Patient Cost Transparency Implementation Guide
2.0.2 - 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 2.0.2 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

ValueSet: PCT GFE Item Adjudication Value Set

Official URL: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS Version: 2.0.2
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

    SystemCodeDisplay (en)DefinitionJSONXML
    http://terminology.hl7.org/CodeSystem/adjudication  submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
    http://terminology.hl7.org/CodeSystem/adjudication  copayCoPayPatient Co-Payment
    http://terminology.hl7.org/CodeSystem/adjudication  eligibleEligible AmountAmount of the change which is considered for adjudication.
    http://terminology.hl7.org/CodeSystem/adjudication  deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
    http://terminology.hl7.org/CodeSystem/adjudication  unallocdeductUnallocated DeductibleThe amount of deductible which could not allocated to other line items.
    http://terminology.hl7.org/CodeSystem/adjudication  eligpercentEligible %Eligible Percentage.
    http://terminology.hl7.org/CodeSystem/adjudication  taxTaxThe amount of tax.
    http://terminology.hl7.org/CodeSystem/adjudication  benefitBenefit AmountAmount payable under the coverage
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS  billingnetworkstatusBilling Network StatusIndicates the Billing Provider network status in relation to the patient's coverage.
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS  renderingnetworkstatusRendering Network StatusIndicates the Rendering Provider network status in relation to the patient's coverage.
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS  benefitpaymentstatusBenefit Payment StatusIndicates the in network or out of network payment status of the claim.
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS  adjustmentreasonAdjustment ReasonDefines the adjudication slice to identify the adjustment reason
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS  medicalmanagementMedical ManagementDefines the adjudication slice to identify medical management
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS  memberliabilityMember LiabilityDefines the adjudication slice to identify member liability

    Description of the above table(s).