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 xmlns="http://hl7.org/fhir">
<id value="C4BBAdjudication"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication 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">coinsurance<a name="C4BBAdjudication-coinsurance"> </a></td><td>Co-insurance</td><td>The 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%.</td></tr><tr><td style="white-space:nowrap">noncovered<a name="C4BBAdjudication-noncovered"> </a></td><td>Noncovered</td><td>The 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.</td></tr><tr><td style="white-space:nowrap">priorpayerpaid<a name="C4BBAdjudication-priorpayerpaid"> </a></td><td>Prior payer paid</td><td>The reduction in the payment amount to reflect the carrier as a secondary payer.</td></tr><tr><td style="white-space:nowrap">paidbypatient<a name="C4BBAdjudication-paidbypatient"> </a></td><td>Paid by patient</td><td>The amount paid by the patient.</td></tr><tr><td style="white-space:nowrap">paidbypatientcash<a name="C4BBAdjudication-paidbypatientcash"> </a></td><td>Paid by patient - cash</td><td>The amount paid by the patient using cash, check, or other personal account.</td></tr><tr><td style="white-space:nowrap">paidbypatientother<a name="C4BBAdjudication-paidbypatientother"> </a></td><td>Paid by patient - other</td><td>The amount paid by the patient using another method like HSA, HRA, or another means other than by cash, check, or other personal account.</td></tr><tr><td style="white-space:nowrap">paidtoprovider<a name="C4BBAdjudication-paidtoprovider"> </a></td><td>Paid to provider</td><td>The amount paid to the provider.</td></tr><tr><td style="white-space:nowrap">paidtopatient<a name="C4BBAdjudication-paidtopatient"> </a></td><td>Paid to patient</td><td>paid to patient</td></tr><tr><td style="white-space:nowrap">memberliability<a name="C4BBAdjudication-memberliability"> </a></td><td>Member liability</td><td>The amount of the member's liability.</td></tr><tr><td style="white-space:nowrap">discount<a name="C4BBAdjudication-discount"> </a></td><td>Discount</td><td>The amount of the discount</td></tr><tr><td style="white-space:nowrap">drugcost<a name="C4BBAdjudication-drugcost"> </a></td><td>Drug cost</td><td>Price 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</td></tr></table></div>
</text>
<url value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"/>
<version value="1.2.0"/>
<name value="C4BBAdjudication"/>
<title value="C4BB Adjudication"/>
<status value="active"/>
<date value="2021-12-06T20:26:50+00:00"/>
<publisher value="HL7 Financial Management Working Group"/>
<contact>
<name value="HL7 Financial Management Working Group"/>
<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 amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication."/>
<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="11"/>
<concept>
<code value="coinsurance"/>
<display value="Co-insurance"/>
<definition
value="The 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%."/>
</concept>
<concept>
<code value="noncovered"/>
<display value="Noncovered"/>
<definition
value="The 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."/>
</concept>
<concept>
<code value="priorpayerpaid"/>
<display value="Prior payer paid"/>
<definition
value="The reduction in the payment amount to reflect the carrier as a secondary payer."/>
</concept>
<concept>
<code value="paidbypatient"/>
<display value="Paid by patient"/>
<definition value="The amount paid by the patient."/>
</concept>
<concept>
<code value="paidbypatientcash"/>
<display value="Paid by patient - cash"/>
<definition
value="The amount paid by the patient using cash, check, or other personal account."/>
</concept>
<concept>
<code value="paidbypatientother"/>
<display value="Paid by patient - other"/>
<definition
value="The amount paid by the patient using another method like HSA, HRA, or another means other than by cash, check, or other personal account."/>
</concept>
<concept>
<code value="paidtoprovider"/>
<display value="Paid to provider"/>
<definition value="The amount paid to the provider."/>
</concept>
<concept>
<code value="paidtopatient"/>
<display value="Paid to patient"/>
<definition value="paid to patient"/>
</concept>
<concept>
<code value="memberliability"/>
<display value="Member liability"/>
<definition value="The amount of the member's liability."/>
</concept>
<concept>
<code value="discount"/>
<display value="Discount"/>
<definition value="The amount of the discount"/>
</concept>
<concept>
<code value="drugcost"/>
<display value="Drug cost"/>
<definition
value="Price 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"/>
</concept>
</CodeSystem>