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Code System: Adjudication

Usage

System URI: https://bluebutton.cms.gov/resources/codesystem/adjudication

Description

This code system includes a selection of Adjudication Value Codes which convey the payers assessment of the item provided in the claim under the terms of the patient’s insurance coverage.

Each code in the system is itself a URL providing additional information about that code. (Example:https://bluebutton.cms.gov/resources/variables/line_nch_pmt_amt/).

Note that adjudications typically have two codings. The first coding comes from the CARIN C4BB IG specified code system (https://terminology.hl7.org/5.1.0/CodeSystem-adjudication.html). The code system described here is supplied as a second coding, providing more granular detail about the adjudication and backwards compatibility with older versions.

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