{"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://terminology.hl7.org/CodeSystem/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\">submitted<a name=\"adjudication-submitted\"> </a></td><td>Submitted Amount</td><td>The total submitted amount for the claim or group or line item.</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>Deductible</td><td>Amount deducted from the eligible amount prior to adjudication.</td></tr><tr><td style=\"white-space:nowrap\">unallocdeduct<a name=\"adjudication-unallocdeduct\"> </a></td><td>Unallocated Deductible</td><td>The amount of deductible which could not allocated to other line items.</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>Tax</td><td>The amount of tax.</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-standards-status","valueCode":"draft"},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm","valueInteger":1},{"extension":[{"url":"packageId","valueId":"hl7.fhir.uv.xver-r4.r5"},{"url":"version","valueString":"0.1.0"},{"url":"uri","valueUri":"http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r5"}],"url":"http://hl7.org/fhir/StructureDefinition/package-source"},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"fm"}],"url":"http://terminology.hl7.org/CodeSystem/adjudication","version":"4.0.1","name":"AdjudicationValueCodes","title":"Adjudication Value Codes","status":"draft","experimental":false,"date":"2026-03-20T13:38:33+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":"submitted","display":"Submitted Amount","definition":"The total submitted amount for the claim or group or line item."},{"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":"Deductible","definition":"Amount deducted from the eligible amount prior to adjudication."},{"code":"unallocdeduct","display":"Unallocated Deductible","definition":"The amount of deductible which could not allocated to other line items."},{"code":"eligpercent","display":"Eligible %","definition":"Eligible Percentage."},{"code":"tax","display":"Tax","definition":"The amount of tax."},{"code":"benefit","display":"Benefit Amount","definition":"Amount payable under the coverage"}]}