FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5
0.0.1-snapshot-2 - informative International flag

FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions

: Cross-version VS for R5.ActInvoiceDetailGenericAdjudicatorCode for use in FHIR R4 - XML Representation

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4</b></p><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4"> </a><a name="hcR5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4"> </a><p>This value set expansion contains 6 concepts.</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>System</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COIN"> </a>  <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-COIN">COIN</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</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>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COPAYMENT"> </a>  <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-COPAYMENT">COPAYMENT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</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>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-DEDUCTIBLE"> </a>  <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-DEDUCTIBLE">DEDUCTIBLE</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</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>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PAY"> </a>  <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-PAY">PAY</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</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>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-SPEND"> </a>  <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-SPEND">SPEND</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</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>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COINS"> </a>  <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-COINS">COINS</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>co-insurance</td><td><div><p>The covered party pays a percentage of the cost of covered services.</p>
</div></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fhir"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/package-source">
    <extension url="packageId">
      <valueId value="hl7.fhir.uv.xver-r5.r4"/>
    </extension>
    <extension url="version">
      <valueString value="0.0.1-snapshot-2"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="0">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="informative">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/5.0/ValueSet/R5-v3-ActInvoiceDetailGenericAdjudicatorCode-for-R4"/>
  <version value="0.0.1-snapshot-2"/>
  <name value="R5_v3_ActInvoiceDetailGenericAdjudicatorCode_for_R4"/>
  <title
         value="Cross-version VS for R5.ActInvoiceDetailGenericAdjudicatorCode for use in FHIR R4"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-09-01T22:37:04.900444+10:00"/>
  <publisher value="FHIR Infrastructure"/>
  <contact>
    <name value="FHIR Infrastructure"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <description
               value="This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericAdjudicatorCode|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4."/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <concept>
        <code value="COIN"/>
        <display value="coinsurance"/>
      </concept>
      <concept>
        <code value="COPAYMENT"/>
        <display value="patient co-pay"/>
      </concept>
      <concept>
        <code value="DEDUCTIBLE"/>
        <display value="deductible"/>
      </concept>
      <concept>
        <code value="PAY"/>
        <display value="payment"/>
      </concept>
      <concept>
        <code value="SPEND"/>
        <display value="spend down"/>
      </concept>
      <concept>
        <code value="COINS"/>
        <display value="co-insurance"/>
      </concept>
    </include>
  </compose>
  <expansion>
    <timestamp value="2025-09-01T22:37:04.900441+10:00"/>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="COIN"/>
      <display value="coinsurance"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="COPAYMENT"/>
      <display value="patient co-pay"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="DEDUCTIBLE"/>
      <display value="deductible"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="PAY"/>
      <display value="payment"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="SPEND"/>
      <display value="spend down"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="COINS"/>
      <display value="co-insurance"/>
    </contains>
  </expansion>
</ValueSet>