C4BBAdjudication

C4BB Adjudication Code System

activeCARIN Blue Button2.2.0complete12 concepts

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.

Metadata

hl7.org/fhir

Canonical URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication
ID: C4BBAdjudication
Version: 2.2.0
Publisher: HL7 International / Financial Management
Case Sensitive: Yes

Concepts (12)

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