adjudication
type: CodeSystem
node role: treeRoot
id:
  v: adjudication
meta:
  last updated:
    v: 2024-04-24T00:00:00+00:00
  profile:
    v: http://hl7.org/fhir/StructureDefinition/shareablecodesystem
    link: http://hl7.org/fhir/StructureDefinition/shareablecodesystem
text:
  status:
    v: generated
  div: Generated Narrative: CodeSystem adjudication Last updated: 2024-04-24 00:00:00+0000 Profile: Shareable CodeSystem This case-sensitive code system http://terminology.hl7.org/CodeSystem/adjudication defines the following codes: Code Display Definition submitted Submitted Amount The total submitted amount for the claim or group or line item. copay CoPay Patient Co-Payment eligible Eligible Amount Amount of the change which is considered for adjudication. deductible Deductible Amount deducted from the eligible amount prior to adjudication. unallocdeduct Unallocated Deductible The amount of deductible which could not allocated to other line items. eligpercent Eligible % Eligible Percentage. tax Tax The amount of tax. benefit Benefit Amount Amount payable under the coverage
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
  value: code
    v: fm
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
  value: integer
    v: 1
url:
  v: http://terminology.hl7.org/CodeSystem/adjudication
identifier:
  system:
    v: urn:ietf:rfc:3986
  value:
    v: urn:oid:2.16.840.1.113883.4.642.1.1171
version:
  v: 1.0.1
name:
  v: AdjudicationValueCodes
title:
  v: Adjudication Value Codes
status:
  v: active
experimental:
  v: false
date:
  v: 2025-05-13T16:02:33+00:00
publisher:
  v: Health Level Seven International
contact:
  telecom:
    system:
      v: url
    value:
      v: http://hl7.org
  telecom:
    system:
      v: email
description:
  v: 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:
  v: 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
case sensitive:
  v: true
value set:
  v: http://terminology.hl7.org/ValueSet/adjudication
  link: http://terminology.hl7.org/ValueSet/adjudication
content:
  v: complete
concept:
  code:
    v: submitted
  display:
    v: Submitted Amount
  definition:
    v: The total submitted amount for the claim or group or line item.
concept:
  code:
    v: copay
  display:
    v: CoPay
  definition:
    v: Patient Co-Payment
concept:
  code:
    v: eligible
  display:
    v: Eligible Amount
  definition:
    v: Amount of the change which is considered for adjudication.
concept:
  code:
    v: deductible
  display:
    v: Deductible
  definition:
    v: Amount deducted from the eligible amount prior to adjudication.
concept:
  code:
    v: unallocdeduct
  display:
    v: Unallocated Deductible
  definition:
    v: The amount of deductible which could not allocated to other line items.
concept:
  code:
    v: eligpercent
  display:
    v: Eligible %
  definition:
    v: Eligible Percentage.
concept:
  code:
    v: tax
  display:
    v: Tax
  definition:
    v: The amount of tax.
concept:
  code:
    v: benefit
  display:
    v: Benefit Amount
  definition:
    v: Amount payable under the coverage