This value set includes codes based on the following rules:

• Include these codes as defined in http://terminology.hl7.org/CodeSystem/adjudication

  Code	Display	Definition
  submitted	Submitted Amount	The total submitted amount for the claim or group or line item.
  copay	CoPay	Patient Co-Payment
  eligible	Eligible Amount	Amount of the change which is considered for adjudication.
  deductible	Deductible	Amount deducted from the eligible amount prior to adjudication.
  benefit	Benefit Amount	Amount payable under the coverage

• Include these codes as defined in http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexAdjudicationCS

  Code	Display	Definition
  coinsurance	Coinsurance	The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.
  noncovered	Noncovered	The portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract.
  priorpayerpaid	Prior payer paid	The reduction in the payment amount to reflect the carrier as a secondary payor.
  paidbypatient	Paid by patient	The amount paid by the patient at the point of service.
  paidtopatient	Paid to patient	paid to patient
  paidtoprovider	Paid to provider	The amount paid to the provider.
  memberliability	Member liability	The amount of the member's liability.
  discount	Discount	The amount of the discount
  drugcost	Drug cost	Price paid for the drug excluding mfr or other discounts. It typically is the sum of the following components: ingredient cost, dispensing fee, sales tax, and vaccine administration

This value set contains 14 concepts.