Valueset c4bb-adjudication-category-discriminator

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

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

innetwork

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus

In Network

Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider

outofnetwork

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus

Out Of Network

Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider

other

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus

Other

Indicates other network status or when a network does not apply

allowedunits

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator

allowed units

defines the adjudication slice to define allowed units

denialreason

http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator

Denial Reason

defines the adjudication slice to identify the denial reason