XIG: CodeSystem/adjudication

FHIR IG Statistics: CodeSystem/adjudication

Package	hl7.terminology
Resource Type	CodeSystem
Id	adjudication
FHIR Version	R5
Source	http://terminology.hl7.org/https://build.fhir.org/ig/HL7/UTG/CodeSystem-adjudication.html
URL	http://terminology.hl7.org/CodeSystem/adjudication
Version	1.0.1
Status	active
Date	2025-08-07T21:08:36+00:00
Name	AdjudicationValueCodes
Title	Adjudication Value Codes
Realm	uv
Authority	hl7
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.
Copyright	This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
Content	complete

Resources that use this resource

ValueSet
PCTAdjudicationCategoryVS	PCT GFE Item Adjudication Value Set
PCTAdjudicationVS	PCT Adjudication Value Set
adjudication	Adjudication Value Codes
C4BBAdjudication	C4BB Adjudication Value Set
PDexAdjudication	PDex Adjudication

Resources that this resource uses

No resources found

Narrative

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

Generated Narrative: CodeSystem adjudication

Last updated: 2024-04-24 00:00:00+0000

Profile: Shareable CodeSystem

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

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.
unallocdeduct	Unallocated Deductible	The amount of deductible which could not allocated to other line items.
eligpercent	Eligible %	Eligible Percentage.
tax	Tax	The amount of tax.
benefit	Benefit Amount	Amount payable under the coverage

Source

{
  "resourceType": "CodeSystem",
  "id": "adjudication",
  "meta": {
    "lastUpdated": "2024-04-24T00:00:00+00:00",
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1
    }
  ],
  "url": "http://terminology.hl7.org/CodeSystem/adjudication",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.1.1171"
    }
  ],
  "version": "1.0.1",
  "name": "AdjudicationValueCodes",
  "title": "Adjudication Value Codes",
  "status": "active",
  "experimental": false,
  "date": "2025-08-07T21:08:36+00:00",
  "publisher": "Health Level Seven International",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org"
        },
        {
          "system": "email",
          "value": "hq@HL7.org"
        }
      ]
    }
  ],
  "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.",
  "copyright": "This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license",
  "caseSensitive": true,
  "valueSet": "http://terminology.hl7.org/ValueSet/adjudication",
  "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"
    }
  ]
}