XIG: CodeSystem/C4BBPayerAdjudicationStatus

FHIR IG Statistics: CodeSystem/C4BBPayerAdjudicationStatus

Package	hl7.fhir.us.carin-bb
Type	CodeSystem
Id	C4BBPayerAdjudicationStatus
FHIR Version	R4
Source	http://hl7.org/fhir/us/carin-bb/https://build.fhir.org/ig/HL7/carin-bb/CodeSystem-C4BBPayerAdjudicationStatus.html
URL	http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus
Version	2.1.0
Status	active
Date	2025-02-17T19:01:44+00:00
Name	C4BBPayerAdjudicationStatus
Title	C4BB Payer Adjudication Status Code System
Realm	us
Authority	hl7
Description	Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was in or not in network for the service. 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
C4BBPayerBenefitPaymentStatus	C4BB Payer Benefit Payment Status Value Set
C4BBPayerClaimPaymentStatusCode	C4BB Payer Claim Payment Status Code Value Set
C4BBPayerProviderNetworkStatus	C4BB Payer Provider Network Status Value Set

Resources that this resource uses

No resources found

Narrative

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

Generated Narrative: CodeSystem C4BBPayerAdjudicationStatus

This case-sensitive code system http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus defines the following codes:

Code	Display	Definition
innetwork	In Network	Indicates an in network status in relation to a patient's coverage
outofnetwork	Out Of Network	Indicates a not in network status in relation to a patient's coverage
other	Other	Indicates other network status or when a network does not apply
paid	Paid	Indicates if the claim was approved for payment
denied	Denied	Indicates if the claim was denied
partiallypaid	Partially Paid	Indicates that some line items on the claim were denied

Source

{
  "resourceType": "CodeSystem",
  "id": "C4BBPayerAdjudicationStatus",
  "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/C4BBPayerAdjudicationStatus",
  "version": "2.1.0",
  "name": "C4BBPayerAdjudicationStatus",
  "title": "C4BB Payer Adjudication Status 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 status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was in or not in network for the service.\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": 6,
  "concept": [
    {
      "code": "innetwork",
      "display": "In Network",
      "definition": "Indicates an in network status in relation to a patient's coverage"
    },
    {
      "code": "outofnetwork",
      "display": "Out Of Network",
      "definition": "Indicates a not in network status in relation to a patient's coverage"
    },
    {
      "code": "other",
      "display": "Other",
      "definition": "Indicates other network status or when a network does not apply"
    },
    {
      "code": "paid",
      "display": "Paid",
      "definition": "Indicates if the claim was approved for payment"
    },
    {
      "code": "denied",
      "display": "Denied",
      "definition": "Indicates if the claim was denied"
    },
    {
      "code": "partiallypaid",
      "display": "Partially Paid",
      "definition": "Indicates that some line items on the claim were denied"
    }
  ]
}