Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

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 2.0.1 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

## CodeSystem: PCT Adjudication Code System

Official URL: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication | Version: 2.0.1
Standards status: Trial-use | Maturity Level: 2 | Computable Name: PCTAdjudication
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.16.2
Copyright/Legal: This CodeSystem is not copyrighted.

Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions.

This Code system is referenced in the content logical definition of the following value sets:

- PCTAdjudicationVS

Changes since version 1.1.0:

- The resource metadata has changed (description)

This case-sensitive code system `http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication` defines the following codes:

Code | Display | Definition
coinsurance | Co-insurance | 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.
memberliability | Member liability | The amount of the member's liability.
discount | Discount | The amount of the discount