Extensions for Using Data Elements from FHIR STU3 in FHIR R5 - Downloaded Version null See the Directory of published versions

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: Adjudication Value Codes - JSON Representation

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{
  "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"
    }
  ]
}