Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

CodeSystem: PCT Adjudication Category CodeSystem

Official URL: Version: 2.0.0-ballot
Standards status: Trial-use Computable Name: PCTAdjudicationCategoryCS
Other Identifiers: OID:2.16.840.1.113883.4.642.

Codes indicating the type of adjudication information provided. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions.

This Code system is referenced in the content logical definition of the following value sets:

Generated Narrative: CodeSystem PCTAdjudicationCategoryCS

This case-sensitive code system defines the following codes:

billingnetworkstatus Billing Network Status Indicates the Billing Provider network status in relation to the patient's coverage.
renderingnetworkstatus Rendering Network Status Indicates the Rendering Provider network status in relation to the patient's coverage.
benefitpaymentstatus Benefit Payment Status Indicates the in network or out of network payment status of the claim.
adjustmentreason Adjustment Reason Defines the adjudication slice to identify the adjustment reason
medicalmanagement Medical Management Defines the adjudication slice to identify medical management
memberliability Member Liability Defines the adjudication slice to identify member liability