CodeSystem-C4BBAdjudication

Sourcehl7.fhir.us.carin-bb#current:CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) (v4.0.1)
resourceTypeCodeSystem
idC4BBAdjudication
canonicalhttp://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
version2.0.0
statusactive
publisherHL7 Financial Management Working Group
nameC4BBAdjudication
titleC4BB Adjudication Code System
date2023-08-02T12:35:50+00:00
experimentalfalse
descriptionDescribes 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.
copyrightThis CodeSystem is not copyrighted.
jurisdictionsus
caseSensitivetrue
contentcomplete
Usages

This case-sensitive code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication defines the following codes:

Code Display Definition
coinsurance Co-insurance 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%.
noncovered Noncovered 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 Prior payer paid The reduction in the payment amount to reflect the carrier as a secondary payer.
paidbypatient Paid by patient The total amount paid by the patient without specifying the source.
paidbypatientcash Paid by patient - cash The amount paid by the patient using cash, check, or other personal account.
paidbypatientother Paid by patient - other The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.
paidbypatienthealthaccount Paid by patient - health account The amount paid by the patient using another method like HSA, HRA, FSA or other type of health account.
paidtoprovider Paid to provider The amount paid to the provider.
paidtopatient Paid to patient paid to patient
memberliability Member liability The amount of the member's liability.
discount Discount The amount of the discount
drugcost Drug 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

Produced 08 Sep 2023