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FHIR IG Statistics: ValueSet/C4BBAdjudication

Packagehl7.fhir.us.carin-bb
TypeValueSet
IdC4BBAdjudication
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/carin-bb/https://build.fhir.org/ig/HL7/carin-bb/ValueSet-C4BBAdjudication.html
URLhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication
Version2.1.0
Statusactive
Date2025-02-17T19:01:44+00:00
NameC4BBAdjudication
TitleC4BB Adjudication Value Set
Realmus
Authorityhl7
DescriptionDescribes the various amount fields used when payers receive and adjudicate a claim. It includes the values defined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.
CopyrightThis Valueset is not copyrighted.

Resources that use this resource

StructureDefinition
C4BB-ExplanationOfBenefit-Inpatient-InstitutionalC4BB ExplanationOfBenefit Inpatient Institutional
C4BB-ExplanationOfBenefit-OralC4BB ExplanationOfBenefit Oral
C4BB-ExplanationOfBenefit-Outpatient-InstitutionalC4BB ExplanationOfBenefit Outpatient Institutional
C4BB-ExplanationOfBenefit-PharmacyC4BB ExplanationOfBenefit Pharmacy
C4BB-ExplanationOfBenefit-Professional-NonClinicianC4BB ExplanationOfBenefit Professional NonClinician
ValueSet
C4BBAdjudicationCategoryDiscriminatorC4BB Adjudication Category Discriminator Value Set
C4BBTotalCategoryDiscriminatorC4BB Total Category Discriminator Value Set

Resources that this resource uses

CodeSystem
adjudicationAdjudication Value Codes
C4BBAdjudicationC4BB Adjudication Code System
adjudicationAdjudication Value Codes

Narrative

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

Generated Narrative: ValueSet C4BBAdjudication

This value set includes codes based on the following rules:

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/adjudication
    CodeDisplayDefinition
    submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
    copayCoPayPatient Co-Payment
    eligibleEligible AmountAmount of the change which is considered for adjudication.
    deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
    benefitBenefit AmountAmount payable under the coverage
  • Include these codes as defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
    CodeDisplayDefinition
    coinsuranceCoinsuranceThe 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%.
    noncoveredNoncoveredThe 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.
    priorpayerpaidPrior payer paidThe reduction in the payment amount to reflect the carrier as a secondary payer.
    paidbypatientPaid by patientThe total amount paid by the patient without specifying the source.
    paidbypatientcashPaid by patient - cashThe amount paid by the patient using cash, check, or other personal account.
    paidbypatientotherPaid by patient - otherThe amount paid by the patient using a method different than cash (cash, check, or personal account) or health account.
    paidtopatientPaid to patientpaid to patient
    paidtoproviderPaid to providerThe amount paid to the provider.
    memberliabilityMember liabilityThe amount of the member's liability.
    discountDiscountThe amount of the discount
    drugcostDrug 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

Source

{
  "resourceType": "ValueSet",
  "id": "C4BBAdjudication",
  "text": {
    "status": "extensions",
    "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/ValueSet/C4BBAdjudication",
  "version": "2.1.0",
  "name": "C4BBAdjudication",
  "title": "C4BB Adjudication Value Set",
  "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 includes the values \ndefined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "copyright": "This Valueset is not copyrighted.",
  "compose": {
    "include": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
        "concept": [
          {
            "code": "submitted"
          },
          {
            "code": "copay"
          },
          {
            "code": "eligible"
          },
          {
            "code": "deductible"
          },
          {
            "code": "benefit"
          }
        ]
      },
      {
        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
        "concept": [
          {
            "code": "coinsurance",
            "display": "Coinsurance"
          },
          {
            "code": "noncovered",
            "display": "Noncovered"
          },
          {
            "code": "priorpayerpaid",
            "display": "Prior payer paid"
          },
          {
            "code": "paidbypatient",
            "display": "Paid by patient"
          },
          {
            "code": "paidbypatientcash",
            "display": "Paid by patient - cash"
          },
          {
            "code": "paidbypatientother",
            "display": "Paid by patient - other"
          },
          {
            "code": "paidtopatient",
            "display": "Paid to patient"
          },
          {
            "code": "paidtoprovider",
            "display": "Paid to provider"
          },
          {
            "code": "memberliability",
            "display": "Member liability"
          },
          {
            "code": "discount",
            "display": "Discount"
          },
          {
            "code": "drugcost",
            "display": "Drug cost"
          }
        ]
      }
    ]
  }
}