CARIN Consumer Directed Payer Data Exchange
0.1.3 - STU1

CARIN Consumer Directed Payer Data Exchange, published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 0.1.3). 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

Summary

Defining URL:http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
Version:0.1.3
Name:C4BBAdjudication ("C4BB Adjudication")
Status:Active as of 2020-09-27T22:31:09+00:00
Definition:

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.

Publisher:HL7 Financial Management Working Group
Copyright:

This CodeSystem is not copyrighted.

Content:Complete: All the concepts defined by the code system are included in the code system resource
Source Resource:XML / JSON / Turtle

This Code system is referenced in the content logical definition of the following value sets:

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

CodeDisplayDefinition
coinsurance Co-insuranceThe 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 NoncoveredThe 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 paidThe reduction in the payment amount to reflect the carrier as a secondary payor.
paidbypatient Paid by patientThe amount paid by the patient at the point of service.
paidtoprovider Paid to providerThe amount paid to the provider.
paidtopatient Paid to patientpaid to patient
memberliability Member liabilityThe amount of the member's liability.
discount DiscountThe amount of the discount
drugcost Drug costPrice 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
paid Paidpaid
denied Denieddenied
innetwork In-networkin-network
outofnetwork Out-of-networkout-of-network
other Otherother