{
  "resourceType": "ValueSet",
  "id": "C4BBAdjudication",
  "text": {
    "status": "extensions",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This value set includes codes based on the following rules:</p><ul><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html\"><code>http://terminology.hl7.org/CodeSystem/adjudication</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html#adjudication-submitted\">submitted</a></td><td>Submitted Amount</td><td>The total submitted amount for the claim or group or line item.</td></tr><tr><td><a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html#adjudication-copay\">copay</a></td><td>CoPay</td><td>Patient Co-Payment</td></tr><tr><td><a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html#adjudication-eligible\">eligible</a></td><td>Eligible Amount</td><td>Amount of the change which is considered for adjudication.</td></tr><tr><td><a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html#adjudication-deductible\">deductible</a></td><td>Deductible</td><td>Amount deducted from the eligible amount prior to adjudication.</td></tr><tr><td><a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html#adjudication-benefit\">benefit</a></td><td>Benefit Amount</td><td>Amount payable under the coverage</td></tr></table></li><li>Include these codes as defined in <a href=\"CodeSystem-C4BBAdjudication.html\"><code>http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-coinsurance\">coinsurance</a></td><td>Coinsurance</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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-noncovered\">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><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-priorpayerpaid\">priorpayerpaid</a></td><td>Prior payer paid</td><td>The reduction in the payment amount to reflect the carrier as a secondary payer.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidbypatient\">paidbypatient</a></td><td>Paid by patient</td><td>The total amount paid by the patient without specifying the source.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidbypatientcash\">paidbypatientcash</a></td><td>Paid by patient - cash</td><td>The amount paid by the patient using cash, check, or other personal account.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidbypatientother\">paidbypatientother</a></td><td>Paid by patient - other</td><td>The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidtopatient\">paidtopatient</a></td><td>Paid to patient</td><td>paid to patient</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-paidtoprovider\">paidtoprovider</a></td><td>Paid to provider</td><td>The amount paid to the provider.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-memberliability\">memberliability</a></td><td>Member liability</td><td>The amount of the member's liability.</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-discount\">discount</a></td><td>Discount</td><td>The amount of the discount</td></tr><tr><td><a href=\"CodeSystem-C4BBAdjudication.html#C4BBAdjudication-drugcost\">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></li></ul></div>"
  },
  "url": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication",
  "version": "2.0.0",
  "name": "C4BBAdjudication",
  "title": "C4BB Adjudication Value Set",
  "status": "active",
  "experimental": false,
  "date": "2022-11-28T15:16:46+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"
        },
        {
          "system": "email",
          "value": "fm@lists.HL7.org"
        }
      ]
    }
  ],
  "description": "Describes the various amount fields used when payers receive and adjudicate a claim.  It includes the values \ndefined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "copyright": "This Valueset is not copyrighted.",
  "compose": {
    "include": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
        "concept": [
          {
            "code": "submitted"
          },
          {
            "code": "copay"
          },
          {
            "code": "eligible"
          },
          {
            "code": "deductible"
          },
          {
            "code": "benefit"
          }
        ]
      },
      {
        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
        "concept": [
          {
            "code": "coinsurance",
            "display": "Coinsurance"
          },
          {
            "code": "noncovered",
            "display": "Noncovered"
          },
          {
            "code": "priorpayerpaid",
            "display": "Prior payer paid"
          },
          {
            "code": "paidbypatient",
            "display": "Paid by patient"
          },
          {
            "code": "paidbypatientcash",
            "display": "Paid by patient - cash"
          },
          {
            "code": "paidbypatientother",
            "display": "Paid by patient - other"
          },
          {
            "code": "paidtopatient",
            "display": "Paid to patient"
          },
          {
            "code": "paidtoprovider",
            "display": "Paid to provider"
          },
          {
            "code": "memberliability",
            "display": "Member liability"
          },
          {
            "code": "discount",
            "display": "Discount"
          },
          {
            "code": "drugcost",
            "display": "Drug cost"
          }
        ]
      }
    ]
  }
}