Release 4

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU) in it's permanent home (it will always be available at this URL). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R4B R4 R3

Codesystem-adjudication.json

Financial Management Work GroupMaturity Level: N/AStandards Status: Informative

Raw JSON (canonical form + also see JSON Format Specification)

Definition for Code System AdjudicationValueCodes

{
  "resourceType" : "CodeSystem",
  "id" : "adjudication",
  "meta" : {
    "lastUpdated" : "2019-11-01T09:29:23.356+11:00",
    "profile" : ["http://hl7.org/fhir/StructureDefinition/shareablecodesystem"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div>!-- Snipped for Brevity --></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fm"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "draft"
  },
  {
    "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:2.16.840.1.113883.4.642.4.1171"
  }],
  "version" : "4.0.1",
  "name" : "AdjudicationValueCodes",
  "title" : "Adjudication Value Codes",
  "status" : "draft",
  "experimental" : false,
  "publisher" : "FHIR Project team",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://hl7.org/fhir"
    }]
  }],
  "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 is an example set.",
  "caseSensitive" : true,
  "valueSet" : "http://hl7.org/fhir/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"
  }]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.