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Specification:

US CARIN Blue Button (FHIR)
Raised in Version:

1.2.0
Work Group:

Financial Mgmt
Related Artifact(s):

C4BB Adjudication Discriminator Code System
C4BB Payer Adjudication Status Code System
C4BB Payer Provider Contracting Status [deprecated]
Grouping:
- Block-Vote-8
Resolution Description:

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Make change as requested.

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Make change as requested.
Resolution Vote:
Corey Spears / Mary Kay McDaniel: 9-0-0
Change Category:
Correction
Change Impact:
Non-compatible
Pre Applied:
Yes
Applied for Version:

current

Remove the code in the C4BBPayerBenefitPaymentStatus CodeSystem from the C4BBAdjudicationCategoryDiscriminator ValueSet

Code	Display	Definition
billingnetworkstatus	Billing Network Status	Indicates the Billing Provider network status in relation to a patient's coverage as of the effective date of service or admission.
renderingnetworkstatus	Rendering Network Status	Indicates the Rendering Provider network status in relation to a patient's coverage as of the effective date of service or admission.
benefitpaymentstatus	Benefit Payment Status	Indicates the network payment status in relation to a patient's coverage as of the effective date of service or admission.

Change C4BBPayerProviderContractingStatus ValueSet to C4BBPayerProviderNetworkStatus

Change the codes included to C4BBPayerAdjudicationStatus:
innetwork
outofnetwork

Update the following code definitions in C4BBPayerAdjudicationStatus CodeSystem

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

Remove the following codes from C4BBPayerAdjudicationStatus
contracted
noncontracted

relates to

FHIR-35273 Provide means to declare an in or out of network/coverage status for AEOB

FHIR-34955 Network status in advanced EOB profile