ActInvoiceOverrideCode - HL7 Terminology (THO) v7.1.0

HL7 Terminology (THO)
7.1.0 - Continuous Process Integration (ci build) International flag

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: ActInvoiceOverrideCode

Official URL: http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode	Version: 3.0.0	Highlight text changes?
	Responsible: Health Level Seven International	Computable Name: ActInvoiceOverrideCode
Other Identifiers: OID:2.16.840.1.113883.1.11.17590
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

Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

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)

Language: en

This value set includes codes based on the following rules:

Include codes fromhttp://terminology.hl7.org/CodeSystem/v3-ActCode version 📦10.0.0 where concept is-a _ActInvoiceOverrideCode

This value set excludes codes based on the following rules:

Exclude these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActCode version 📦10.0.0

Code	Display	Definition
_ActInvoiceOverrideCode	ActInvoiceOverrideCode	Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

Expansion

Expansion performed internally based on codesystem ActCode v10.0.0 (CodeSystem)

This value set contains 15 concepts

System	Code	Display (en)	Definition	JSON	XML
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	COVGE	coverage problem	Insurance coverage problems have been encountered. Additional explanation information to be supplied.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	EFORM	electronic form to follow	Electronic form with supporting or additional information to follow.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	FAX	fax to follow	Fax with supporting or additional information to follow.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	GFTH	good faith indicator	The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	LATE	late invoice	Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	MANUAL	manual review	Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	OOJ	out of jurisdiction	The medical service and/or product was provided to a patient that has coverage in another jurisdiction.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	ORTHO	orthodontic service	The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	PAPER	paper documentation to follow	Paper documentation (or other physical format) with supporting or additional information to follow.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	PIE	public insurance exhausted	Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	PYRDELAY	delayed by a previous payor	Allows provider to explain lateness of invoice to a subsequent payor.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	REFNR	referral not required	Rules of practice do not require a physician's referral for the provider to perform a billable service.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	REPSERV	repeated service	The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	UNRELAT	unrelated service	The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items.
`http://terminology.hl7.org/CodeSystem/v3-ActCode`	VERBAUTH	verbal authorization	The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.