HL7 Terminology (THO)
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HL7 Terminology (THO), published by HL7 International - Vocabulary Work Group. This guide is not an authorized publication; it is the continuous build for version 7.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/UTG/ and changes regularly. See the Directory of published versions

ValueSet: Adjudication Value Codes

Official URL: http://terminology.hl7.org/ValueSet/adjudication Version: 1.0.1
Maturity Level: 1 Responsible: Health Level Seven International Computable Name: AdjudicationValueCodes
Other Identifiers: OID:2.16.840.1.113883.4.642.3.596

Copyright/Legal: This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html

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.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

Last updated: 2024-04-24 00:00:00+0000; Language: en

Profile: Shareable ValueSet

 

Expansion

Expansion performed internally based on codesystem Adjudication Value Codes v1.0.1 (CodeSystem)

This value set contains 8 concepts

SystemCodeDisplay (en)DefinitionJSONXML
http://terminology.hl7.org/CodeSystem/adjudication  submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
http://terminology.hl7.org/CodeSystem/adjudication  copayCoPayPatient Co-Payment
http://terminology.hl7.org/CodeSystem/adjudication  eligibleEligible AmountAmount of the change which is considered for adjudication.
http://terminology.hl7.org/CodeSystem/adjudication  deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
http://terminology.hl7.org/CodeSystem/adjudication  unallocdeductUnallocated DeductibleThe amount of deductible which could not allocated to other line items.
http://terminology.hl7.org/CodeSystem/adjudication  eligpercentEligible %Eligible Percentage.
http://terminology.hl7.org/CodeSystem/adjudication  taxTaxThe amount of tax.
http://terminology.hl7.org/CodeSystem/adjudication  benefitBenefit AmountAmount payable under the coverage

Description of the above table(s).

History

DateActionCustodianAuthorComment
2023-11-14reviseTSMGMarc DuteauAdd standard copyright and contact to internal content; up-476
2020-10-14reviseVocabulary WGGrahame GrieveReset Version after migration to UTG
2020-05-06reviseVocabulary WGTed KleinMigrated to the UTG maintenance environment and publishing tooling.