Release 5 R6 Ballot (1st Full Ballot)

This page is part of the FHIR Specification (v5.0.0: R5 - STU v6.0.0-ballot4: Release 6 Ballot (1st Full Ballot) (see Ballot Notes ). This is the The current published version in it's permanent home (it will always be available at this URL). is 5.0.0 . For a full list of available versions, see the Directory of published versions for published versions icon . Page versions: R5 R4B R4 R3 R2

4.4.1.753 4.4.1.693 ValueSet http://hl7.org/fhir/ValueSet/adjudication

  Maturity Level : 1
Responsible Owner: Financial Management icon Work Group Draft Normative Use Context : Country: World, Not Intended for Production use World
Official URL : http://hl7.org/fhir/ValueSet/adjudication Version : 5.0.0 6.0.0-ballot4
draft active as of 2023-03-26 2025-12-18 Computable Name : AdjudicationValueCodes
Flags : Experimental OID : 2.16.840.1.113883.4.642.3.596

This value set is used in the following places:

4.4.1.753.1 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.

4.4.1.753.2 4.4.1.693.2 Content Logical Definition

Generated Narrative: ValueSet adjudication

Last updated: 2025-12-18T07:07:42.17+11:00

 

4.4.1.753.3 4.4.1.693.3 Expansion

This expansion generated 26 Mar 2023 18 Dec 2025

This value set contains 8 concepts

ValueSet

Expansion performed internally based on codesystem Adjudication Value Codes v0.1.0 v1.0.1 (CodeSystem) icon

This value set contains 8 concepts

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