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

ValueSet: C4BB Total Category Discriminator Value Set

Official URL: Version: 2.0.0
Active as of 2022-11-28 Computable Name: C4BBTotalCategoryDiscriminator

Copyright/Legal: This Valueset is not copyrighted.

Used as the discriminator for total.category for the CARIN IG for Blue Button®


Logical Definition (CLD)

This value set includes codes based on the following rules:



This value set contains 19 concepts

  submitted Amount

The total submitted amount for the claim or group or line item.


Patient Co-Payment

  eligible Amount

Amount of the change which is considered for adjudication.


Amount deducted from the eligible amount prior to adjudication.

  benefit Amount

Amount payable under the coverage


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%.


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 payer paid

The reduction in the payment amount to reflect the carrier as a secondary payer.

  paidbypatient by patient

The total amount paid by the patient without specifying the source.

  paidbypatientcash by patient - cash

The amount paid by the patient using cash, check, or other personal account.

  paidbypatientother by patient - other

The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.

  paidtopatient to patient

paid to patient

  paidtoprovider to provider

The amount paid to the provider.

  memberliability liability

The amount of the member's liability.


The amount of the discount

  drugcost 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

  innetwork Network

Indicates an in network status in relation to a patient's coverage

  outofnetwork Of Network

Indicates a not in network status in relation to a patient's coverage


Indicates other network status or when a network does not apply

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code