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

This page is part of the CARIN Blue Button Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

CodeSystem: C4BB Payer Adjudication Status Code System

Official URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus Version: 2.0.0
Active as of 2022-11-28 Computable Name: C4BBPayerAdjudicationStatus

Copyright/Legal: This CodeSystem is not copyrighted.

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.

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/C4BBPayerAdjudicationStatus defines the following codes:

CodeDisplayDefinition
innetwork In NetworkIndicates an in network status in relation to a patient's coverage
outofnetwork Out Of NetworkIndicates a not in network status in relation to a patient's coverage
other OtherIndicates other network status or when a network does not apply
paid PaidIndicates if the claim was approved for payment
denied DeniedIndicates if the claim was denied
partiallypaid Partially PaidIndicates that some line items on the claim were denied