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Packagehl7.fhir.uv.xver-r5.r4b
Resource TypeValueSet
IdValueSet-R5-v3-InvoiceElementAdjudicated-for-R4B.json
FHIR VersionR4B
Sourcehttp://hl7.org/fhir/uv/xver-r5.r4b/0.0.1-snapshot-2/ValueSet-R5-v3-InvoiceElementAdjudicated-for-R4B.html
URLhttp://hl7.org/fhir/5.0/ValueSet/R5-v3-InvoiceElementAdjudicated-for-R4B
Version0.0.1-snapshot-2
Statusactive
Date2025-09-01T22:37:05.182782+10:00
NameR5_v3_InvoiceElementAdjudicated_for_R4B
TitleCross-version VS for R5.InvoiceElementAdjudicated for use in FHIR R4B
Realmuv
Authorityhl7
DescriptionThis cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-InvoiceElementAdjudicated|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B.

Resources that use this resource

No resources found


Resources that this resource uses

CodeSystem
v3-ActCodeActCode

Narrative

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

Generated Narrative: ValueSet R5-v3-InvoiceElementAdjudicated-for-R4B

This value set expansion contains 40 concepts.

CodeSystemDisplayDefinition
  ADNFPPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

  ADCNPPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

  ADNFPPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

  ADCNPPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

  ADNFPPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADCNPPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADNFPPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADCNPPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADNFSPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

  ADCNSPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

  ADNFSPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

  ADCNSPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

  ADNFSPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADCNSPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADNFSPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADCNSPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. nullified same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

  ADNPPPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

  ADNPPPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

  ADNPPPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

  ADNPPPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

  ADNPSPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

  ADNPSPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

  ADNPSPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

  ADNPSPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. non-payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

  ADPPPPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

  ADPPPPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

  ADPPPPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable prior-period manual amout

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

  ADPPPPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

  ADPPSPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

  ADPPSPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

  ADPPSPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

  ADPPSPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

  ADRFPPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

  ADRFPPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

  ADRFPPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

  ADRFPPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

  ADRFSPELAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

  ADRFSPELCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

  ADRFSPMNAThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

  ADRFSPMNCThttp://terminology.hl7.org/CodeSystem/v3-ActCodeadjud. refused same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.


Source1

{
  "resourceType": "ValueSet",
  "id": "R5-v3-InvoiceElementAdjudicated-for-R4B",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
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          "valueString": "0.0.1-snapshot-2"
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    {
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      "valueInteger": 0,
      "_valueInteger": {
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  ],
  "url": "http://hl7.org/fhir/5.0/ValueSet/R5-v3-InvoiceElementAdjudicated-for-R4B",
  "version": "0.0.1-snapshot-2",
  "name": "R5_v3_InvoiceElementAdjudicated_for_R4B",
  "title": "Cross-version VS for R5.InvoiceElementAdjudicated for use in FHIR R4B",
  "status": "active",
  "experimental": false,
  "date": "2025-09-01T22:37:05.182782+10:00",
  "publisher": "FHIR Infrastructure",
  "contact": [
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      "telecom": [
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  "description": "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-InvoiceElementAdjudicated|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001",
          "display": "World"
        }
      ]
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  "compose": {
    "include": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "concept": [
          {
            "code": "ADNFPPELAT",
            "display": "adjud. nullified prior-period electronic amount"
          },
          {
            "code": "ADCNPPELAT",
            "display": "adjud. nullified prior-period electronic amount"
          },
          {
            "code": "ADNFPPELCT",
            "display": "adjud. nullified prior-period electronic count"
          },
          {
            "code": "ADCNPPELCT",
            "display": "adjud. nullified prior-period electronic count"
          },
          {
            "code": "ADNFPPMNAT",
            "display": "adjud. nullified prior-period manual amount"
          },
          {
            "code": "ADCNPPMNAT",
            "display": "adjud. nullified prior-period manual amount"
          },
          {
            "code": "ADNFPPMNCT",
            "display": "adjud. nullified prior-period manual count"
          },
          {
            "code": "ADCNPPMNCT",
            "display": "adjud. nullified prior-period manual count"
          },
          {
            "code": "ADNFSPELAT",
            "display": "adjud. nullified same-period electronic amount"
          },
          {
            "code": "ADCNSPELAT",
            "display": "adjud. nullified same-period electronic amount"
          },
          {
            "code": "ADNFSPELCT",
            "display": "adjud. nullified same-period electronic count"
          },
          {
            "code": "ADCNSPELCT",
            "display": "adjud. nullified same-period electronic count"
          },
          {
            "code": "ADNFSPMNAT",
            "display": "adjud. nullified same-period manual amount"
          },
          {
            "code": "ADCNSPMNAT",
            "display": "adjud. nullified same-period manual amount"
          },
          {
            "code": "ADNFSPMNCT",
            "display": "adjud. nullified same-period manual count"
          },
          {
            "code": "ADCNSPMNCT",
            "display": "adjud. nullified same-period manual count"
          },
          {
            "code": "ADNPPPELAT",
            "display": "adjud. non-payee payable prior-period electronic amount"
          },
          {
            "code": "ADNPPPELCT",
            "display": "adjud. non-payee payable prior-period electronic count"
          },
          {
            "code": "ADNPPPMNAT",
            "display": "adjud. non-payee payable prior-period manual amount"
          },
          {
            "code": "ADNPPPMNCT",
            "display": "adjud. non-payee payable prior-period manual count"
          },
          {
            "code": "ADNPSPELAT",
            "display": "adjud. non-payee payable same-period electronic amount"
          },
          {
            "code": "ADNPSPELCT",
            "display": "adjud. non-payee payable same-period electronic count"
          },
          {
            "code": "ADNPSPMNAT",
            "display": "adjud. non-payee payable same-period manual amount"
          },
          {
            "code": "ADNPSPMNCT",
            "display": "adjud. non-payee payable same-period manual count"
          },
          {
            "code": "ADPPPPELAT",
            "display": "adjud. payee payable prior-period electronic amount"
          },
          {
            "code": "ADPPPPELCT",
            "display": "adjud. payee payable prior-period electronic count"
          },
          {
            "code": "ADPPPPMNAT",
            "display": "adjud. payee payable prior-period manual amout"
          },
          {
            "code": "ADPPPPMNCT",
            "display": "adjud. payee payable prior-period manual count"
          },
          {
            "code": "ADPPSPELAT",
            "display": "adjud. payee payable same-period electronic amount"
          },
          {
            "code": "ADPPSPELCT",
            "display": "adjud. payee payable same-period electronic count"
          },
          {
            "code": "ADPPSPMNAT",
            "display": "adjud. payee payable same-period manual amount"
          },
          {
            "code": "ADPPSPMNCT",
            "display": "adjud. payee payable same-period manual count"
          },
          {
            "code": "ADRFPPELAT",
            "display": "adjud. refused prior-period electronic amount"
          },
          {
            "code": "ADRFPPELCT",
            "display": "adjud. refused prior-period electronic count"
          },
          {
            "code": "ADRFPPMNAT",
            "display": "adjud. refused prior-period manual amount"
          },
          {
            "code": "ADRFPPMNCT",
            "display": "adjud. refused prior-period manual count"
          },
          {
            "code": "ADRFSPELAT",
            "display": "adjud. refused same-period electronic amount"
          },
          {
            "code": "ADRFSPELCT",
            "display": "adjud. refused same-period electronic count"
          },
          {
            "code": "ADRFSPMNAT",
            "display": "adjud. refused same-period manual amount"
          },
          {
            "code": "ADRFSPMNCT",
            "display": "adjud. refused same-period manual count"
          }
        ]
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        "code": "ADNFPPELAT",
        "display": "adjud. nullified prior-period electronic amount"
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        "code": "ADNFSPELAT",
        "display": "adjud. nullified same-period electronic amount"
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      {
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        "code": "ADCNSPELAT",
        "display": "adjud. nullified same-period electronic amount"
      },
      {
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        "version": "8.0.0",
        "code": "ADNFSPELCT",
        "display": "adjud. nullified same-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADCNSPELCT",
        "display": "adjud. nullified same-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNFSPMNAT",
        "display": "adjud. nullified same-period manual amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADCNSPMNAT",
        "display": "adjud. nullified same-period manual amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNFSPMNCT",
        "display": "adjud. nullified same-period manual count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADCNSPMNCT",
        "display": "adjud. nullified same-period manual count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNPPPELAT",
        "display": "adjud. non-payee payable prior-period electronic amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNPPPELCT",
        "display": "adjud. non-payee payable prior-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNPPPMNAT",
        "display": "adjud. non-payee payable prior-period manual amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNPPPMNCT",
        "display": "adjud. non-payee payable prior-period manual count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNPSPELAT",
        "display": "adjud. non-payee payable same-period electronic amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADNPSPELCT",
        "display": "adjud. non-payee payable same-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADNPSPMNAT",
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      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADNPSPMNCT",
        "display": "adjud. non-payee payable same-period manual count"
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      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADPPPPELAT",
        "display": "adjud. payee payable prior-period electronic amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADPPPPELCT",
        "display": "adjud. payee payable prior-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADPPPPMNAT",
        "display": "adjud. payee payable prior-period manual amout"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADPPPPMNCT",
        "display": "adjud. payee payable prior-period manual count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADPPSPELAT",
        "display": "adjud. payee payable same-period electronic amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADPPSPELCT",
        "display": "adjud. payee payable same-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADPPSPMNAT",
        "display": "adjud. payee payable same-period manual amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADPPSPMNCT",
        "display": "adjud. payee payable same-period manual count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFPPELAT",
        "display": "adjud. refused prior-period electronic amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFPPELCT",
        "display": "adjud. refused prior-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFPPMNAT",
        "display": "adjud. refused prior-period manual amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version": "8.0.0",
        "code": "ADRFPPMNCT",
        "display": "adjud. refused prior-period manual count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFSPELAT",
        "display": "adjud. refused same-period electronic amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFSPELCT",
        "display": "adjud. refused same-period electronic count"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFSPMNAT",
        "display": "adjud. refused same-period manual amount"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "code": "ADRFSPMNCT",
        "display": "adjud. refused same-period manual count"
      }
    ]
  }
}