This page is part of the CARIN Blue Button Implementation Guide (v2.1.0-snapshot1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

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: C4BB Payer Adjudication Status Code System - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="C4BBPayerAdjudicationStatus"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem C4BBPayerAdjudicationStatus</b></p><a name="C4BBPayerAdjudicationStatus"> </a><a name="hcC4BBPayerAdjudicationStatus"> </a><a name="C4BBPayerAdjudicationStatus-en-US"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">innetwork<a name="C4BBPayerAdjudicationStatus-innetwork"> </a></td><td>In Network</td><td>Indicates an in network status in relation to a patient's coverage</td></tr><tr><td style="white-space:nowrap">outofnetwork<a name="C4BBPayerAdjudicationStatus-outofnetwork"> </a></td><td>Out Of Network</td><td>Indicates a not in network status in relation to a patient's coverage</td></tr><tr><td style="white-space:nowrap">other<a name="C4BBPayerAdjudicationStatus-other"> </a></td><td>Other</td><td>Indicates other network status or when a network does not apply</td></tr><tr><td style="white-space:nowrap">paid<a name="C4BBPayerAdjudicationStatus-paid"> </a></td><td>Paid</td><td>Indicates if the claim was approved for payment</td></tr><tr><td style="white-space:nowrap">denied<a name="C4BBPayerAdjudicationStatus-denied"> </a></td><td>Denied</td><td>Indicates if the claim was denied</td></tr><tr><td style="white-space:nowrap">partiallypaid<a name="C4BBPayerAdjudicationStatus-partiallypaid"> </a></td><td>Partially Paid</td><td>Indicates that some line items on the claim were denied</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"/>
  <version value="2.1.0-snapshot1"/>
  <name value="C4BBPayerAdjudicationStatus"/>
  <title value="C4BB Payer Adjudication Status Code System"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-07-27T20:09:37+08:00"/>
  <publisher value="HL7 International / Financial Management"/>
  <contact>
    <name value="HL7 International / Financial Management"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fm@lists.HL7.org"/>
    </telecom>
  </contact>
  <description
               value="Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was in or not in network for the service.

This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <copyright value="This CodeSystem is not copyrighted."/>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="6"/>
  <concept>
    <code value="innetwork"/>
    <display value="In Network"/>
    <definition
                value="Indicates an in network status in relation to a patient's coverage"/>
  </concept>
  <concept>
    <code value="outofnetwork"/>
    <display value="Out Of Network"/>
    <definition
                value="Indicates a not in network status in relation to a patient's coverage"/>
  </concept>
  <concept>
    <code value="other"/>
    <display value="Other"/>
    <definition
                value="Indicates other network status or when a network does not apply"/>
  </concept>
  <concept>
    <code value="paid"/>
    <display value="Paid"/>
    <definition value="Indicates if the claim was approved for payment"/>
  </concept>
  <concept>
    <code value="denied"/>
    <display value="Denied"/>
    <definition value="Indicates if the claim was denied"/>
  </concept>
  <concept>
    <code value="partiallypaid"/>
    <display value="Partially Paid"/>
    <definition
                value="Indicates that some line items on the claim were denied"/>
  </concept>
</CodeSystem>