Patient Cost Transparency Implementation Guide
1.1.0 - STU 1 United States of America flag

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v1.1.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

CodeSystem: PCT Adjudication Code System

Official URL: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication Version: 1.1.0
Standards status: Trial-use Computable Name: PCTAdjudication

Copyright/Legal: This CodeSystem is not copyrighted.

Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication defines the following codes:

CodeDisplayDefinition
coinsurance Co-insuranceThe amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.
noncovered NoncoveredThe portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract.
memberliability Member liabilityThe amount of the member's liability.
discount DiscountThe amount of the discount