LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
| Official URL: http://linuxforhealth.org/fhir/cdm/ValueSet/payer-claim-adjustment-type | Version: 8.0.0 | |||
| Active as of 2022-11-10 | Computable Name: PayerClaimAdjustmentTypeValueSet | |||
Value set containing payer codes indicating the type of adjustment for the claim
References
http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type
This value set contains 6 concepts
Expansion based on Payer Claim Adjustment Type Codes v8.0.0 (CodeSystem)
| Code | System | Display | Definition |
| 1 | http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type | Adjustment (positive or negative adjustment) | An adjustment is a claim line where one or more of the financial fields display the difference between the original amount and the final amount. Any financial not being adjusted should be zero as well as any quantity. |
| 2 | http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type | Void (void, reversal or back-out) | A void is a claim line where all financials and quantities are negated |
| 3 | http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type | Original or Replacement (original, resubmit or replacement) | An original or replacement claim line where all financials and quantities are positive and supplements a void claim line |
| 4 | http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type | Bulk Adjustment (gross or bulk adjustment) | Adjustments (positive or negative) that aren't tied to a particular service at the claim-line level. Examples include, but aren't limited to, value-based reimbursement payments to providers, Drug Rebates, etc. |
| B | http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type | Adjustment Debit | Claim adjustments are sometimes required to correct erroneous payments made to providers. Adjustments may need to be made for a range of reasons, for example, recording of an incorrect procedure code, listing of a wrong place of service, data entry errors etc. A claim adjustment debit increases the balance due to the provider due to an underpayment made in error. |
| C | http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type | Adjustment Credit | Claim adjustments are sometimes required to correct erroneous payments made to providers. Adjustments may need to be made for a range of reasons, for example, recording of an incorrect procedure code, listing of a wrong place of service, data entry errors etc. A claim adjustment credit decreased the balance due to the provider due to an overpayment made in error. |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |