{ "resourceType": "CodeSystem", "id": "adjudication", "meta": { "lastUpdated": "2019-11-01T09:29:23.356+11:00", "profile": [ "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ] }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "fm" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "draft" }, { "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:2.16.840.1.113883.4.642.4.1171" } ], "version": "4.0.1", "name": "AdjudicationValueCodes", "title": "Adjudication Value Codes", "status": "draft", "experimental": false, "publisher": "FHIR Project team", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] } ], "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 is an example set.", "caseSensitive": true, "valueSet": "http://hl7.org/fhir/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" } ] }