Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values defined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.

Changes since version 1.1.0:

This value set includes codes based on the following rules:

• Include these codes as defined in http://terminology.hl7.org/CodeSystem/adjudication version 📍1.0.1

  Code	Display	Definition
  submitted	Submitted Amount	The total submitted amount for the claim or group or line item.
  copay	CoPay	Patient Co-Payment
  eligible	Eligible Amount	Amount of the change which is considered for adjudication.
  deductible	Deductible	Amount deducted from the eligible amount prior to adjudication.
  benefit	Benefit Amount	Amount payable under the coverage

• Include these codes as defined in http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication version 📦2.0.2

  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

This value set contains 9 concepts