XIG: CodeSystem/C4BBAdjudication

FHIR IG Statistics: CodeSystem/C4BBAdjudication

Package	hl7.fhir.us.carin-bb
Resource Type	CodeSystem
Id	C4BBAdjudication
FHIR Version	R4
Source	http://hl7.org/fhir/us/carin-bb/https://build.fhir.org/ig/HL7/carin-bb/CodeSystem-C4BBAdjudication.html
URL	http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
Version	2.1.0
Status	active
Date	2025-02-17T19:01:44+00:00
Name	C4BBAdjudication
Title	C4BB Adjudication Code System
Realm	us
Authority	hl7
Description	Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.
Copyright	This CodeSystem is not copyrighted.
Content	complete

Resources that use this resource

ValueSet
C4BBAdjudication	C4BB Adjudication Value Set
PDexAdjudication	PDex Adjudication
PDexAdjudicationCategoryDiscriminator	PDex Adjudication Category Discriminator

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CodeSystem C4BBAdjudication

This case-sensitive code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication defines the following codes:

Code	Display	Definition
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%.
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.
priorpayerpaid	Prior payer paid	The reduction in the payment amount to reflect the carrier as a secondary payer.
paidbypatient	Paid by patient	The total amount paid by the patient without specifying the source.
paidbypatientcash	Paid by patient - cash	The amount paid by the patient using cash, check, or other personal account.
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.
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.
paidtoprovider	Paid to provider	The amount paid to the provider.
paidtopatient	Paid to patient	paid to patient
memberliability	Member liability	The amount of the member's liability.
discount	Discount	The amount of the discount
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

Source

{
  "resourceType": "CodeSystem",
  "id": "C4BBAdjudication",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
  "version": "2.1.0",
  "name": "C4BBAdjudication",
  "title": "C4BB Adjudication Code System",
  "status": "active",
  "experimental": false,
  "date": "2025-02-17T19:01:44+00:00",
  "publisher": "HL7 International / Financial Management",
  "contact": [
    {
      "name": "HL7 International / Financial Management",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        },
        {
          "system": "email",
          "value": "fm@lists.HL7.org"
        }
      ]
    }
  ],
  "description": "Describes the various amount fields used when payers receive and adjudicate a claim.  It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "copyright": "This CodeSystem is not copyrighted.",
  "caseSensitive": true,
  "content": "complete",
  "count": 12,
  "concept": [
    {
      "code": "coinsurance",
      "display": "Co-insurance",
      "definition": "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%."
    },
    {
      "code": "noncovered",
      "display": "Noncovered",
      "definition": "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."
    },
    {
      "code": "priorpayerpaid",
      "display": "Prior payer paid",
      "definition": "The reduction in the payment amount to reflect the carrier as a secondary payer."
    },
    {
      "code": "paidbypatient",
      "display": "Paid by patient",
      "definition": "The total amount paid by the patient without specifying the source."
    },
    {
      "code": "paidbypatientcash",
      "display": "Paid by patient - cash",
      "definition": "The amount paid by the patient using cash, check, or other personal account."
    },
    {
      "code": "paidbypatientother",
      "display": "Paid by patient - other",
      "definition": "The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account."
    },
    {
      "code": "paidbypatienthealthaccount",
      "display": "Paid by patient - health account",
      "definition": "The amount paid by the patient using another method like HSA, HRA, FSA or other type of health account."
    },
    {
      "code": "paidtoprovider",
      "display": "Paid to provider",
      "definition": "The amount paid to the provider."
    },
    {
      "code": "paidtopatient",
      "display": "Paid to patient",
      "definition": "paid to patient"
    },
    {
      "code": "memberliability",
      "display": "Member liability",
      "definition": "The amount of the member's liability."
    },
    {
      "code": "discount",
      "display": "Discount",
      "definition": "The amount of the discount"
    },
    {
      "code": "drugcost",
      "display": "Drug cost",
      "definition": "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"
    }
  ]
}