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

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

: C4BB Adjudication - JSON Representation

Raw json | Download


{
  "resourceType" : "CodeSystem",
  "id" : "C4BBAdjudication",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication 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\">coinsurance<a name=\"C4BBAdjudication-coinsurance\"> </a></td><td>Co-insurance</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 style=\"white-space:nowrap\">noncovered<a name=\"C4BBAdjudication-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 style=\"white-space:nowrap\">priorpayerpaid<a name=\"C4BBAdjudication-priorpayerpaid\"> </a></td><td>Prior payer paid</td><td>The reduction in the payment amount to reflect the carrier as a secondary payor.</td></tr><tr><td style=\"white-space:nowrap\">paidbypatient<a name=\"C4BBAdjudication-paidbypatient\"> </a></td><td>Paid by patient</td><td>The amount paid by the patient at the point of service.</td></tr><tr><td style=\"white-space:nowrap\">paidtoprovider<a name=\"C4BBAdjudication-paidtoprovider\"> </a></td><td>Paid to provider</td><td>The amount paid to the provider.</td></tr><tr><td style=\"white-space:nowrap\">paidtopatient<a name=\"C4BBAdjudication-paidtopatient\"> </a></td><td>Paid to patient</td><td>paid to patient</td></tr><tr><td style=\"white-space:nowrap\">memberliability<a name=\"C4BBAdjudication-memberliability\"> </a></td><td>Member liability</td><td>The amount of the member's liability.</td></tr><tr><td style=\"white-space:nowrap\">discount<a name=\"C4BBAdjudication-discount\"> </a></td><td>Discount</td><td>The amount of the discount</td></tr><tr><td style=\"white-space:nowrap\">drugcost<a name=\"C4BBAdjudication-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></div>"
  },
  "url" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
  "version" : "1.0.0",
  "name" : "C4BBAdjudication",
  "title" : "C4BB Adjudication",
  "status" : "active",
  "date" : "2020-11-23T17:26:16+00:00",
  "publisher" : "HL7 Financial Management Working Group",
  "contact" : [
    {
      "name" : "HL7 Financial Management Working Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm/index.cfm"
        },
        {
          "system" : "email",
          "value" : "fm@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "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.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "copyright" : "This CodeSystem is not copyrighted.",
  "content" : "complete",
  "count" : 9,
  "concept" : [
    {
      "code" : "coinsurance",
      "display" : "Co-insurance",
      "definition" : "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%."
    },
    {
      "code" : "noncovered",
      "display" : "Noncovered",
      "definition" : "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."
    },
    {
      "code" : "priorpayerpaid",
      "display" : "Prior payer paid",
      "definition" : "The reduction in the payment amount to reflect the carrier as a secondary payor."
    },
    {
      "code" : "paidbypatient",
      "display" : "Paid by patient",
      "definition" : "The amount paid by the patient at the point of service."
    },
    {
      "code" : "paidtoprovider",
      "display" : "Paid to provider",
      "definition" : "The amount paid to the provider."
    },
    {
      "code" : "paidtopatient",
      "display" : "Paid to patient",
      "definition" : "paid to patient"
    },
    {
      "code" : "memberliability",
      "display" : "Member liability",
      "definition" : "The amount of the member's liability."
    },
    {
      "code" : "discount",
      "display" : "Discount",
      "definition" : "The amount of the discount"
    },
    {
      "code" : "drugcost",
      "display" : "Drug cost",
      "definition" : "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"
    }
  ]
}