HL7.FHIR.US.CARIN-BB\C4BB Adjudication

This page is part of the CARIN Blue Button Implementation Guide (v1.0.0: 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 Adjudication

Summary

Defining URL:

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication

Version:

1.0.0

Name:

C4BBAdjudication

Title:

C4BB Adjudication

Status:

Active as of 2020-11-23T17:26:16+00:00

Definition:

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.

Publisher:

HL7 Financial Management Working Group

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:

C4BBAdjudication

This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication defines the following codes:

Code	Display	Definition
coinsurance	Co-insurance	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%.
noncovered	Noncovered	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.
priorpayerpaid	Prior payer paid	The reduction in the payment amount to reflect the carrier as a secondary payor.
paidbypatient	Paid by patient	The amount paid by the patient at the point of service.
paidtoprovider	Paid to provider	The amount paid to the provider.
paidtopatient	Paid to patient	paid to patient
memberliability	Member liability	The amount of the member's liability.
discount	Discount	The amount of the discount
drugcost	Drug cost	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