Adjudication - Healthcare Financial Services IG Edition 1 v0.3.0

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

ValueSet: Adjudication

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)

Adjudication Value codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.

References

Logical Definition (CLD)

Generated Narrative: ValueSet adjudication

version: 10; Last updated: 2024-09-01 14:15:31+0300

This value set includes codes based on the following rules:

Include all codes defined in http://terminology.hl7.org/CodeSystem/adjudication
Include all codes defined in http://nphies.sa/terminology/CodeSystem/ksa-adjudication

Expansion

ValueSet

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