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

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), 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 and changes regularly. See the Directory of published versions

ValueSet: C4BB Total Category Discriminator


Defining URL:
Title:C4BB Total Category Discriminator
Status:Active as of 2020-11-23T16:49:10+00:00

Used as the discriminator for total.category for the CARIN IG for Blue Button®

Publisher:HL7 Financial Management Working Group

This Valueset is not copyrighted.

Source Resource:XML / JSON / Turtle


Logical Definition (CLD)

This value set includes codes based on the following rules:



This value set contains 17 concepts

submitted AmountThe total submitted amount for the claim or group or line item.
copay Co-Payment
eligible AmountAmount of the change which is considered for adjudication.
deductible deducted from the eligible amount prior to adjudication.
benefit AmountAmount payable under the coverage
coinsurance 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 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 payer paidThe reduction in the payment amount to reflect the carrier as a secondary payor.
paidbypatient by patientThe amount paid by the patient at the point of service.
paidtopatient to patientpaid to patient
paidtoprovider to providerThe amount paid to the provider.
memberliability liabilityThe amount of the member's liability.
discount amount of the discount
drugcost 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
innetwork NetworkIndicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork Of NetworkIndicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other other network status or when a network does not apply

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code