This page is part of the FHIR Specification (v4.3.0: R4B - STU). 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: R4B R4 R3
| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative |
Raw JSON (canonical form + also see JSON Format Specification)
Definition for Code SystemAdjudicationCodes
{
"resourceType" : "CodeSystem",
"id" : "adjudication",
"meta" : {
"lastUpdated" : "2022-05-28T12:47:40.239+10:00",
"profile" : ["http://hl7.org/fhir/StructureDefinition/shareablecodesystem"]
},
"text" : {
"status" : "generated",
"div" : "<div>!-- Snipped for Brevity --></div>"
},
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "fm"
}],
"url" : "http://terminology.hl7.org/CodeSystem/adjudication",
"identifier" : [{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.4.642.1.1171"
}],
"version" : "4.3.0",
"name" : "AdjudicationCodes",
"title" : "Adjudication Codes",
"status" : "draft",
"experimental" : false,
"description" : "This value set includes a smattering of Adjudication codes.",
"copyright" : "This is an example set.",
"caseSensitive" : true,
"content" : "complete",
"concept" : [{
"code" : "submitted",
"display" : "Submitted Amount",
"definition" : "The total submitted amount for the claim or group or line item."
},
{
"code" : "copay",
"display" : "CoPay",
"definition" : "Patient Co-Payment"
},
{
"code" : "eligible",
"display" : "Eligible Amount",
"definition" : "Amount of the change which is considered for adjudication."
},
{
"code" : "deductible",
"display" : "Deductible",
"definition" : "Amount deducted from the eligible amount prior to adjudication."
},
{
"code" : "unallocdeduct",
"display" : "Unallocated Deductible",
"definition" : "The amount of deductible which could not allocated to other line items."
},
{
"code" : "eligpercent",
"display" : "Eligible %",
"definition" : "Eligible Percentage."
},
{
"code" : "tax",
"display" : "Tax",
"definition" : "The amount of tax."
},
{
"code" : "benefit",
"display" : "Benefit Amount",
"definition" : "Amount payable under the coverage"
}]
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.