{
  "description": "Describes the various amount fields used when payers receive and adjudicate a claim.  It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.",
  "_filename": "CodeSystem-PDexAdjudicationCS.json",
  "package_name": "hl7.fhir.us.davinci-pdex.r4",
  "date": "2024-08-14T20:04:35+00:00",
  "publisher": "HL7 International / Financial Management",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "content": "complete",
  "name": "PDexAdjudicationCS",
  "copyright": "This CodeSystem is not copyrighted.",
  "type": null,
  "experimental": "false",
  "resourceType": "CodeSystem",
  "title": "PDex Adjudication Codes",
  "package_version": "2.1.0-ballot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "fm"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "trial-use",
    "_valueCode": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical": "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
      } ]
    }
  } ],
  "status": "active",
  "id": "4729b9bf-b1c5-4d8e-8eca-c753ff0a25fb",
  "kind": null,
  "count": 9,
  "url": "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexAdjudicationCS",
  "concept": [ {
    "code": "coinsurance",
    "display": "Co-insurance",
    "definition": "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%."
  }, {
    "code": "noncovered",
    "display": "Noncovered",
    "definition": "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."
  }, {
    "code": "priorpayerpaid",
    "display": "Prior payer paid",
    "definition": "The reduction in the payment amount to reflect the carrier as a secondary payor."
  }, {
    "code": "paidbypatient",
    "display": "Paid by patient",
    "definition": "The amount paid by the patient at the point of service."
  }, {
    "code": "paidtoprovider",
    "display": "Paid to provider",
    "definition": "The amount paid to the provider."
  }, {
    "code": "paidtopatient",
    "display": "Paid to patient",
    "definition": "paid to patient"
  }, {
    "code": "memberliability",
    "display": "Member liability",
    "definition": "The amount of the member's liability."
  }, {
    "code": "discount",
    "display": "Discount",
    "definition": "The amount of the discount"
  }, {
    "code": "drugcost",
    "display": "Drug cost",
    "definition": "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"
  } ],
  "caseSensitive": false,
  "version": "2.1.0-ballot",
  "contact": [ {
    "name": "HL7 International / Financial Management",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/fm",
      "system": "url"
    }, {
      "value": "fm@lists.HL7.org",
      "system": "email"
    } ]
  }, {
    "name": "Mark Scrimshire (mark.scrimshire@onyxhealth.io)",
    "telecom": [ {
      "value": "mailto:mark.scrimshire@onyxhealth.io",
      "system": "email"
    } ]
  }, {
    "name": "HL7 International - Financial Management",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/fm",
      "system": "url"
    } ]
  } ]
}