Patient Cost Transparency Implementation Guide
2.0.0-draft - STU 2 - Draft United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-draft built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

ValueSet: PCT GFE Item Adjudication Value Set

Official URL: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS Version: 2.0.0-draft
Standards status: Trial-use Computable Name: PCTAdjudicationCategoryVS
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.48.7

Copyright/Legal: This Valueset is not copyrighted.

Value Set containing codes for the type of adjudication information provided.

References

Changes since version 1.1.0:

  • No changes

    • Logical Definition (CLD)

    Generated Narrative: ValueSet PCTAdjudicationCategoryVS

    This value set includes codes based on the following rules:

     

    Expansion

    Generated Narrative: ValueSet

    This value set contains 14 concepts

    CodeSystemDisplay (en-US)Definition
      submittedhttp://terminology.hl7.org/CodeSystem/adjudication

    The total submitted amount for the claim or group or line item.

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

    Patient Co-Payment

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

    Amount of the change which is considered for adjudication.

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

    Amount deducted from the eligible amount prior to adjudication.

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

    The amount of deductible which could not allocated to other line items.

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

    Eligible Percentage.

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

    The amount of tax.

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

    Amount payable under the coverage

      billingnetworkstatushttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS

    Indicates the Billing Provider network status in relation to the patient's coverage.

      renderingnetworkstatushttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS

    Indicates the Rendering Provider network status in relation to the patient's coverage.

      benefitpaymentstatushttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS

    Indicates the in network or out of network payment status of the claim.

      adjustmentreasonhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS

    Defines the adjudication slice to identify the adjustment reason

      medicalmanagementhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS

    Defines the adjudication slice to identify medical management

      memberliabilityhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS

    Defines the adjudication slice to identify member liability

    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. In this scheme, some codes are under other codes, and imply that the code they are under also applies
    System 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)
    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