{
  "resourceType" : "CodeSystem",
  "id" : "adjudication",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem adjudication</b></p><a name=\"adjudication\"> </a><a name=\"hcadjudication\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/adjudication</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\">total<a name=\"adjudication-total\"> </a></td><td>Total</td><td>Total submitted</td></tr><tr><td style=\"white-space:nowrap\">copay<a name=\"adjudication-copay\"> </a></td><td>CoPay</td><td>Patient Co-Payment</td></tr><tr><td style=\"white-space:nowrap\">eligible<a name=\"adjudication-eligible\"> </a></td><td>Eligible Amount</td><td>Amount of the change which is considered for adjudication</td></tr><tr><td style=\"white-space:nowrap\">deductible<a name=\"adjudication-deductible\"> </a></td><td>Deductable</td><td>Amount deducted from the eligible amount prior to adjudication</td></tr><tr><td style=\"white-space:nowrap\">eligpercent<a name=\"adjudication-eligpercent\"> </a></td><td>Eligible %</td><td>Eligible Percentage</td></tr><tr><td style=\"white-space:nowrap\">tax<a name=\"adjudication-tax\"> </a></td><td>Emergency Department</td><td>Emergency Department</td></tr><tr><td style=\"white-space:nowrap\">benefit<a name=\"adjudication-benefit\"> </a></td><td>Benefit Amount</td><td>Amount payable under the coverage</td></tr></table></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-ballot-status",
    "valueString" : "Informative"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 1
  },
  {
    "extension" : [{
      "url" : "packageId",
      "valueId" : "hl7.fhir.uv.xver-r3.r5"
    },
    {
      "url" : "version",
      "valueString" : "0.1.0"
    },
    {
      "url" : "uri",
      "valueUri" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r3.r5"
    }],
    "url" : "http://hl7.org/fhir/StructureDefinition/package-source"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fm"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "informative",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r3.r5"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/adjudication",
  "version" : "3.0.2",
  "name" : "Adjudication Value Codes",
  "status" : "draft",
  "experimental" : true,
  "date" : "2026-03-20T12:39:37+11:00",
  "publisher" : "Financial Management",
  "contact" : [{
    "name" : "Financial Management",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/fm"
    }]
  }],
  "description" : "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.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "001",
      "display" : "World"
    }]
  }],
  "copyright" : "This is an example set.",
  "caseSensitive" : true,
  "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0",
  "content" : "complete",
  "concept" : [{
    "code" : "total",
    "display" : "Total",
    "definition" : "Total submitted"
  },
  {
    "code" : "copay",
    "display" : "CoPay",
    "definition" : "Patient Co-Payment"
  },
  {
    "code" : "eligible",
    "display" : "Eligible Amount",
    "definition" : "Amount of the change which is considered for adjudication"
  },
  {
    "code" : "deductible",
    "display" : "Deductable",
    "definition" : "Amount deducted from the eligible amount prior to adjudication"
  },
  {
    "code" : "eligpercent",
    "display" : "Eligible %",
    "definition" : "Eligible Percentage"
  },
  {
    "code" : "tax",
    "display" : "Emergency Department",
    "definition" : "Emergency Department"
  },
  {
    "code" : "benefit",
    "display" : "Benefit Amount",
    "definition" : "Amount payable under the coverage"
  }]
}