Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). 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: R5 R4B R4 R3 R2

4.4.1.686 Value Set http://hl7.org/fhir/ValueSet/adjudication

Financial Management

Work Group

Maturity Level: 1

Draft

Use Context: Not Intended for Production use

This is a value set defined by the FHIR project.

Summary

Defining URL:

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

Version:

4.3.0

Name:

AdjudicationValueCodes

Title:

Adjudication Value Codes

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.

Committee:

Financial Management

Work Group

OID:

2.16.840.1.113883.4.642.3.596 (for OID based terminology systems)

Copyright:

This is an example set.

Source Resource

XML / JSON

This value set is used in the following places:

Resource: ExplanationOfBenefit.item.adjudication.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.total.category (CodeableConcept / Example)
Resource: ClaimResponse.item.adjudication.category (CodeableConcept / Example)
Resource: ClaimResponse.total.category (CodeableConcept / Example)

4.4.1.686.1 Content Logical Definition

Include all codes defined in http://terminology.hl7.org/CodeSystem/adjudication

4.4.1.686.2 Expansion

This expansion generated 28 May 2022

This value set contains 8 concepts

Expansion based on Adjudication Codes v4.3.0 (CodeSystem)

All codes in this table are from the system http://terminology.hl7.org/CodeSystem/adjudication

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

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