HL7 Terminology (THO)
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HL7 Terminology (THO), published by HL7 International - Vocabulary Work Group. This is not an authorized publication; it is the continuous build for version 5.3.0). This version is based on the current content of https://github.com/HL7/UTG/ and changes regularly. See the Directory of published versions

CodeSystem: Adjudication Value Codes

Official URL: http://terminology.hl7.org/CodeSystem/adjudication Version: 0.1.0
Draft as of 2023-09-20 Maturity Level: 1 Responsible: FHIR Project team Computable Name: AdjudicationValueCodes
Other Identifiers: id: urn:oid:2.16.840.1.113883.4.642.1.1171

Copyright/Legal: This is an example set.

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.

This Code system is referenced in the content logical definition of the following value sets:

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

submitted Submitted AmountThe total submitted amount for the claim or group or line item.
copay CoPayPatient Co-Payment
eligible Eligible AmountAmount of the change which is considered for adjudication.
deductible DeductibleAmount deducted from the eligible amount prior to adjudication.
unallocdeduct Unallocated DeductibleThe amount of deductible which could not allocated to other line items.
eligpercent Eligible %Eligible Percentage.
tax TaxThe amount of tax.
benefit Benefit AmountAmount payable under the coverage


2020-10-14reviseGrahame GrieveVocabulary WGReset Version after migration to UTG
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.