| Source | hl7.fhir.us.davinci-pct#current:Patient Cost Transparency Implementation Guide (v4.0.1) |
| resourceType | ValueSet |
| id | PCTAdjudication |
| canonical | http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudication |
| version | 1.0.0 |
| status | active |
| publisher | HL7 International - Financial Management Work Group |
| name | PCTAdjudication |
| title | PCT Adjudication Value Set |
| date | 2023-03-29T20:18:58+00:00 |
| experimental | false |
| description | Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values defined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem. |
| copyright | This Valueset is not copyrighted. |
| jurisdictions | us |
| Usages |
|
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/adjudication
| Code | Display |
| submitted | |
| copay | |
| eligible | |
| deductible | |
| benefit |
http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
| Code | Display | Definition |
| coinsurance | Coinsurance | 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. |
| memberliability | Member liability | The amount of the member's liability. |
| discount | Discount | The amount of the discount |
Produced 06 Apr 2023