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 2.0.2 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
: PCT Adjudication Code System
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/PCTAdjudication> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "PCTAdjudication"] ;
fhir:Resource.language [ fhir:value "en"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem PCTAdjudication</b></p><a name=\"PCTAdjudication\"> </a><a name=\"hcPCTAdjudication\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">coinsurance<a name=\"PCTAdjudication-coinsurance\"> </a></td><td>Co-insurance</td><td>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%.</td></tr><tr><td style=\"white-space:nowrap\">noncovered<a name=\"PCTAdjudication-noncovered\"> </a></td><td>Noncovered</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">memberliability<a name=\"PCTAdjudication-memberliability\"> </a></td><td>Member liability</td><td>The amount of the member's liability.</td></tr><tr><td style=\"white-space:nowrap\">discount<a name=\"PCTAdjudication-discount\"> </a></td><td>Discount</td><td>The amount of the discount</td></tr></table></div>"
] ;
fhir:DomainResource.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:Extension.valueCode [ fhir:value "fm" ]
], [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm" ] ;
fhir:Extension.valueInteger [
fhir:value "2"^^xsd:integer ;
fhir:Element.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
fhir:Extension.valueCanonical [
fhir:value "http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct" ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct>
]
]
]
], [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:Extension.valueCode [
fhir:value "trial-use" ;
fhir:Element.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
fhir:Extension.valueCanonical [
fhir:value "http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct" ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct>
]
]
]
] ;
fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication"] ;
fhir:CodeSystem.identifier [
fhir:index -1 ;
fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ] ;
fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.4.642.40.4.16.2" ]
] ;
fhir:CodeSystem.version [ fhir:value "2.0.2"] ;
fhir:CodeSystem.name [ fhir:value "PCTAdjudication"] ;
fhir:CodeSystem.title [ fhir:value "PCT Adjudication Code System"] ;
fhir:CodeSystem.status [ fhir:value "active"] ;
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2026-11-09T22:17:29+00:00"^^xsd:dateTime] ;
fhir:CodeSystem.publisher [ fhir:value "HL7 International / Financial Management"] ;
fhir:CodeSystem.contact [
fhir:index -1 ;
fhir:ContactDetail.name [ fhir:value "HL7 International / Financial Management" ] ;
fhir:ContactDetail.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/fm" ]
], [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "email" ] ;
fhir:ContactPoint.value [ fhir:value "fmlists@lists.hl7.org" ]
]
] ;
fhir:CodeSystem.description [ fhir:value "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."] ;
fhir:CodeSystem.jurisdiction [
fhir:index -1 ;
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
fhir:Coding.code [ fhir:value "US" ]
]
] ;
fhir:CodeSystem.copyright [ fhir:value "This CodeSystem is not copyrighted."] ;
fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ;
fhir:CodeSystem.content [ fhir:value "complete"] ;
fhir:CodeSystem.count [ fhir:value "4"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "coinsurance" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Co-insurance" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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%." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "noncovered" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Noncovered" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "memberliability" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Member liability" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The amount of the member's liability." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "discount" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Discount" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The amount of the discount" ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/PCTAdjudication.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/PCTAdjudication.ttl> .
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