Delete Value Set  CARIN Blue Button Adjudication Amount Category Value Set Delete Value Set CARIN Blue Button Claim Adjudication Category Value Set Delete Value Set CARIN Blue Button Claim Information Category Value Set Delete CARIN Blue Button Claim Information Category Code System   Replace with Value Set:   Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication Name: C4BBAdjudication Title: C4BB Adjudication Definition: Describes the various amount fields used when payers receive and adjudicate a claim Copyright: This Value Set is not copyrighted.  Logical Definition: This value set includes codes from the following code systems: ·       Include submitted, copay, eligible, deductible and benefit defined in http://terminology.hl7.org/CodeSystem/adjudication ·       Include all codes defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication Expansion: This value set contains 14 concepts 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 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 payor. paidbypatient Paid by patient The amount paid by the patient at the point of service. paidtoprovider Paid to provider The amount paid to the provider. paidtopatient Paid to patient The amount paid to the 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   Bind with binding strength Required to the the slice adjudicationamounttype, data element item.adjudication.category, adjudication.category and total.category in the Inpatient Institutional and Outpatient Institutional Profiles Bind with binding strength Required to the slice adjudicationamounttype, data element item.adjudication.category and total.category in the Professional and Non-Clinician Profile Bind with binding strength Required to the slice adjudicationamounttype, data element total.category in the Pharmacy Profile Delete Code System  CARIN-BB-Adjudication-Category Replace with Code System:  (This assumes that HL7 does not include the values in http://terminology.hl7.org/CodeSystem/adjudication as proposed in the attached harmonization of RTPBC and C4BB.)   Defining URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication Name: C4BBAdjudication Title: C4BB Adjudication Definition: Describes the various amount fields used when payers receive and adjudicate a claim.  It complements he values defined in http://terminology.hl7.org/CodeSystem/adjudication .  Copyright: This Code System is not copyrighted.   Content: 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 payor. paidbypatient Paid by patient The amount paid by the patient at the point of service. paidtoprovider Paid to provider The amount paid to the provider. Paidtopatient Paid to patient The amount paid to the 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