C4BB Adjudication Category Discriminator Value Set - CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) v2.2.0

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
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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 2.2.0 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

ValueSet: C4BB Adjudication Category Discriminator Value Set

Official URL: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator	Version: 2.2.0	Highlight text changes?
Standards status: Trial-use Active as of 2026-03-03		Computable Name: C4BBAdjudicationCategoryDiscriminator
Copyright/Legal: This Valueset is not copyrighted.

Used as the discriminator for adjudication.category and item.adjudication.category for the CARIN IG for Blue Button®

References

Logical Definition (CLD)

This value set includes codes based on the following rules:

Import all the codes that are contained in C4BB Adjudication Value Set
Include all codes defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator version 📦2.2.0

Expansion

Expansion performed internally based on:

This value set contains 23 concepts

System	Code	Display (en)	Definition	JSON	XML
`http://terminology.hl7.org/CodeSystem/adjudication`	submitted	Submitted Amount	The total submitted amount for the claim or group or line item.
`http://terminology.hl7.org/CodeSystem/adjudication`	copay	CoPay	Patient Co-Payment
`http://terminology.hl7.org/CodeSystem/adjudication`	eligible	Eligible Amount	Amount of the change which is considered for adjudication.
`http://terminology.hl7.org/CodeSystem/adjudication`	deductible	Deductible	Amount deducted from the eligible amount prior to adjudication.
`http://terminology.hl7.org/CodeSystem/adjudication`	benefit	Benefit Amount	Amount payable under the coverage
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	coinsurance	Co-insurance	The 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%.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	noncovered	Noncovered	The 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.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	priorpayerpaid	Prior payer paid	The reduction in the payment amount to reflect the carrier as a secondary payer.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	paidbypatient	Paid by patient	The total amount paid by the patient without specifying the source.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	paidbypatientcash	Paid by patient - cash	The amount paid by the patient using cash, check, or other personal account.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	paidbypatientother	Paid by patient - other	The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	paidbypatienthealthaccount	Paid by patient - health account	The amount paid by the patient using another method like HSA, HRA, FSA or other type of health account.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	paidtopatient	Paid to patient	paid to patient
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	paidtoprovider	Paid to provider	The amount paid to the provider.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	memberliability	Member liability	The amount of the member's liability.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	discount	Discount	The amount of the discount
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication`	drugcost	Drug cost	Price 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
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator`	allowedunits	allowed units	defines the adjudication slice to define allowed units
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator`	adjustmentreason	Adjustment Reason	Defines the adjudication slice to identify the adjustment reason
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator`	rejectreason	Reject Reason	Defines the adjudication slice to identify the reject reason
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator`	billingnetworkstatus	Billing Network Status	Indicates the Billing Provider network status in relation to a patient's coverage as of the effective date of service or admission.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator`	renderingnetworkstatus	Rendering Network Status	Indicates the Rendering Provider network status in relation to a patient's coverage as of the effective date of service or admission.
`http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator`	benefitpaymentstatus	Benefit Payment Status	Indicates the network payment status in relation to a patient's coverage as of the effective date of service or admission.

Description of the above table(s).

IG © 2026+ HL7 International / Financial Management. Package hl7.fhir.us.carin-bb#2.2.0 based on FHIR 4.0.1. Generated 2026-03-03
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