CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue ButtonĀ®) - Local Development build (v0.1.10). See the Directory of published versions
Summary
| Defining URL: | http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication | 
| Version: | 0.1.10 | 
| Name: | C4BBAdjudication | 
| Title: | C4BB Adjudication | 
| Status: | Active as of 2020-11-12T01:33:42+00:00 | 
| Definition: | Describes 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.  | 
| Publisher: | HL7 Financial Management Working Group | 
| Copyright: | This Valueset is not copyrighted.  | 
| Source Resource: | XML / JSON / Turtle | 
References
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/adjudication| Code | Display | Definition | 
| submitted | Submitted Amount | The total submitted amount for the claim or group or line item. | 
| copay | CoPay | Patient Co-Payment | 
| eligible | Eligible Amount | Amount of the change which is considered for adjudication. | 
| deductible | Deductible | Amount deducted from the eligible amount prior to adjudication. | 
| benefit | Benefit Amount | Amount payable under the coverage | 
http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication| Code | Display | Definition | 
| coinsurance | Coinsurance | 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 payor. | 
| paidbypatient | Paid by patient | The amount paid by the patient at the point of service. | 
| paidtopatient | Paid to patient | paid to patient | 
| paidtoprovider | Paid to provider | The amount paid to the provider. | 
| 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 | 
This value set contains 14 concepts
Expansion based on:
| Code | System | Display | Definition | 
| submitted | http://terminology.hl7.org/CodeSystem/adjudication | Submitted Amount | The total submitted amount for the claim or group or line item. | 
| copay | http://terminology.hl7.org/CodeSystem/adjudication | CoPay | Patient Co-Payment | 
| eligible | http://terminology.hl7.org/CodeSystem/adjudication | Eligible Amount | Amount of the change which is considered for adjudication. | 
| deductible | http://terminology.hl7.org/CodeSystem/adjudication | Deductible | Amount deducted from the eligible amount prior to adjudication. | 
| benefit | http://terminology.hl7.org/CodeSystem/adjudication | Benefit Amount | Amount payable under the coverage | 
| coinsurance | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Coinsurance | 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 | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | 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 | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Prior payer paid | The reduction in the payment amount to reflect the carrier as a secondary payor. | 
| paidbypatient | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Paid by patient | The amount paid by the patient at the point of service. | 
| paidtopatient | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Paid to patient | paid to patient | 
| paidtoprovider | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Paid to provider | The amount paid to the provider. | 
| memberliability | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Member liability | The amount of the member's liability. | 
| discount | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | Discount | The amount of the discount | 
| drugcost | http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication | 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 | 
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 |