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
: PCT Adjudication Code System - XML Representation
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<CodeSystem xmlns="http://hl7.org/fhir">
<id value="PCTAdjudication"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">coinsurance<a name="PCTAdjudication-coinsurance"> </a></td><td>Co-insurance</td><td>The 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%.</td></tr><tr><td style="white-space:nowrap">noncovered<a name="PCTAdjudication-noncovered"> </a></td><td>Noncovered</td><td>The 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.</td></tr><tr><td style="white-space:nowrap">memberliability<a name="PCTAdjudication-memberliability"> </a></td><td>Member liability</td><td>The amount of the member's liability.</td></tr><tr><td style="white-space:nowrap">discount<a name="PCTAdjudication-discount"> </a></td><td>Discount</td><td>The amount of the discount</td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"/>
</extension>
</valueCode>
</extension>
<url value="http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication"/>
<version value="1.1.0"/>
<name value="PCTAdjudication"/>
<title value="PCT Adjudication Code System"/>
<status value="active"/>
<experimental value="false"/>
<date value="2024-01-03T18:32:02+00:00"/>
<publisher value="HL7 International / Financial Management"/>
<contact>
<name value="HL7 International / Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fm"/>
</telecom>
<telecom>
<system value="email"/>
<value value="fmlists@lists.hl7.org"/>
</telecom>
</contact>
<description
value="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."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<copyright value="This CodeSystem is not copyrighted."/>
<caseSensitive value="true"/>
<content value="complete"/>
<count value="4"/>
<concept>
<code value="coinsurance"/>
<display value="Co-insurance"/>
<definition
value="The 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%."/>
</concept>
<concept>
<code value="noncovered"/>
<display value="Noncovered"/>
<definition
value="The 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."/>
</concept>
<concept>
<code value="memberliability"/>
<display value="Member liability"/>
<definition value="The amount of the member's liability."/>
</concept>
<concept>
<code value="discount"/>
<display value="Discount"/>
<definition value="The amount of the discount"/>
</concept>
</CodeSystem>
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