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 - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="ClaimAdjudicationCategoryCS"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url
       value="http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS"/>
  <version value="0.3.1"/>
  <name value="ClaimAdjudicationCategoryCS"/>
  <title value="Claim Adjudication Category"/>
  <status value="active"/>
  <date value="2020-08-04T02:04:45+00:00"/>
  <publisher value="HL7 Financial Management Working Group"/>
  <contact>
    <name value="HL7 Financial Management Working Group"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm/index.cfm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fm@lists.HL7.org"/>
    </telecom>
  </contact>
  <description
               value="Values for EOB.item.adjudication.category and total.category"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <content value="complete"/>
  <count value="17"/>
  <concept>
    <code value="benefitPaymentStatusCode"/>
    <display value="Benefit payment status code"/>
    <definition value="Benefit payment status code"/>
  </concept>
  <concept>
    <code value="paymentDenialCode"/>
    <display value="Payment denial code"/>
    <definition value="Payment Denial Code"/>
  </concept>
  <concept>
    <code value="submittedamount"/>
    <display value="submitted amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="allowedamount"/>
    <display value="allowed amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="deductibleamount"/>
    <display value="deductible amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="coinsuranceamount"/>
    <display value="coinsurance amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="copayamount"/>
    <display value="copay amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="noncoveredamount"/>
    <display value="noncovered amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="cobamount"/>
    <display value="cob amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="paymentamount"/>
    <display value="payment amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="patientpayamount"/>
    <display value="patient pay amount"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="denialreason"/>
    <display value="payment denial reason"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="innetworkbenefitpaymentstatus"/>
    <display value="in network benefit payment status"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="outofnetworkbenefitpaymentstatus"/>
    <display value="out of network benefit payment status"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="otherbenefitpaymentstatus"/>
    <display value="other benefit payment status"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="allowedunits"/>
    <display value="allowed units"/>
    <definition value="Undefined"/>
  </concept>
  <concept>
    <code value="inoutnetwork"/>
    <display value="In or Out of Network"/>
    <definition value="Undefined"/>
  </concept>
</CodeSystem>