CodeSystem-C4BBPayerAdjudicationStatus

Source

hl7.fhir.us.carin-bb#current:CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) (v4.0.1)

resourceType

CodeSystem

C4BBPayerAdjudicationStatus

canonical

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus

version

2.0.0

status

active

publisher

HL7 Financial Management Working Group

name

C4BBPayerAdjudicationStatus

title

C4BB Payer Adjudication Status Code System

date

2023-08-02T12:35:50+00:00

experimental

false

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 in or not in network for the service. 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 CodeSystem is not copyrighted.

jurisdictions

caseSensitive

true

content

complete

Usages

C4BB Payer Provider Network Status Value Set (system)
C4BB Payer Claim Payment Status Code Value Set (system)
C4BB Payer Benefit Payment Status Value Set (system)

This case-sensitive code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus defines the following codes:

Code	Display	Definition
innetwork	In Network	Indicates an in network status in relation to a patient's coverage
outofnetwork	Out Of Network	Indicates a not in network status in relation to a patient's coverage
other	Other	Indicates other network status or when a network does not apply
paid	Paid	Indicates if the claim was approved for payment
denied	Denied	Indicates if the claim was denied
partiallypaid	Partially Paid	Indicates that some line items on the claim were denied

Produced 08 Sep 2023