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

• Narrative Content
• XML
• JSON

: C4BB Payer Adjudication Status Code System - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "C4BBPayerAdjudicationStatus",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem C4BBPayerAdjudicationStatus</b></p><a name=\"C4BBPayerAdjudicationStatus\"> </a><a name=\"hcC4BBPayerAdjudicationStatus\"> </a><a name=\"C4BBPayerAdjudicationStatus-en-US\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">innetwork<a name=\"C4BBPayerAdjudicationStatus-innetwork\"> </a></td><td>In Network</td><td>Indicates an in network status in relation to a patient's coverage</td></tr><tr><td style=\"white-space:nowrap\">outofnetwork<a name=\"C4BBPayerAdjudicationStatus-outofnetwork\"> </a></td><td>Out Of Network</td><td>Indicates a not in network status in relation to a patient's coverage</td></tr><tr><td style=\"white-space:nowrap\">other<a name=\"C4BBPayerAdjudicationStatus-other\"> </a></td><td>Other</td><td>Indicates other network status or when a network does not apply</td></tr><tr><td style=\"white-space:nowrap\">paid<a name=\"C4BBPayerAdjudicationStatus-paid\"> </a></td><td>Paid</td><td>Indicates if the claim was approved for payment</td></tr><tr><td style=\"white-space:nowrap\">denied<a name=\"C4BBPayerAdjudicationStatus-denied\"> </a></td><td>Denied</td><td>Indicates if the claim was denied</td></tr><tr><td style=\"white-space:nowrap\">partiallypaid<a name=\"C4BBPayerAdjudicationStatus-partiallypaid\"> </a></td><td>Partially Paid</td><td>Indicates that some line items on the claim were denied</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
  "version" : "2.1.0",
  "name" : "C4BBPayerAdjudicationStatus",
  "title" : "C4BB Payer Adjudication Status Code System",
  "status" : "active",
  "experimental" : false,
  "date" : "2024-12-18T23:56:31+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [
    {
      "name" : "HL7 International / Financial Management",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        },
        {
          "system" : "email",
          "value" : "fm@lists.HL7.org"
        }
      ]
    }
  ],
  "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.\n\nThis 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.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "copyright" : "This CodeSystem is not copyrighted.",
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 6,
  "concept" : [
    {
      "code" : "innetwork",
      "display" : "In Network",
      "definition" : "Indicates an in network status in relation to a patient's coverage"
    },
    {
      "code" : "outofnetwork",
      "display" : "Out Of Network",
      "definition" : "Indicates a not in network status in relation to a patient's coverage"
    },
    {
      "code" : "other",
      "display" : "Other",
      "definition" : "Indicates other network status or when a network does not apply"
    },
    {
      "code" : "paid",
      "display" : "Paid",
      "definition" : "Indicates if the claim was approved for payment"
    },
    {
      "code" : "denied",
      "display" : "Denied",
      "definition" : "Indicates if the claim was denied"
    },
    {
      "code" : "partiallypaid",
      "display" : "Partially Paid",
      "definition" : "Indicates that some line items on the claim were denied"
    }
  ]
}