CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.0.0 - STU 2 US

This page is part of the CARIN Blue Button Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

CodeSystem: C4BB Adjudication Code System

Official URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication Version: 2.0.0
Active as of 2022-11-28 Computable Name: C4BBAdjudication

Copyright/Legal: This CodeSystem is not copyrighted.

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.

This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.

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/C4BBAdjudication defines the following codes:

CodeDisplayDefinition
coinsurance Co-insuranceThe 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 NoncoveredThe 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 paidThe reduction in the payment amount to reflect the carrier as a secondary payer.
paidbypatient Paid by patientThe total amount paid by the patient without specifying the source.
paidbypatientcash Paid by patient - cashThe amount paid by the patient using cash, check, or other personal account.
paidbypatientother Paid by patient - otherThe amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.
paidbypatienthealthaccount Paid by patient - health accountThe amount paid by the patient using another method like HSA, HRA, FSA or other type of health account.
paidtoprovider Paid to providerThe amount paid to the provider.
paidtopatient Paid to patientpaid to patient
memberliability Member liabilityThe amount of the member's liability.
discount DiscountThe amount of the discount
drugcost Drug costPrice 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