R6 Ballot (3rd Draft)

This page is part of the FHIR Specification v6.0.0-ballot3: Release 6 Ballot (3rd Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

4.4.1.783 ValueSet http://hl7.org/fhir/ValueSet/adjudication

Financial Management icon Work Group  Maturity Level: 1 Draft Use Context: Country: World
Official URL: http://hl7.org/fhir/ValueSet/adjudication Version: 6.0.0-ballot3
draft as of 2025-04-01 Computable Name: AdjudicationValueCodes
Flags: OID: 2.16.840.1.113883.4.642.3.596

This value set is used in the following places:

4.4.1.783.1 Definition

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.

4.4.1.783.2 Content Logical Definition

Generated Narrative: ValueSet adjudication

Last updated: 2025-04-01T12:16:37.966+11:00

Profile: Shareable ValueSet

 

4.4.1.783.3 Expansion

This expansion generated 01 Apr 2025

ValueSet

Expansion performed internally based on codesystem Adjudication Value Codes v1.0.1 (CodeSystem) icon

This value set contains 8 concepts

CodeSystemDisplayDefinition
  submitted icon http://terminology.hl7.org/CodeSystem/adjudication Submitted Amount

The total submitted amount for the claim or group or line item.

  copay icon http://terminology.hl7.org/CodeSystem/adjudication CoPay

Patient Co-Payment

  eligible icon http://terminology.hl7.org/CodeSystem/adjudication Eligible Amount

Amount of the change which is considered for adjudication.

  deductible icon http://terminology.hl7.org/CodeSystem/adjudication Deductible

Amount deducted from the eligible amount prior to adjudication.

  unallocdeduct icon http://terminology.hl7.org/CodeSystem/adjudication Unallocated Deductible

The amount of deductible which could not allocated to other line items.

  eligpercent icon http://terminology.hl7.org/CodeSystem/adjudication Eligible %

Eligible Percentage.

  tax icon http://terminology.hl7.org/CodeSystem/adjudication Tax

The amount of tax.

  benefit icon http://terminology.hl7.org/CodeSystem/adjudication Benefit Amount

Amount payable under the coverage

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

Lvl A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code