CodeSystem-PDexAdjudicationCS

Sourcehl7.fhir.us.davinci-pdex#current:Da Vinci Payer Data Exchange (v4.0.1)
resourceTypeCodeSystem
idPDexAdjudicationCS
canonicalhttp://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexAdjudicationCS
version2.0.0
statusdraft
publisherHL7 Financial Management Working Group
namePDexAdjudicationCS
titlePDex Adjudication Codes
date2023-08-14T14:40:10+00:00
experimentaltrue
descriptionDescribes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.
copyrightThis CodeSystem is not copyrighted.
jurisdictionsus
caseSensitivefalse
contentcomplete
Usages

This case-insensitive code system http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexAdjudicationCS defines the following codes:

Code Display Definition
coinsurance Co-insurance The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.
noncovered Noncovered The portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract.
priorpayerpaid Prior payer paid The reduction in the payment amount to reflect the carrier as a secondary payor.
paidbypatient Paid by patient The amount paid by the patient at the point of service.
paidtoprovider Paid to provider The amount paid to the provider.
paidtopatient Paid to patient paid to patient
memberliability Member liability The amount of the member's liability.
discount Discount The amount of the discount
drugcost Drug cost Price paid for the drug excluding mfr or other discounts. It typically is the sum of the following components: ingredient cost, dispensing fee, sales tax, and vaccine administration

Produced 08 Sep 2023