CARIN Consumer Directed Payer Data Exchange
0.3.1 - 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 0.3.1). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

: Claim Adjudication Category - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "ClaimAdjudicationCategoryCS",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS 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\">benefitPaymentStatusCode<a name=\"ClaimAdjudicationCategoryCS-benefitPaymentStatusCode\"> </a></td><td>Benefit payment status code</td><td>Benefit payment status code</td></tr><tr><td style=\"white-space:nowrap\">paymentDenialCode<a name=\"ClaimAdjudicationCategoryCS-paymentDenialCode\"> </a></td><td>Payment denial code</td><td>Payment Denial Code</td></tr><tr><td style=\"white-space:nowrap\">submittedamount<a name=\"ClaimAdjudicationCategoryCS-submittedamount\"> </a></td><td>submitted amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">allowedamount<a name=\"ClaimAdjudicationCategoryCS-allowedamount\"> </a></td><td>allowed amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">deductibleamount<a name=\"ClaimAdjudicationCategoryCS-deductibleamount\"> </a></td><td>deductible amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">coinsuranceamount<a name=\"ClaimAdjudicationCategoryCS-coinsuranceamount\"> </a></td><td>coinsurance amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">copayamount<a name=\"ClaimAdjudicationCategoryCS-copayamount\"> </a></td><td>copay amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">noncoveredamount<a name=\"ClaimAdjudicationCategoryCS-noncoveredamount\"> </a></td><td>noncovered amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">cobamount<a name=\"ClaimAdjudicationCategoryCS-cobamount\"> </a></td><td>cob amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">paymentamount<a name=\"ClaimAdjudicationCategoryCS-paymentamount\"> </a></td><td>payment amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">patientpayamount<a name=\"ClaimAdjudicationCategoryCS-patientpayamount\"> </a></td><td>patient pay amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">denialreason<a name=\"ClaimAdjudicationCategoryCS-denialreason\"> </a></td><td>payment denial reason</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">innetworkbenefitpaymentstatus<a name=\"ClaimAdjudicationCategoryCS-innetworkbenefitpaymentstatus\"> </a></td><td>in network benefit payment status</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">outofnetworkbenefitpaymentstatus<a name=\"ClaimAdjudicationCategoryCS-outofnetworkbenefitpaymentstatus\"> </a></td><td>out of network benefit payment status</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">otherbenefitpaymentstatus<a name=\"ClaimAdjudicationCategoryCS-otherbenefitpaymentstatus\"> </a></td><td>other benefit payment status</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">allowedunits<a name=\"ClaimAdjudicationCategoryCS-allowedunits\"> </a></td><td>allowed units</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">inoutnetwork<a name=\"ClaimAdjudicationCategoryCS-inoutnetwork\"> </a></td><td>In or Out of Network</td><td>Undefined</td></tr></table></div>"
  },
  "url" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS",
  "version" : "0.3.1",
  "name" : "ClaimAdjudicationCategoryCS",
  "title" : "Claim Adjudication Category",
  "status" : "active",
  "date" : "2020-08-04T02:04:45+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" : "Values for EOB.item.adjudication.category and total.category",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "content" : "complete",
  "count" : 17,
  "concept" : [
    {
      "code" : "benefitPaymentStatusCode",
      "display" : "Benefit payment status code",
      "definition" : "Benefit payment status code"
    },
    {
      "code" : "paymentDenialCode",
      "display" : "Payment denial code",
      "definition" : "Payment Denial Code"
    },
    {
      "code" : "submittedamount",
      "display" : "submitted amount",
      "definition" : "Undefined"
    },
    {
      "code" : "allowedamount",
      "display" : "allowed amount",
      "definition" : "Undefined"
    },
    {
      "code" : "deductibleamount",
      "display" : "deductible amount",
      "definition" : "Undefined"
    },
    {
      "code" : "coinsuranceamount",
      "display" : "coinsurance amount",
      "definition" : "Undefined"
    },
    {
      "code" : "copayamount",
      "display" : "copay amount",
      "definition" : "Undefined"
    },
    {
      "code" : "noncoveredamount",
      "display" : "noncovered amount",
      "definition" : "Undefined"
    },
    {
      "code" : "cobamount",
      "display" : "cob amount",
      "definition" : "Undefined"
    },
    {
      "code" : "paymentamount",
      "display" : "payment amount",
      "definition" : "Undefined"
    },
    {
      "code" : "patientpayamount",
      "display" : "patient pay amount",
      "definition" : "Undefined"
    },
    {
      "code" : "denialreason",
      "display" : "payment denial reason",
      "definition" : "Undefined"
    },
    {
      "code" : "innetworkbenefitpaymentstatus",
      "display" : "in network benefit payment status",
      "definition" : "Undefined"
    },
    {
      "code" : "outofnetworkbenefitpaymentstatus",
      "display" : "out of network benefit payment status",
      "definition" : "Undefined"
    },
    {
      "code" : "otherbenefitpaymentstatus",
      "display" : "other benefit payment status",
      "definition" : "Undefined"
    },
    {
      "code" : "allowedunits",
      "display" : "allowed units",
      "definition" : "Undefined"
    },
    {
      "code" : "inoutnetwork",
      "display" : "In or Out of Network",
      "definition" : "Undefined"
    }
  ]
}