R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R4B R4 R3

4.2.13.597 Code System http://hl7.org/fhir/adjudication

Financial Management Work Group Maturity Level: 1Draft Use Context: Not Intended for Production use

This is a code system defined by the FHIR project.

Summary

Defining URL:http://hl7.org/fhir/adjudication
Name:Adjudication Value Codes
Definition:

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.

Committee:Financial Management Work Group
OID:2.16.840.1.113883.4.642.1.597 (for OID based terminology systems)
Copyright:This is an example set.
Source ResourceXML / JSON

This Code system is used in the following value sets:

  • Adjudication Value Codes (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.)

4.2.13.597.1 Content

4.2.13.597.2 Adjudication Value Codes

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.

Copyright Statement: This is an example set.

This code system http://hl7.org/fhir/adjudication defines the following codes:

CodeDisplayDefinition
submitted Submitted AmountThe total submitted amount for the claim or group or line item.
copay CoPayPatient Co-Payment
eligible Eligible AmountAmount of the change which is considered for adjudication.
deductible DeductableAmount deducted from the eligible amount prior to adjudication.
unallocdeduct Unallocated DeductableThe amount of deductable which could not allocated to other line items.
eligpercent Eligible %Eligible Percentage.
tax TaxThe amount of tax.
benefit Benefit AmountAmount payable under the coverage

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

LvlA few code lists that FHIR defines are hierarchical - each code is assigned a level. See Code System for further information.
SourceThe source of the definition of the code (when the value set draws in codes defined elsewhere)
CodeThe code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
DisplayThe 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
DefinitionAn explanation of the meaning of the concept
CommentsAdditional notes about how to use the code