Release 4B R5 Final QA

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-draft-final: Final QA Preview for R5 - STU see ballot notes ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Using Codes Code Systems Value Sets Concept Maps Identifier Systems

4.4.1.686 4.4.1.775 Value Set ValueSet http://hl7.org/fhir/ValueSet/adjudication

Financial Management icon Work Group   Maturity Level : 1 Draft Use Context : Country: World, Not Intended for Production use
This is a value set defined by the FHIR project. Summary
  • Defining URL: Narrative http://hl7.org/fhir/ValueSet/adjudication
  • Version: XML 4.3.0
  • Name: JSON AdjudicationValueCodes
  • Title: TTL Adjudication Value Codes
OID: 2.16.840.1.113883.4.642.3.596 (for OID based terminology systems)
Official URL : Definition: http://hl7.org/fhir/ValueSet/adjudication 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. Committee: Financial Management Work Group Version : 5.0.0-draft-final
draft as of 2023-03-01 Copyright: Computable Name : AdjudicationValueCodes This is an example set.
Source Resource Flags : Experimental XML / JSON OID : 2.16.840.1.113883.4.642.3.596

This value set is used in the following places:

4.4.1.686.1 4.4.1.775.1 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.

4.4.1.775.2 Content Logical Definition

 

4.4.1.686.2 4.4.1.775.3 Expansion

This expansion generated 28 May 2022 01 Mar 2023

This value set contains 8 concepts

Expansion based on Adjudication Value Codes v4.3.0 v0.1.0 (CodeSystem) All codes in this table are from the system http://terminology.hl7.org/CodeSystem/adjudication icon

Code System Display Definition
   submitted icon http://terminology.hl7.org/CodeSystem/adjudication Submitted Amount

The total submitted amount for the claim or group or line item.

   copay icon http://terminology.hl7.org/CodeSystem/adjudication CoPay

Patient Co-Payment

   eligible icon http://terminology.hl7.org/CodeSystem/adjudication Eligible Amount

Amount of the change which is considered for adjudication.

   deductible icon http://terminology.hl7.org/CodeSystem/adjudication Deductible

Amount deducted from the eligible amount prior to adjudication.

   unallocdeduct icon http://terminology.hl7.org/CodeSystem/adjudication Unallocated Deductible

The amount of deductible which could not allocated to other line items.

   eligpercent icon http://terminology.hl7.org/CodeSystem/adjudication Eligible %

Eligible Percentage.

   tax icon http://terminology.hl7.org/CodeSystem/adjudication Tax

The amount of tax.

   benefit icon http://terminology.hl7.org/CodeSystem/adjudication Benefit Amount

Amount payable under the coverage

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

Lvl A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information
Source 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). If the code is in italics, this indicates that the code is not selectable ('Abstract')
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