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

: C4BB Payer Adjudication Status - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "C4BBPayerAdjudicationStatus"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus 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 the claim or claim line was paid in network.  This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">outofnetwork<a name=\"C4BBPayerAdjudicationStatus-outofnetwork\"> </a></td><td>Out Of Network</td><td>Indicates the claim or claim line was paid out of network.  This does not indicate the contracting status of the provider</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\">contracted<a name=\"C4BBPayerAdjudicationStatus-contracted\"> </a></td><td>Contracted</td><td>Indicates the provider was contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">noncontracted<a name=\"C4BBPayerAdjudicationStatus-noncontracted\"> </a></td><td>Non-Contracted</td><td>Indicates the provider was not contracted for the service</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>"
  ];
  fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"];
  fhir:CodeSystem.version [ fhir:value "1.2.0"];
  fhir:CodeSystem.name [ fhir:value "C4BBPayerAdjudicationStatus"];
  fhir:CodeSystem.title [ fhir:value "C4BB Payer Adjudication Status"];
  fhir:CodeSystem.status [ fhir:value "active"];
  fhir:CodeSystem.date [ fhir:value "2021-12-06T20:26:50+00:00"^^xsd:dateTime];
  fhir:CodeSystem.publisher [ fhir:value "HL7 Financial Management Working Group"];
  fhir:CodeSystem.contact [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "HL7 Financial Management Working Group" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/fm" ]     ], [
       fhir:index 1;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "fm@lists.HL7.org" ]     ]
  ];
  fhir:CodeSystem.description [ fhir: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 contracted or non-contracted for the service"];
  fhir:CodeSystem.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ]     ]
  ];
  fhir:CodeSystem.copyright [ fhir:value "This CodeSystem is not copyrighted."];
  fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean];
  fhir:CodeSystem.content [ fhir:value "complete"];
  fhir:CodeSystem.count [ fhir:value "8"^^xsd:nonNegativeInteger];
  fhir:CodeSystem.concept [
     fhir:index 0;
     fhir:CodeSystem.concept.code [ fhir:value "innetwork" ];
     fhir:CodeSystem.concept.display [ fhir:value "In Network" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates the claim or claim line was paid in network.  This does not indicate the contracting status of the provider" ]
  ], [
     fhir:index 1;
     fhir:CodeSystem.concept.code [ fhir:value "outofnetwork" ];
     fhir:CodeSystem.concept.display [ fhir:value "Out Of Network" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates the claim or claim line was paid out of network.  This does not indicate the contracting status of the provider" ]
  ], [
     fhir:index 2;
     fhir:CodeSystem.concept.code [ fhir:value "other" ];
     fhir:CodeSystem.concept.display [ fhir:value "Other" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates other network status or when a network does not apply" ]
  ], [
     fhir:index 3;
     fhir:CodeSystem.concept.code [ fhir:value "contracted" ];
     fhir:CodeSystem.concept.display [ fhir:value "Contracted" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates the provider was contracted for the service" ]
  ], [
     fhir:index 4;
     fhir:CodeSystem.concept.code [ fhir:value "noncontracted" ];
     fhir:CodeSystem.concept.display [ fhir:value "Non-Contracted" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates the provider was not contracted for the service" ]
  ], [
     fhir:index 5;
     fhir:CodeSystem.concept.code [ fhir:value "paid" ];
     fhir:CodeSystem.concept.display [ fhir:value "Paid" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates if the claim was approved for payment" ]
  ], [
     fhir:index 6;
     fhir:CodeSystem.concept.code [ fhir:value "denied" ];
     fhir:CodeSystem.concept.display [ fhir:value "Denied" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates if the claim was denied" ]
  ], [
     fhir:index 7;
     fhir:CodeSystem.concept.code [ fhir:value "partiallypaid" ];
     fhir:CodeSystem.concept.display [ fhir:value "Partially Paid" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Indicates that some line items on the claim were denied" ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.