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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: Adjudication Codes - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="adjudication"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
            <p>This code system http://terminology.hl7.org/CodeSystem/adjudication 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>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/package-source">
    <extension url="packageId">
      <valueId value="hl7.fhir.uv.xver-r4b.r4"/>
    </extension>
    <extension url="version">
      <valueString value="0.0.1-snapshot-2"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <url value="http://terminology.hl7.org/CodeSystem/adjudication"/>
  <version value="4.3.0"/>
  <name value="AdjudicationCodes"/>
  <title value="Adjudication Codes"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2025-09-13T16:38:45-04:00"/>
  <publisher value="Financial Management"/>
  <contact>
    <name value="Financial Management"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm"/>
    </telecom>
  </contact>
  <description
               value="This value set includes a smattering of Adjudication codes."/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <copyright value="This is an example set."/>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <concept>
    <code value="submitted"/>
    <display value="Submitted Amount"/>
    <definition
                value="The total submitted amount for the claim or group or line item."/>
  </concept>
  <concept>
    <code value="copay"/>
    <display value="CoPay"/>
    <definition value="Patient Co-Payment"/>
  </concept>
  <concept>
    <code value="eligible"/>
    <display value="Eligible Amount"/>
    <definition
                value="Amount of the change which is considered for adjudication."/>
  </concept>
  <concept>
    <code value="deductible"/>
    <display value="Deductible"/>
    <definition
                value="Amount deducted from the eligible amount prior to adjudication."/>
  </concept>
  <concept>
    <code value="unallocdeduct"/>
    <display value="Unallocated Deductible"/>
    <definition
                value="The amount of deductible which could not allocated to other line items."/>
  </concept>
  <concept>
    <code value="eligpercent"/>
    <display value="Eligible %"/>
    <definition value="Eligible Percentage."/>
  </concept>
  <concept>
    <code value="tax"/>
    <display value="Tax"/>
    <definition value="The amount of tax."/>
  </concept>
  <concept>
    <code value="benefit"/>
    <display value="Benefit Amount"/>
    <definition value="Amount payable under the coverage"/>
  </concept>
</CodeSystem>