This is the ValueSet that contains all the codes in PDex Adjudication (http://hl7.org/fhir/us/davinci-pdex/ValueSet/PDexAdjudication) and PDex Adjudication (http://hl7.org/fhir/us/davinci-pdex/ValueSet/PDexAdjudication). E.g. what you have to deal with if you get resources containing codes in either of them
Generated Narrative: ValueSet 3622043c-4b23-4156-8db7-869770fad33e-158
This value set includes codes based on the following rules:
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 |
http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
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 payer. |
paidbypatient | Paid by patient | The total amount paid by the patient without specifying the source. |
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 |