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  1. FHIR Specification Feedback
  2. FHIR-27009

Define Claim Payment Status Code

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    Details

    • Type: Change Request
    • Status: Published (View Workflow)
    • Priority: Highest
    • Resolution: Persuasive with Modification
    • Specification:
      US CARIN Blue Button (FHIR)
    • Raised in Version:
      0.1
    • Work Group:
      Financial Mgmt
    • Related Page(s):
      (NA)
    • Related Section(s):
      Terminology
    • Grouping:
    • Resolution Description:
      Hide

      Define Value Set:

       

      Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode
      Name: C4BBPayerClaimPaymentStatusCode
      Title: C4BBPayer Claim Payment Status Code
      Definition: Indicates whether the claim was paid, denied or if some of the line items were denied
      Copyright: This Value Set is not copyrighted. 
      Logical Definition: This value set includes codes from the following code system:
      ·       Include paid and denied defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus
      Expansion: This value set contains 3 concepts
      Code Display Definition
      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

      Bind with binding strength Required to the data element payment.type in all four profiles

      The Code System for this Value Set was defined in FHIR-27002

      Show
      Define Value Set:   Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode Name: C4BBPayerClaimPaymentStatusCode Title: C4BBPayer Claim Payment Status Code Definition: Indicates whether the claim was paid, denied or if some of the line items were denied Copyright: This Value Set is not copyrighted.  Logical Definition: This value set includes codes from the following code system: ·       Include paid and denied defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus Expansion: This value set contains 3 concepts Code Display Definition 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 Bind with binding strength Required to the data element payment.type in all four profiles The Code System for this Value Set was defined in FHIR-27002
    • Resolution Vote:
      Pat Taylor/Mark Roberts: 24-0-2
    • Change Category:
      Correction
    • Change Impact:
      Non-substantive

      Description

      Ballot feedback was that the Terminology Section of the IG requires a major overall, renaming the Value Sets and Code Systems and updating links.  Following is a recommended resolution for the categories of a payer's payment status code:

      1)  Define Value Set ClaimPaymentStatusCode

      2)  Title:  Claim Payment Status Code

      3) Description:  Indicates whether the claim was paid or denied.

      4) Value Set:

      http://hl7.org/fhir/us/ValueSet/payer-paymentstatuscode  where values include the following codes from the Code System, payer-adjudication-category:  paid | denied

      7) The Code System is also used to source the following Value Sets: Payer Benefit Payment Status, Payer Provider Contracting Status

      8)  Bind the ValueSet with binding strength required to EOB.payment.type in the Inpatient Institutional, Outpatient Institutional,  Professional and Non-clinician and Pharmacy Profiles

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              Assignee:
              Unassigned Unassigned
              Reporter:
              taylorpatriciab Patricia Taylor
              Request in-person:
              Patricia Taylor
              Watchers:
              1 Start watching this issue

                Dates

                Created:
                Updated:
                Resolved:
                Vote Date: