FHIR Cross-Version Extensions package for FHIR R4 from FHIR R4B - Version 0.0.1-snapshot-2. See the Directory of published versions

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• XML
• JSON
• TTL

: Adjudication Codes - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "adjudication",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p>This code system http://terminology.hl7.org/CodeSystem/adjudication defines the following codes:</p>\n            <table class=\"codes\">\n              <tr>\n                <td style=\"white-space:nowrap\">\n                  <b>Code</b>\n                </td>\n                <td>\n                  <b>Display</b>\n                </td>\n                <td>\n                  <b>Definition</b>\n                </td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">submitted\n                  <a name=\"adjudication-submitted\"> </a>\n                </td>\n                <td>Submitted Amount</td>\n                <td>The total submitted amount for the claim or group or line item.</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">copay\n                  <a name=\"adjudication-copay\"> </a>\n                </td>\n                <td>CoPay</td>\n                <td>Patient Co-Payment</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">eligible\n                  <a name=\"adjudication-eligible\"> </a>\n                </td>\n                <td>Eligible Amount</td>\n                <td>Amount of the change which is considered for adjudication.</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">deductible\n                  <a name=\"adjudication-deductible\"> </a>\n                </td>\n                <td>Deductible</td>\n                <td>Amount deducted from the eligible amount prior to adjudication.</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">unallocdeduct\n                  <a name=\"adjudication-unallocdeduct\"> </a>\n                </td>\n                <td>Unallocated Deductible</td>\n                <td>The amount of deductible which could not allocated to other line items.</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">eligpercent\n                  <a name=\"adjudication-eligpercent\"> </a>\n                </td>\n                <td>Eligible %</td>\n                <td>Eligible Percentage.</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">tax\n                  <a name=\"adjudication-tax\"> </a>\n                </td>\n                <td>Tax</td>\n                <td>The amount of tax.</td>\n              </tr>\n              <tr>\n                <td style=\"white-space:nowrap\">benefit\n                  <a name=\"adjudication-benefit\"> </a>\n                </td>\n                <td>Benefit Amount</td>\n                <td>Amount payable under the coverage</td>\n              </tr>\n            </table>\n          </div>"
  },
  "extension" : [
    {
      "extension" : [
        {
          "url" : "packageId",
          "valueId" : "hl7.fhir.uv.xver-r4b.r4"
        },
        {
          "url" : "version",
          "valueString" : "0.0.1-snapshot-2"
        }
      ],
      "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" : "4.3.0",
  "name" : "AdjudicationCodes",
  "title" : "Adjudication Codes",
  "status" : "draft",
  "experimental" : false,
  "date" : "2025-09-13T16:38:45-04:00",
  "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 codes.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "copyright" : "This is an example set.",
  "caseSensitive" : true,
  "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"
    }
  ]
}