PCTAdjudication

PCT Adjudication Code System

activeDa Vinci PCT2.0.1complete4 concepts

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. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
ID
PCTAdjudication
Version
2.0.1
Publisher
HL7 International / Financial Management
Case Sensitive
Yes

Concepts (4)

CodeDisplayDefinition
coinsuranceCo-insuranceThe 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%.
noncoveredNoncoveredThe 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.
memberliabilityMember liabilityThe amount of the member's liability.
discountDiscountThe amount of the discount