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Type:
Change Request
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Resolution: Persuasive with Modification
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Priority:
Highest
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US CARIN Blue Button (FHIR)
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0.1 [deprecated]
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Financial Mgmt
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(NA)
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Terminology
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Mark Roberts/Pat Taylor: 10-0-2
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Correction
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Compatible, substantive
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 Adjudication Denial Reasons:
1) Delete Value Set CARINBBAdjudicationDenialReason
2) Define X12CARCCMSRARC
3) Title: X12-CARC-CMS-RARC
4) Description: The Value Set is a combination of two Code Systems: X12 Claim Adjustment Reason Codes (CARC) and CMS Remittance Advice Remark Codes (RARC)
5) Value Set: http://hl7.org/fhir/us/ValueSet/x12-carc–cms-rarc
6) Code System URIs:
CARC codes are available at https://nex12.org/index.php/codes/11-claim-adjustment-reason-codes
RARC codes are available at https://nex12.org/index.php/codes/12-remittance-advice-remark-codes
7) Code System Definition:
CARC codes are owned, maintained and distributed by X12. Use of X12 codes require licenses.
RARC codes are owned by CMS and are available for use.
8) Bind the ValueSet with binding strength required to adjudication.reason, item.adjudication in the Inpatient Facility and Outpatient Facility Profiles
9) Bind the ValueSet with binding strength required to item.adjudication in the Professional and Non-Clinician and Pharmacy Profiles
- relates to
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FHIR-26715 Define Claim Adjustment Reason Codes (CARC) as an External Code System
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- Published
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FHIR-29650 Update External Code Systems and Value Sets per HTA and UTG definitions
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- Published
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FHIR-26706 The Terminology Section of the IG requires a major overhaul, renaming the Value Sets and Code Systems and updating links
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- Published
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FHIR-26716 Define Remittance Advice Remark Codes (RARC) as an External Code System
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- Published
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