Patient Cost Transparency Implementation Guide
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This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: PCT Adjudication Code System - JSON Representation

Active as of 2023-03-30

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{
  "resourceType" : "CodeSystem",
  "id" : "PCTAdjudication",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This 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>"
  },
  "url" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication",
  "version" : "1.0.0",
  "name" : "PCTAdjudication",
  "title" : "PCT Adjudication Code System",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-03-30T13:34:22+00:00",
  "publisher" : "HL7 International - Financial Management Work Group",
  "contact" : [
    {
      "name" : "HL7 International - Financial Management Work Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://hl7.org/Special/committees/fm"
        },
        {
          "system" : "email",
          "value" : "fmlists@lists.hl7.org"
        }
      ]
    }
  ],
  "description" : "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" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "copyright" : "This CodeSystem is not copyrighted.",
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 4,
  "concept" : [
    {
      "code" : "coinsurance",
      "display" : "Co-insurance",
      "definition" : "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%."
    },
    {
      "code" : "noncovered",
      "display" : "Noncovered",
      "definition" : "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."
    },
    {
      "code" : "memberliability",
      "display" : "Member liability",
      "definition" : "The amount of the member's liability."
    },
    {
      "code" : "discount",
      "display" : "Discount",
      "definition" : "The amount of the discount"
    }
  ]
}