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TX: CodeSystem adjudication

Properties

Profile http://hl7.org/fhir/StructureDefinition/shareablecodesystem
Language en
Defining URL http://terminology.hl7.org/CodeSystem/adjudication
Version 1.0.1
Name AdjudicationValueCodes
Title Adjudication Value Codes
Status active
Definition

This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.
Publisher Health Level Seven International
Committee fm
Copyright This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
EXT_FMM_LEVEL 1
Value Set Adjudication Value Codes

This case-sensitive code system http://terminology.hl7.org/CodeSystem/adjudication defines the following codes:

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.
unallocdeduct Unallocated Deductible The amount of deductible which could not allocated to other line items.
eligpercent Eligible % Eligible Percentage.
tax Tax The amount of tax.
benefit Benefit Amount Amount payable under the coverage