R6 Ballot (3rd Draft) (1st Full Ballot)

This page is part of the FHIR Specification v6.0.0-ballot3: v6.0.0-ballot4: Release 6 Ballot (3rd Draft) (1st Full Ballot) (see Ballot Notes ). The current version is 5.0.0 . For a full list of available versions, see the Directory of published versions for published versions icon

4.4.1.783 4.4.1.693 ValueSet http://hl7.org/fhir/ValueSet/adjudication

Responsible Owner: Financial Management icon Work Group   Maturity Level : 1 Draft Normative Use Context : Country: World
Official URL : http://hl7.org/fhir/ValueSet/adjudication Version : 6.0.0-ballot3 6.0.0-ballot4
draft active as of 2025-04-01 2025-12-18 Computable Name : AdjudicationValueCodes
Flags : OID : 2.16.840.1.113883.4.642.3.596

This value set is used in the following places:

4.4.1.783.1 4.4.1.693.1 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.

4.4.1.783.2 4.4.1.693.2 Content Logical Definition

Generated Narrative: ValueSet adjudication

Last updated: 2025-04-01T12:16:37.966+11:00 Profile: Shareable ValueSet 2025-12-18T07:07:42.17+11:00

 

4.4.1.783.3 4.4.1.693.3 Expansion

This expansion generated 01 Apr 18 Dec 2025

ValueSet

Expansion performed internally based on codesystem Adjudication Value Codes v1.0.1 (CodeSystem) icon

This value set contains 8 concepts

Code System System Code Display Definition
http://terminology.hl7.org/CodeSystem/adjudication    submitted icon http://terminology.hl7.org/CodeSystem/adjudication Submitted Amount The total submitted amount for the claim or group or line item.
http://terminology.hl7.org/CodeSystem/adjudication    copay icon http://terminology.hl7.org/CodeSystem/adjudication CoPay Patient Co-Payment
http://terminology.hl7.org/CodeSystem/adjudication    eligible icon http://terminology.hl7.org/CodeSystem/adjudication Eligible Amount Amount of the change which is considered for adjudication.
http://terminology.hl7.org/CodeSystem/adjudication    deductible icon http://terminology.hl7.org/CodeSystem/adjudication Deductible Amount deducted from the eligible amount prior to adjudication.
http://terminology.hl7.org/CodeSystem/adjudication    unallocdeduct icon http://terminology.hl7.org/CodeSystem/adjudication Unallocated Deductible The amount of deductible which could not allocated to other line items.
http://terminology.hl7.org/CodeSystem/adjudication    eligpercent icon http://terminology.hl7.org/CodeSystem/adjudication Eligible % Eligible Percentage.
http://terminology.hl7.org/CodeSystem/adjudication    tax icon http://terminology.hl7.org/CodeSystem/adjudication Tax The amount of tax.
http://terminology.hl7.org/CodeSystem/adjudication    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