Extensions for Using Data Elements from FHIR R5 in FHIR R4B
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Extensions for Using Data Elements from FHIR R5 in FHIR R4B - Downloaded Version null See the Directory of published versions

ValueSet: R5V3ActInvoiceDetailGenericAdjudicatorCodeForR4B

Official URL: http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: R5V3ActInvoiceDetailGenericAdjudicatorCodeForR4B

This cross-version ValueSet represents content from http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0 for use in FHIR R4B.

This value set is part of the cross-version definitions generated to enable use of the value set http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0 as defined in FHIR R5 in FHIR R4B.

The source value set is bound to the following FHIR R5 elements:

Note that all concepts are included in this cross-version definition because no concepts have compatible representations

Following are the generation technical comments:

FHIR ValueSet http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0, defined in FHIR R5 does not have any mapping to FHIR R4B

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActCode version 📍8.0.0
    CodeDisplayDefinition
    COINcoinsuranceThat portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.
    COINSco-insuranceThe covered party pays a percentage of the cost of covered services.
    COPAYMENTpatient co-payThat portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.
    DEDUCTIBLEdeductibleThat portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.
    PAYpaymentThe guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.
    SPENDspend downThat total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results

 

Expansion

This value set expansion contains 6 concepts.

SystemVersionCodeDisplayDefinitionJSONXML
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0  COINcoinsurance

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0  COINSco-insurance

The covered party pays a percentage of the cost of covered services.

http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0  COPAYMENTpatient co-pay

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0  DEDUCTIBLEdeductible

That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0  PAYpayment

The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.

http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0  SPENDspend down

That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code