CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.2.0 - STU 2 Ballot
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 
@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:ValueSet;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "C4BBAdjudication"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This value set includes codes based on the following rules:</p><ul><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-adjudication.html\"><code>http://terminology.hl7.org/CodeSystem/adjudication</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-adjudication.html#adjudication-submitted\">submitted</a></td><td>Submitted Amount</td><td>The total submitted amount for the claim or group or line item.</td></tr><tr><td><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-adjudication.html#adjudication-copay\">copay</a></td><td>CoPay</td><td>Patient Co-Payment</td></tr><tr><td><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-adjudication.html#adjudication-eligible\">eligible</a></td><td>Eligible Amount</td><td>Amount of the change which is considered for adjudication.</td></tr><tr><td><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-adjudication.html#adjudication-deductible\">deductible</a></td><td>Deductible</td><td>Amount deducted from the eligible amount prior to adjudication.</td></tr><tr><td><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-adjudication.html#adjudication-benefit\">benefit</a></td><td>Benefit Amount</td><td>Amount payable under the coverage</td></tr></table></li><li>Include these codes as defined in <a href=\"CodeSystem-C4BBAdjudication.html\"><code>http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-coinsurance\">coinsurance</a></td><td>Coinsurance</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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-noncovered\">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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-priorpayerpaid\">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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidbypatient\">paidbypatient</a></td><td>Paid by patient</td><td>The amount paid by the patient.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidbypatientcash\">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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidbypatientother\">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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidtopatient\">paidtopatient</a></td><td>Paid to patient</td><td>paid to patient</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidtoprovider\">paidtoprovider</a></td><td>Paid to provider</td><td>The amount paid to the provider.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-memberliability\">memberliability</a></td><td>Member liability</td><td>The amount of the member's liability.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-discount\">discount</a></td><td>Discount</td><td>The amount of the discount</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-drugcost\">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></li></ul></div>"
];
fhir:ValueSet.url [ fhir:value "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"];
fhir:ValueSet.version [ fhir:value "1.2.0"];
fhir:ValueSet.name [ fhir:value "C4BBAdjudication"];
fhir:ValueSet.title [ fhir:value "C4BB Adjudication"];
fhir:ValueSet.status [ fhir:value "active"];
fhir:ValueSet.date [ fhir:value "2021-12-06T20:26:50+00:00"^^xsd:dateTime];
fhir:ValueSet.publisher [ fhir:value "HL7 Financial Management Working Group"];
fhir:ValueSet.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:ValueSet.description [ fhir:value "Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values \ndefined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem."];
fhir:ValueSet.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:ValueSet.copyright [ fhir:value "This Valueset is not copyrighted."];
fhir:ValueSet.compose [
fhir:ValueSet.compose.include [
fhir:index 0;
fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ];
fhir:ValueSet.compose.include.concept [
fhir:index 0;
fhir:ValueSet.compose.include.concept.code [ fhir:value "submitted" ] ], [
fhir:index 1;
fhir:ValueSet.compose.include.concept.code [ fhir:value "copay" ] ], [
fhir:index 2;
fhir:ValueSet.compose.include.concept.code [ fhir:value "eligible" ] ], [
fhir:index 3;
fhir:ValueSet.compose.include.concept.code [ fhir:value "deductible" ] ], [
fhir:index 4;
fhir:ValueSet.compose.include.concept.code [ fhir:value "benefit" ] ] ], [
fhir:index 1;
fhir:ValueSet.compose.include.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
fhir:ValueSet.compose.include.concept [
fhir:index 0;
fhir:ValueSet.compose.include.concept.code [ fhir:value "coinsurance" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Coinsurance" ] ], [
fhir:index 1;
fhir:ValueSet.compose.include.concept.code [ fhir:value "noncovered" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Noncovered" ] ], [
fhir:index 2;
fhir:ValueSet.compose.include.concept.code [ fhir:value "priorpayerpaid" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Prior payer paid" ] ], [
fhir:index 3;
fhir:ValueSet.compose.include.concept.code [ fhir:value "paidbypatient" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Paid by patient" ] ], [
fhir:index 4;
fhir:ValueSet.compose.include.concept.code [ fhir:value "paidbypatientcash" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Paid by patient - cash" ] ], [
fhir:index 5;
fhir:ValueSet.compose.include.concept.code [ fhir:value "paidbypatientother" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Paid by patient - other" ] ], [
fhir:index 6;
fhir:ValueSet.compose.include.concept.code [ fhir:value "paidtopatient" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Paid to patient" ] ], [
fhir:index 7;
fhir:ValueSet.compose.include.concept.code [ fhir:value "paidtoprovider" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Paid to provider" ] ], [
fhir:index 8;
fhir:ValueSet.compose.include.concept.code [ fhir:value "memberliability" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Member liability" ] ], [
fhir:index 9;
fhir:ValueSet.compose.include.concept.code [ fhir:value "discount" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Discount" ] ], [
fhir:index 10;
fhir:ValueSet.compose.include.concept.code [ fhir:value "drugcost" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Drug cost" ] ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ HL7 Financial Management Working Group. Package hl7.fhir.us.carin-bb#1.2.0 based on FHIR 4.0.1. Generated 2021-12-06
Links: Table of Contents |
QA Report
| Version History |
Search |
|
Propose a change