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 - TTL Representation

Active as of 2023-03-30

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "PCTAdjudication"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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>"
  ] ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "1.0.0"] ; # 
  fhir:name [ fhir:v "PCTAdjudication"] ; # 
  fhir:title [ fhir:v "PCT Adjudication Code System"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v "false"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2023-03-30T13:34:22+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International - Financial Management Work Group"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HL7 International - Financial Management Work Group" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org/Special/committees/fm" ]     ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "fmlists@lists.hl7.org" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "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."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ]     ] )
  ] ) ; # 
  fhir:copyright [ fhir:v "This CodeSystem is not copyrighted."] ; # 
  fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:content [ fhir:v "complete"] ; # 
  fhir:count [ fhir:v "4"^^xsd:nonNegativeInteger] ; # 
  fhir:concept ( [
fhir:code [ fhir:v "coinsurance" ] ;
fhir:display [ fhir:v "Co-insurance" ] ;
fhir:definition [ fhir:v "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%." ]
  ] [
fhir:code [ fhir:v "noncovered" ] ;
fhir:display [ fhir:v "Noncovered" ] ;
fhir:definition [ fhir:v "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." ]
  ] [
fhir:code [ fhir:v "memberliability" ] ;
fhir:display [ fhir:v "Member liability" ] ;
fhir:definition [ fhir:v "The amount of the member's liability." ]
  ] [
fhir:code [ fhir:v "discount" ] ;
fhir:display [ fhir:v "Discount" ] ;
fhir:definition [ fhir:v "The amount of the discount" ]
  ] ) . #