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

: R5V3ActInvoiceDetailGenericAdjudicatorCodeForR4B - JSON Representation

Page standards status: Trial-use Maturity Level: 0

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{
  "resourceType" : "ValueSet",
  "id" : "R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B</b></p><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B\"> </a><a name=\"hcR5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B\"> </a><p>This value set expansion contains 6 concepts.</p><table class=\"codes\"><tr><td><b>System</b></td><td><b>Version</b></td><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B-http://terminology.hl7.org/CodeSystem/v3-ActCode-COIN\"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style=\"white-space:nowrap\">\u00a0\u00a0<a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-COIN\">COIN</a></td><td>coinsurance</td><td><div><p>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.</p>\n</div></td></tr><tr><td><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B-http://terminology.hl7.org/CodeSystem/v3-ActCode-COINS\"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style=\"white-space:nowrap\">\u00a0\u00a0<a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-COINS\">COINS</a></td><td>co-insurance</td><td><div><p>The covered party pays a percentage of the cost of covered services.</p>\n</div></td></tr><tr><td><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B-http://terminology.hl7.org/CodeSystem/v3-ActCode-COPAYMENT\"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style=\"white-space:nowrap\">\u00a0\u00a0<a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-COPAYMENT\">COPAYMENT</a></td><td>patient co-pay</td><td><div><p>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.</p>\n</div></td></tr><tr><td><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B-http://terminology.hl7.org/CodeSystem/v3-ActCode-DEDUCTIBLE\"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style=\"white-space:nowrap\">\u00a0\u00a0<a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-DEDUCTIBLE\">DEDUCTIBLE</a></td><td>deductible</td><td><div><p>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.</p>\n</div></td></tr><tr><td><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B-http://terminology.hl7.org/CodeSystem/v3-ActCode-PAY\"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style=\"white-space:nowrap\">\u00a0\u00a0<a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-PAY\">PAY</a></td><td>payment</td><td><div><p>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.</p>\n</div></td></tr><tr><td><a name=\"R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B-http://terminology.hl7.org/CodeSystem/v3-ActCode-SPEND\"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style=\"white-space:nowrap\">\u00a0\u00a0<a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-SPEND\">SPEND</a></td><td>spend down</td><td><div><p>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</p>\n</div></td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fhir"
    },
    {
      "extension" : [
        {
          "url" : "packageId",
          "valueId" : "hl7.fhir.uv.xver-r5.r4b"
        },
        {
          "url" : "version",
          "valueString" : "0.1.0"
        },
        {
          "url" : "uri",
          "valueUri" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4b"
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/package-source"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 0,
      "_valueInteger" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4b"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4b"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4B",
  "version" : "0.1.0",
  "name" : "R5V3ActInvoiceDetailGenericAdjudicatorCodeForR4B",
  "title" : "Cross-version ValueSet R5.ActInvoiceDetailGenericAdjudicatorCode for use in FHIR R4B",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-03-17T21:02:03.8104715+00:00",
  "publisher" : "FHIR Infrastructure",
  "contact" : [
    {
      "name" : "FHIR Infrastructure",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fiwg"
        }
      ]
    }
  ],
  "description" : "This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0` for use in FHIR R4B.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "purpose" : "This value set is part of the cross-version definitions generated to enable use of the\r\nvalue set `http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0` as defined in FHIR R5\r\nin FHIR R4B.\r\n\r\nThe source value set is bound to the following FHIR R5 elements:\r\n* \r\n\r\nNote that all concepts are included in this cross-version definition because no concepts have compatible representations\r\n\r\nFollowing are the generation technical comments:\r\n\nFHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4B",
  "compose" : {
    "include" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "concept" : [
          {
            "code" : "COIN",
            "display" : "coinsurance"
          },
          {
            "code" : "COINS",
            "display" : "co-insurance"
          },
          {
            "code" : "COPAYMENT",
            "display" : "patient co-pay"
          },
          {
            "code" : "DEDUCTIBLE",
            "display" : "deductible"
          },
          {
            "code" : "PAY",
            "display" : "payment"
          },
          {
            "code" : "SPEND",
            "display" : "spend down"
          }
        ]
      }
    ]
  },
  "expansion" : {
    "timestamp" : "2026-03-17T21:02:03.8104715+00:00",
    "contains" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "code" : "COIN",
        "display" : "coinsurance"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "code" : "COINS",
        "display" : "co-insurance"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "code" : "COPAYMENT",
        "display" : "patient co-pay"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "code" : "DEDUCTIBLE",
        "display" : "deductible"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "code" : "PAY",
        "display" : "payment"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "version" : "8.0.0",
        "code" : "SPEND",
        "display" : "spend down"
      }
    ]
  }
}