of the change which is considered for adjudication."
    },
    {
      "code": "deductible",
      "display": "Deductible",
      "definition": "Amount deducted from the eligible amount prior to adjudication."
    },
    {
      "code": "unallocdeduct",
      "display": "Unallocated Deductible",
      "definition": "The amount of deductible which could not allocated to other line items."
    },
    {
      "code": "eligpercent",
      "display": "Eligible %",
      "definition": "Eligible Percentage."
    },
    {
      "code": "tax",
      "display": "Tax",
      "definition": "The amount of tax."
    },
    {
      "code": "benefit",
      "display": "Benefit Amount",
      "definition": "Amount payable under the coverage"
    }
  ]
}