{
  "description": "Financial Type codes for benefitBalance.financial.type.",
  "_filename": "CodeSystem-PCTFinancialType.json",
  "package_name": "hl7.fhir.us.davinci-pct.r4",
  "date": "2023-03-30T13:34:22+00:00",
  "publisher": "HL7 International - Financial Management Work Group",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "content": "complete",
  "name": "PCTFinancialType",
  "copyright": "This CodeSystem is not copyrighted.",
  "type": null,
  "experimental": "false",
  "resourceType": "CodeSystem",
  "title": "PCT Financial Type Code System",
  "package_version": "1.0.0",
  "status": "active",
  "id": "f6f1d9dc-6021-4f38-8d77-5455896cea57",
  "kind": null,
  "count": 10,
  "url": "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType",
  "concept": [ {
    "code": "allowed",
    "display": "Allowed",
    "definition": "The maximum amount a plan will pay for a covered health care service. May also be called \"payment allowance\", or \"negotiated rate\"."
  }, {
    "code": "coinsurance",
    "display": "Co-Insurance",
    "definition": "The amount the insured individual pays, as a set percentage of the cost of covered services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%."
  }, {
    "code": "copay",
    "display": "CoPay",
    "definition": "A fixed amount ($20, for example) the insured individual pays for a covered health care service after the deductible is paid."
  }, {
    "code": "deductible",
    "display": "Deductible",
    "definition": "The amount the insured individual pays for covered health care services before the insurance plan starts to pay."
  }, {
    "code": "eligible",
    "display": "Eligible Amount",
    "definition": "Amount of the charge which is considered for adjudication."
  }, {
    "code": "memberliability",
    "display": "Member Liability",
    "definition": "The amount of the member's liability."
  }, {
    "code": "noncovered",
    "display": "Noncovered",
    "definition": "The portion of the cost of the service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract."
  }, {
    "code": "out-of-pocket-maximum",
    "display": "Out-of-Pocket Maximum",
    "definition": "The most the insured individual has to pay for covered services in a plan year. After this amount is spent on deductibles, copayments, and coinsurance for in-network care and services, the health plan pays 100% of the costs of covered benefits."
  }, {
    "code": "visit",
    "display": "Visit",
    "definition": "A medical visit means diagnostic, therapeutic, or consultative services provided to a client by a healthcare professional in an outpatient setting."
  }, {
    "code": "penalty",
    "display": "Penalty",
    "definition": "Benefit penalty is an approach used by the insurance company to reduce their payment on a claim when the patient or medical provider does not satisfy the rules of the health plan. Benefit penalties may occur when a pre-authorization is not obtained, for example."
  } ],
  "caseSensitive": true,
  "version": "1.0.0",
  "contact": [ {
    "name": "HL7 International - Financial Management Work Group",
    "telecom": [ {
      "value": "http://hl7.org/Special/committees/fm",
      "system": "url"
    }, {
      "value": "fmlists@lists.hl7.org",
      "system": "email"
    } ]
  } ]
}