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
{
"resourceType" : "CodeSystem",
"id" : "C4BBPayerAdjudicationStatus",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus 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\">innetwork<a name=\"C4BBPayerAdjudicationStatus-innetwork\"> </a></td><td>In Network</td><td>Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">outofnetwork<a name=\"C4BBPayerAdjudicationStatus-outofnetwork\"> </a></td><td>Out Of Network</td><td>Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">other<a name=\"C4BBPayerAdjudicationStatus-other\"> </a></td><td>Other</td><td>Indicates other network status or when a network does not apply</td></tr><tr><td style=\"white-space:nowrap\">contracted<a name=\"C4BBPayerAdjudicationStatus-contracted\"> </a></td><td>Contracted</td><td>Indicates the provider was contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">noncontracted<a name=\"C4BBPayerAdjudicationStatus-noncontracted\"> </a></td><td>Non-Contracted</td><td>Indicates the provider was not contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">paid<a name=\"C4BBPayerAdjudicationStatus-paid\"> </a></td><td>Paid</td><td>Indicates if the claim was approved for payment</td></tr><tr><td style=\"white-space:nowrap\">denied<a name=\"C4BBPayerAdjudicationStatus-denied\"> </a></td><td>Denied</td><td>Indicates if the claim was denied</td></tr><tr><td style=\"white-space:nowrap\">partiallypaid<a name=\"C4BBPayerAdjudicationStatus-partiallypaid\"> </a></td><td>Partially Paid</td><td>Indicates that some line items on the claim were denied</td></tr></table></div>"
},
"url" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
"version" : "1.0.0",
"name" : "C4BBPayerAdjudicationStatus",
"title" : "C4BB Payer Adjudication Status",
"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 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",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"copyright" : "This CodeSystem is not copyrighted.",
"content" : "complete",
"count" : 8,
"concept" : [
{
"code" : "innetwork",
"display" : "In Network",
"definition" : "Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider"
},
{
"code" : "outofnetwork",
"display" : "Out Of Network",
"definition" : "Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider"
},
{
"code" : "other",
"display" : "Other",
"definition" : "Indicates other network status or when a network does not apply"
},
{
"code" : "contracted",
"display" : "Contracted",
"definition" : "Indicates the provider was contracted for the service"
},
{
"code" : "noncontracted",
"display" : "Non-Contracted",
"definition" : "Indicates the provider was not contracted for the service"
},
{
"code" : "paid",
"display" : "Paid",
"definition" : "Indicates if the claim was approved for payment"
},
{
"code" : "denied",
"display" : "Denied",
"definition" : "Indicates if the claim was denied"
},
{
"code" : "partiallypaid",
"display" : "Partially Paid",
"definition" : "Indicates that some line items on the claim were denied"
}
]
}