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

## ValueSet: PCT GFE Item Adjudication Value Set

Official URL: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS | Version: 2.0.1
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

- PCT Advanced EOB
- PCT Advanced EOB

Changes since version 1.1.0:

- No changes

### Logical Definition (CLD)

This value set includes codes based on the following rules:

- Include all codes defined in `http://terminology.hl7.org/CodeSystem/adjudication` version 📍1.0.1
- Include all codes defined in `http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` version 📦2.0.1

### Expansion

Expansion performed internally based on:

- codesystem PCT Adjudication Category CodeSystem v2.0.1 (CodeSystem)
- codesystem Adjudication Value Codes v1.0.1 (CodeSystem)

This value set contains 14 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://terminology.hl7.org/CodeSystem/adjudication` | submitted | Submitted Amount | The total submitted amount for the claim or group or line item. |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | copay | CoPay | Patient Co-Payment |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | eligible | Eligible Amount | Amount of the change which is considered for adjudication. |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | deductible | Deductible | Amount deducted from the eligible amount prior to adjudication. |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | unallocdeduct | Unallocated Deductible | The amount of deductible which could not allocated to other line items. |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | eligpercent | Eligible % | Eligible Percentage. |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | tax | Tax | The amount of tax. |  |
`http://terminology.hl7.org/CodeSystem/adjudication` | benefit | Benefit Amount | Amount payable under the coverage |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` | billingnetworkstatus | Billing Network Status | Indicates the Billing Provider network status in relation to the patient's coverage. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` | renderingnetworkstatus | Rendering Network Status | Indicates the Rendering Provider network status in relation to the patient's coverage. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` | benefitpaymentstatus | Benefit Payment Status | Indicates the in network or out of network payment status of the claim. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` | adjustmentreason | Adjustment Reason | Defines the adjudication slice to identify the adjustment reason |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` | medicalmanagement | Medical Management | Defines the adjudication slice to identify medical management |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS` | memberliability | Member Liability | Defines 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