{"resourceType":"CodeSystem","id":"adjudication","meta":{"lastUpdated":"2024-04-24T00:00:00+00:00","profile":["http://hl7.org/fhir/StructureDefinition/shareablecodesystem"]},"text":{"status":"generated","div":"<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/adjudication</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">submitted<a name=\"adjudication-submitted\"> </a></td><td>Submitted Amount</td><td>The total submitted amount for the claim or group or line item.</td></tr><tr><td style=\"white-space:nowrap\">copay<a name=\"adjudication-copay\"> </a></td><td>CoPay</td><td>Patient Co-Payment</td></tr><tr><td style=\"white-space:nowrap\">eligible<a name=\"adjudication-eligible\"> </a></td><td>Eligible Amount</td><td>Amount of the change which is considered for adjudication.</td></tr><tr><td style=\"white-space:nowrap\">deductible<a name=\"adjudication-deductible\"> </a></td><td>Deductible</td><td>Amount deducted from the eligible amount prior to adjudication.</td></tr><tr><td style=\"white-space:nowrap\">unallocdeduct<a name=\"adjudication-unallocdeduct\"> </a></td><td>Unallocated Deductible</td><td>The amount of deductible which could not allocated to other line items.</td></tr><tr><td style=\"white-space:nowrap\">eligpercent<a name=\"adjudication-eligpercent\"> </a></td><td>Eligible %</td><td>Eligible Percentage.</td></tr><tr><td style=\"white-space:nowrap\">tax<a name=\"adjudication-tax\"> </a></td><td>Tax</td><td>The amount of tax.</td></tr><tr><td style=\"white-space:nowrap\">benefit<a name=\"adjudication-benefit\"> </a></td><td>Benefit Amount</td><td>Amount payable under the coverage</td></tr></table></div>"},"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"fm"},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm","valueInteger":1}],"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":"1.0.1","name":"AdjudicationValueCodes","title":"Adjudication Value Codes","status":"active","experimental":false,"date":"2024-04-26T19:30:18+00:00","publisher":"Health Level Seven International","contact":[{"telecom":[{"system":"url","value":"http://hl7.org"},{"system":"email","value":"hq@HL7.org"}]}],"description":"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.","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","caseSensitive":true,"valueSet":"http://terminology.hl7.org/ValueSet/adjudication","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"}]}