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

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 Payer Adjudication Status

Summary

Defining URL:

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus

Version:

1.0.0

Name:

C4BBPayerAdjudicationStatus

Title:

C4BB Payer Adjudication Status

Status:

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

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:

Code	Display	Definition
innetwork	In Network	Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork	Out Of Network	Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other	Other	Indicates other network status or when a network does not apply
contracted	Contracted	Indicates the provider was contracted for the service
noncontracted	Non-Contracted	Indicates the provider was not contracted for the service
paid	Paid	Indicates if the claim was approved for payment
denied	Denied	Indicates if the claim was denied
partiallypaid	Partially Paid	Indicates that some line items on the claim were denied