CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.2.0 - STU 2 Ballot

This page is part of the CARIN Blue Button Implementation Guide (v1.2.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

CodeSystem: C4BB Adjudication

Summary

Defining URL:http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
Version:1.2.0
Name:C4BBAdjudication
Title:C4BB Adjudication
Status:Active as of 12/6/21 8:26 PM
Definition:

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.

Publisher:HL7 Financial Management Working Group
Copyright:

This CodeSystem is not copyrighted.

Content:Complete: All the concepts defined by the code system are included in the code system resource
Source Resource:XML / JSON / Turtle

This Code system is referenced in the content logical definition of the following value sets:

This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication defines the following codes:

CodeDisplayDefinition
coinsurance Co-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%.
noncovered NoncoveredThe 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.
priorpayerpaid Prior payer paidThe reduction in the payment amount to reflect the carrier as a secondary payer.
paidbypatient Paid by patientThe amount paid by the patient.
paidbypatientcash Paid by patient - cashThe amount paid by the patient using cash, check, or other personal account.
paidbypatientother Paid by patient - otherThe amount paid by the patient using another method like HSA, HRA, or another means other than by cash, check, or other personal account.
paidtoprovider Paid to providerThe amount paid to the provider.
paidtopatient Paid to patientpaid to patient
memberliability Member liabilityThe amount of the member's liability.
discount DiscountThe amount of the discount
drugcost Drug costPrice paid for the drug excluding mfr or other discounts. It typically is the sum of the following components: ingredient cost, dispensing fee, sales tax, and vaccine administration