CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1 United States of America flag

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

CodeSystem: C4BB Adjudication Code System

Official URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication Version: 2.1.0
Standards status: Trial-use 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:

Generated Narrative: CodeSystem C4BBAdjudication

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

CodeDisplayDefinition
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