4.3.14.274 Code System http://terminology.hl7.org/CodeSystem/adjudication

Financial Management

Work Group

Maturity Level: 0

Informative

Use Context: Any

This is a code system defined by the FHIR project.

Summary

Defining URL:

http://terminology.hl7.org/CodeSystem/adjudication

Version:

4.1.0

Name:

AdjudicationCodes

Title:

Adjudication Codes

Definition:

This value set includes a smattering of Adjudication codes.

Committee:

Financial Management

Work Group

OID:

2.16.840.1.113883.4.642.1.1171 (for OID based terminology systems)

Copyright:

This is an example set.

Source Resource

XML / JSON

This Code system is used in the following value sets:

ValueSet: 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.)
ValueSet: 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.)

4.3.14.274.1 Content

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

Code	Display	Definition
submitted	Submitted Amount	The total submitted amount for the claim or group or line item.
copay	CoPay	Patient Co-Payment
eligible	Eligible Amount	Amount of the change which is considered for adjudication.
deductible	Deductible	Amount deducted from the eligible amount prior to adjudication.
unallocdeduct	Unallocated Deductible	The amount of deductible which could not allocated to other line items.
eligpercent	Eligible %	Eligible Percentage.
tax	Tax	The amount of tax.
benefit	Benefit Amount	Amount payable under the coverage

See the full registry of code systems defined as part of FHIR.

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. See Code System for further information.

Source

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). If the code is in italics, this indicates that the code is not selectable ('Abstract')

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