For developers
Adjudication codes, normalized.
Adjudication codes label financial amounts on a claim, such as the billed amount, plan payment, and member responsibility. For supported payer endpoints, Flexpa translates these codes to a standard set and calculates missing financial values using its documented equations.
Updated 2026-11-11
How it works
- Supported payer EOB
- Code normalization
- Returned EOB
Normalization for supported payer endpoints
Behind the scenes
- 1Parse the payer's original ExplanationOfBenefit.
- 2Translate its adjudication codes to a standard set.
- 3Calculate missing values from the liability and payment equations.
- 4Return the normalized ExplanationOfBenefit.
Where to look
The financial guide identifies total[], item.adjudication[], and adjudication[] as possible locations for adjudication values in an ExplanationOfBenefit. The location varies by payer and claim type.
Questions
What are adjudication codes?
Adjudication codes identify financial amounts in an ExplanationOfBenefit, such as plan payment or member responsibility. Payers can use different code sets and locations within the resource.
Does Flexpa normalize adjudication codes?
For supported payer endpoints, Flexpa translates adjudication codes into a standard set in the returned ExplanationOfBenefit and calculates financial values using its documented equations.