FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4b |
| Resource Type | ValueSet |
| Id | ValueSet-R5-v3-ActAdjudicationCode-for-R4B.json |
| FHIR Version | R4B |
| Source | http://hl7.org/fhir/uv/xver-r5.r4b/0.0.1-snapshot-2/ValueSet-R5-v3-ActAdjudicationCode-for-R4B.html |
| URL | http://hl7.org/fhir/5.0/ValueSet/R5-v3-ActAdjudicationCode-for-R4B |
| Version | 0.0.1-snapshot-2 |
| Status | active |
| Date | 2025-09-01T22:37:04.446831+10:00 |
| Name | R5_v3_ActAdjudicationCode_for_R4B |
| Title | Cross-version VS for R5.ActAdjudicationCode for use in FHIR R4B |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActAdjudicationCode|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B. |
No resources found
| CodeSystem | |
| v3-ActCode | ActCode |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-v3-ActAdjudicationCode-for-R4B
This value set expansion contains 12 concepts.
| Code | System | Display | Definition |
| CONT | http://terminology.hl7.org/CodeSystem/v3-ActCode | contract | Transaction counts and value totals by Contract Identifier. |
| DAY | http://terminology.hl7.org/CodeSystem/v3-ActCode | day | Transaction counts and value totals for each calendar day within the date range specified. |
| LOC | http://terminology.hl7.org/CodeSystem/v3-ActCode | location | Transaction counts and value totals by service location (e.g clinic). |
| MONTH | http://terminology.hl7.org/CodeSystem/v3-ActCode | month | Transaction counts and value totals for each calendar month within the date range specified. |
| PERIOD | http://terminology.hl7.org/CodeSystem/v3-ActCode | period | Transaction counts and value totals for the date range specified. |
| PROV | http://terminology.hl7.org/CodeSystem/v3-ActCode | provider | Transaction counts and value totals by Provider Identifier. |
| WEEK | http://terminology.hl7.org/CodeSystem/v3-ActCode | week | Transaction counts and value totals for each calendar week within the date range specified. |
| YEAR | http://terminology.hl7.org/CodeSystem/v3-ActCode | year | Transaction counts and value totals for each calendar year within the date range specified. |
| AA | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated with adjustments | The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges). Also includes the concept 'Adjudicate as zero' and items not covered under a particular Policy. Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting). |
| ANF | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated with adjustments and no financial impact | The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges) without changing the amount. Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting). |
| AR | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated as refused | The invoice element has passed through the adjudication process but payment is refused due to one or more reasons. Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late'). If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected. A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer. Invoice element cannot be reversed (nullified) as there is nothing to reverse. Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting). |
| AS | http://terminology.hl7.org/CodeSystem/v3-ActCode | adjudicated as submitted | The invoice element was/will be paid exactly as submitted, without financial adjustment(s). If the dollar amount stays the same, but the billing codes have been amended or financial adjustments have been applied through the adjudication process, the invoice element is treated as "Adjudicated with Adjustment". If information items are included in the adjudication results that do not affect the monetary amounts paid, then this is still Adjudicated as Submitted (e.g. 'reached Plan Maximum on this Claim'). Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting). |
FHIR
FHIRsmith{
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"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
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"version": "0.0.1-snapshot-2",
"name": "R5_v3_ActAdjudicationCode_for_R4B",
"title": "Cross-version VS for R5.ActAdjudicationCode for use in FHIR R4B",
"status": "active",
"experimental": false,
"date": "2025-09-01T22:37:04.446831+10:00",
"publisher": "FHIR Infrastructure",
"contact": [
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"description": "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActAdjudicationCode|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B.",
"jurisdiction": [
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"version": "8.0.0",
"concept": [
{
"code": "CONT",
"display": "contract"
},
{
"code": "DAY",
"display": "day"
},
{
"code": "LOC",
"display": "location"
},
{
"code": "MONTH",
"display": "month"
},
{
"code": "PERIOD",
"display": "period"
},
{
"code": "PROV",
"display": "provider"
},
{
"code": "WEEK",
"display": "week"
},
{
"code": "YEAR",
"display": "year"
},
{
"code": "AA",
"display": "adjudicated with adjustments"
},
{
"code": "ANF",
"display": "adjudicated with adjustments and no financial impact"
},
{
"code": "AR",
"display": "adjudicated as refused"
},
{
"code": "AS",
"display": "adjudicated as submitted"
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"expansion": {
"timestamp": "2025-09-01T22:37:04.446832+10:00",
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{
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{
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"code": "MONTH",
"display": "month"
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{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"version": "8.0.0",
"code": "PERIOD",
"display": "period"
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{
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"code": "PROV",
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"code": "WEEK",
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{
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"display": "year"
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{
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"version": "8.0.0",
"code": "AA",
"display": "adjudicated with adjustments"
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{
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"code": "ANF",
"display": "adjudicated with adjustments and no financial impact"
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{
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"version": "8.0.0",
"code": "AR",
"display": "adjudicated as refused"
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{
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"code": "AS",
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}