draft

4 bindings

Adjudication Value Codes

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

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.

Composition

Code system

http://terminology.hl7.org/CodeSystem/adjudication

Adjudication Value 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

Bound by

Resource	Path	Strength
ClaimResponse	ClaimResponse.item.adjudication.category	example
ClaimResponse	ClaimResponse.total.category	example
ExplanationOfBenefit	ExplanationOfBenefit.item.adjudication.category	example
ExplanationOfBenefit	ExplanationOfBenefit.total.category	example