CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue ButtonĀ®)
1.0.0 - STU1

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue ButtonĀ®), published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

: C4BB Payer Adjudication Status - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "C4BBPayerAdjudicationStatus",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus 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 the claim or claim line was paid in network.  This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">outofnetwork<a name=\"C4BBPayerAdjudicationStatus-outofnetwork\"> </a></td><td>Out Of Network</td><td>Indicates the claim or claim line was paid out of network.  This does not indicate the contracting status of the provider</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\">contracted<a name=\"C4BBPayerAdjudicationStatus-contracted\"> </a></td><td>Contracted</td><td>Indicates the provider was contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">noncontracted<a name=\"C4BBPayerAdjudicationStatus-noncontracted\"> </a></td><td>Non-Contracted</td><td>Indicates the provider was not contracted for the service</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>"
  },
  "url" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
  "version" : "1.0.0",
  "name" : "C4BBPayerAdjudicationStatus",
  "title" : "C4BB Payer Adjudication Status",
  "status" : "active",
  "date" : "2020-11-23T16:49:10+00:00",
  "publisher" : "HL7 Financial Management Working Group",
  "contact" : [
    {
      "name" : "HL7 Financial Management Working Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm/index.cfm"
        },
        {
          "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 contracted or non-contracted for the service",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "copyright" : "This CodeSystem is not copyrighted.",
  "content" : "complete",
  "count" : 8,
  "concept" : [
    {
      "code" : "innetwork",
      "display" : "In Network",
      "definition" : "Indicates the claim or claim line was paid in network.  This does not indicate the contracting status of the provider"
    },
    {
      "code" : "outofnetwork",
      "display" : "Out Of Network",
      "definition" : "Indicates the claim or claim line was paid out of network.  This does not indicate the contracting status of the provider"
    },
    {
      "code" : "other",
      "display" : "Other",
      "definition" : "Indicates other network status or when a network does not apply"
    },
    {
      "code" : "contracted",
      "display" : "Contracted",
      "definition" : "Indicates the provider was contracted for the service"
    },
    {
      "code" : "noncontracted",
      "display" : "Non-Contracted",
      "definition" : "Indicates the provider was not contracted for the service"
    },
    {
      "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"
    }
  ]
}