Patient Cost Transparency Implementation Guide
2.0.0 - STU 2 United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

ValueSet: PCT GFE Item Adjudication Value Set

Official URL: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS Version: 2.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTAdjudicationCategoryVS
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.48.7

Copyright/Legal: This Valueset is not copyrighted.

Value Set containing codes for the type of adjudication information provided.

References

Changes since version 1.1.0:

  • No changes

    • Logical Definition (CLD)

    This value set includes codes based on the following rules:

     

    Expansion

    This value set contains 14 concepts

    CodeSystemDisplayDefinition
      submittedhttp://terminology.hl7.org/CodeSystem/adjudicationSubmitted AmountThe total submitted amount for the claim or group or line item.
      copayhttp://terminology.hl7.org/CodeSystem/adjudicationCoPayPatient Co-Payment
      eligiblehttp://terminology.hl7.org/CodeSystem/adjudicationEligible AmountAmount of the change which is considered for adjudication.
      deductiblehttp://terminology.hl7.org/CodeSystem/adjudicationDeductibleAmount deducted from the eligible amount prior to adjudication.
      unallocdeducthttp://terminology.hl7.org/CodeSystem/adjudicationUnallocated DeductibleThe amount of deductible which could not allocated to other line items.
      eligpercenthttp://terminology.hl7.org/CodeSystem/adjudicationEligible %Eligible Percentage.
      taxhttp://terminology.hl7.org/CodeSystem/adjudicationTaxThe amount of tax.
      benefithttp://terminology.hl7.org/CodeSystem/adjudicationBenefit AmountAmount payable under the coverage
      billingnetworkstatushttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCSBilling Network StatusIndicates the Billing Provider network status in relation to the patient's coverage.
      renderingnetworkstatushttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCSRendering Network StatusIndicates the Rendering Provider network status in relation to the patient's coverage.
      benefitpaymentstatushttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCSBenefit Payment StatusIndicates the in network or out of network payment status of the claim.
      adjustmentreasonhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCSAdjustment ReasonDefines the adjudication slice to identify the adjustment reason
      medicalmanagementhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCSMedical ManagementDefines the adjudication slice to identify medical management
      memberliabilityhttp://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCSMember LiabilityDefines the adjudication slice to identify member liability

    Explanation of the columns that may appear on this page:

    Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
    System The source of the definition of the code (when the value set draws in codes defined elsewhere)
    Code The code (used as the code in the resource instance)
    Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
    Definition An explanation of the meaning of the concept
    Comments Additional notes about how to use the code