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Codesystem-adjudication.xml

Financial Management Work GroupMaturity Level: N/AStandards Status: Informative

Raw XML (canonical form + also see XML Format Specification)

Definition for Code System AdjudicationValueCodes

<?xml version="1.0" encoding="UTF-8"?>

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="adjudication"/> 
  <meta> 
    <lastUpdated value="2019-10-11T20:34:20.609+00:00"/> 
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> 
  </meta> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <h2> Adjudication Value Codes</h2> 
      <div> 
        <p> 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.</p> 

      </div> 
      <p> 
        <b> Copyright Statement:</b>  This is an example set.
      </p> 
      <p> This code system http://terminology.hl7.org/CodeSystem/adjudication defines the following
         codes:</p> 
      <table class="codes">
        <tr> 
          <td style="white-space:nowrap">
            <b> Code</b> 
          </td> 
          <td> 
            <b> Display</b> 
          </td> 
          <td> 
            <b> Definition</b> 
          </td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">submitted
            <a name="adjudication-submitted"> </a> 
          </td> 
          <td> Submitted Amount</td> 
          <td> The total submitted amount for the claim or group or line item.</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">copay
            <a name="adjudication-copay"> </a> 
          </td> 
          <td> CoPay</td> 
          <td> Patient Co-Payment</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">eligible
            <a name="adjudication-eligible"> </a> 
          </td> 
          <td> Eligible Amount</td> 
          <td> Amount of the change which is considered for adjudication.</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">deductible
            <a name="adjudication-deductible"> </a> 
          </td> 
          <td> Deductible</td> 
          <td> Amount deducted from the eligible amount prior to adjudication.</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">unallocdeduct
            <a name="adjudication-unallocdeduct"> </a> 
          </td> 
          <td> Unallocated Deductible</td> 
          <td> The amount of deductible which could not allocated to other line items.</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">eligpercent
            <a name="adjudication-eligpercent"> </a> 
          </td> 
          <td> Eligible %</td> 
          <td> Eligible Percentage.</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">tax
            <a name="adjudication-tax"> </a> 
          </td> 
          <td> Tax</td> 
          <td> The amount of tax.</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">benefit
            <a name="adjudication-benefit"> </a> 
          </td> 
          <td> Benefit Amount</td> 
          <td> Amount payable under the coverage</td> 
        </tr> 
      </table> 
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="draft"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1"/> 
  </extension> 
  <url value="http://terminology.hl7.org/CodeSystem/adjudication"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.1.1171"/> 
  </identifier> 
  <version value="4.1.0"/> 
  <name value="AdjudicationValueCodes"/> 
  <title value="Adjudication Value Codes"/> 
  <status value="draft"/> 
  <experimental value="false"/> 
  <publisher value="FHIR Project team"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
  </contact> 
  <description value="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 value="This is an example set."/> 
  <caseSensitive value="true"/> 
  <valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/> 
  <content value="complete"/> 
  <concept> 
    <code value="submitted"/> 
    <display value="Submitted Amount"/> 
    <definition value="The total submitted amount for the claim or group or line item."/> 
  </concept> 
  <concept> 
    <code value="copay"/> 
    <display value="CoPay"/> 
    <definition value="Patient Co-Payment"/> 
  </concept> 
  <concept> 
    <code value="eligible"/> 
    <display value="Eligible Amount"/> 
    <definition value="Amount of the change which is considered for adjudication."/> 
  </concept> 
  <concept> 
    <code value="deductible"/> 
    <display value="Deductible"/> 
    <definition value="Amount deducted from the eligible amount prior to adjudication."/> 
  </concept> 
  <concept> 
    <code value="unallocdeduct"/> 
    <display value="Unallocated Deductible"/> 
    <definition value="The amount of deductible which could not allocated to other line items."/> 
  </concept> 
  <concept> 
    <code value="eligpercent"/> 
    <display value="Eligible %"/> 
    <definition value="Eligible Percentage."/> 
  </concept> 
  <concept> 
    <code value="tax"/> 
    <display value="Tax"/> 
    <definition value="The amount of tax."/> 
  </concept> 
  <concept> 
    <code value="benefit"/> 
    <display value="Benefit Amount"/> 
    <definition value="Amount payable under the coverage"/> 
  </concept> 
</CodeSystem> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.