CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.1.0 - STU1 Update

This page is part of the CARIN Blue Button Implementation Guide (v1.1.0: STU 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 Payer Adjudication Status

Summary

Defining URL:http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus
Version:1.1.0
Name:C4BBPayerAdjudicationStatus
Title:C4BB Payer Adjudication Status
Status:Active as of 2021-07-02T17:53:32+00:00
Definition:

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

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/C4BBPayerAdjudicationStatus defines the following codes:

CodeDisplayDefinition
innetwork In NetworkIndicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork Out Of NetworkIndicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other OtherIndicates other network status or when a network does not apply
contracted ContractedIndicates the provider was contracted for the service
noncontracted Non-ContractedIndicates the provider was not contracted for the service
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