Patient Cost Transparency Implementation Guide
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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-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

ValueSet: PCT GFE Item Adjudication Value Set

Official URL: Version: 2.0.0-ballot
Standards status: Trial-use Computable Name: PCTAdjudicationCategoryVS
Other Identifiers: OID:2.16.840.1.113883.4.642.

Copyright/Legal: This Valueset is not copyrighted.

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


Logical Definition (CLD)

Generated Narrative: ValueSet PCTAdjudicationCategoryVS

This value set includes codes based on the following rules:



Generated Narrative: ValueSet

This value set contains 14 concepts

  submitted Amount

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


Patient Co-Payment

  eligible Amount

Amount of the change which is considered for adjudication.


Amount deducted from the eligible amount prior to adjudication.

  unallocdeduct Deductible

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

  eligpercent %

Eligible Percentage.


The amount of tax.

  benefit Amount

Amount payable under the coverage

  billingnetworkstatus Network Status

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

  renderingnetworkstatus Network Status

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

  benefitpaymentstatus Payment Status

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

  adjustmentreason Reason

Defines the adjudication slice to identify the adjustment reason

  medicalmanagement Management

Defines the adjudication slice to identify medical management

  memberliability Liability

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