Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: http://nphies.sa/terminology/ValueSet/adjudication | Version: 0.3.0 | |||
| Active as of 2024-09-01 | Computable Name: Adjudication | |||
Copyright/Legal: nphies 2020+ (https://nphies.sa) |
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Adjudication Value codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.
References
version: 10; Last updated: 2024-09-01 14:15:31+0300
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/adjudicationhttp://nphies.sa/terminology/CodeSystem/ksa-adjudication
Expansion performed internally based on:
This value set contains 14 concepts
| Code | System | Display (en-US) | Definition |
| submitted | http://terminology.hl7.org/CodeSystem/adjudication | Submitted Amount | The total submitted amount for the claim or group or line item. |
| copay | http://terminology.hl7.org/CodeSystem/adjudication | CoPay | Patient Co-Payment |
| eligible | http://terminology.hl7.org/CodeSystem/adjudication | Eligible Amount | Amount of the change which is considered for adjudication. |
| deductible | http://terminology.hl7.org/CodeSystem/adjudication | Deductible | Amount deducted from the eligible amount prior to adjudication. |
| unallocdeduct | http://terminology.hl7.org/CodeSystem/adjudication | Unallocated Deductible | The amount of deductible which could not allocated to other line items. |
| eligpercent | http://terminology.hl7.org/CodeSystem/adjudication | Eligible % | Eligible Percentage. |
| tax | http://terminology.hl7.org/CodeSystem/adjudication | Tax | The amount of tax. |
| benefit | http://terminology.hl7.org/CodeSystem/adjudication | Benefit Amount | Amount payable under the coverage |
| discount | http://nphies.sa/terminology/CodeSystem/ksa-adjudication | Discount | Amount discounted |
| rejected | http://nphies.sa/terminology/CodeSystem/ksa-adjudication | Rejected | Amount rejected by the payer |
| patientShare | http://nphies.sa/terminology/CodeSystem/ksa-adjudication | Patient share | Amount to be paid by the patient |
| approved-quantity | http://nphies.sa/terminology/CodeSystem/ksa-adjudication | Approved Quantity | The quantity approved by the payer |
| approved-duration | http://nphies.sa/terminology/CodeSystem/ksa-adjudication | Approved Duration | The treatment duration approved in days |
| approved-refill | http://nphies.sa/terminology/CodeSystem/ksa-adjudication | Approved Refill | The number of refill approved for this item |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |