C4BBPayerAdjudicationStatus

C4BB Payer Adjudication Status Code System

activeCARIN Blue Button2.2.0complete6 concepts

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.

Metadata

hl7.org/fhir

Canonical URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus
ID: C4BBPayerAdjudicationStatus
Version: 2.2.0
Publisher: HL7 International / Financial Management
Case Sensitive: Yes

Concepts (6)

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