{ "description": "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.", "_filename": "CodeSystem-C4BBAdjudication.json", "package_name": "hl7.fhir.us.carin-bb", "date": "2020-11-23T17:26:16+00:00", "publisher": "HL7 Financial Management Working Group", "jurisdiction": [ { "coding": [ { "code": "US", "system": "urn:iso:std:iso:3166" } ] } ], "content": "complete", "name": "C4BBAdjudication", "copyright": "This CodeSystem is not copyrighted.", "type": null, "experimental": null, "resourceType": "CodeSystem", "title": "C4BB Adjudication", "package_version": "1.0.0", "status": "active", "id": "4b454e33-33e8-4d19-9f25-dddadb7fa8ee", "kind": null, "count": 9, "url": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "concept": [ { "code": "coinsurance", "display": "Co-insurance", "definition": "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%." }, { "code": "noncovered", "display": "Noncovered", "definition": "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." }, { "code": "priorpayerpaid", "display": "Prior payer paid", "definition": "The reduction in the payment amount to reflect the carrier as a secondary payor." }, { "code": "paidbypatient", "display": "Paid by patient", "definition": "The amount paid by the patient at the point of service." }, { "code": "paidtoprovider", "display": "Paid to provider", "definition": "The amount paid to the provider." }, { "code": "paidtopatient", "display": "Paid to patient", "definition": "paid to patient" }, { "code": "memberliability", "display": "Member liability", "definition": "The amount of the member's liability." }, { "code": "discount", "display": "Discount", "definition": "The amount of the discount" }, { "code": "drugcost", "display": "Drug cost", "definition": "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" } ], "version": "1.0.0", "contact": [ { "name": "HL7 Financial Management Working Group", "telecom": [ { "value": "http://www.hl7.org/Special/committees/fm/index.cfm", "system": "url" }, { "value": "fm@lists.HL7.org", "system": "email" } ] } ] }