Da Vinci Payer Data Exchange
2.1.0 - STU2 United States of America flag

Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

CodeSystem: PDex Payer Adjudication Status

Official URL: http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus Version: 2.1.0
Active as of 2024-03-01 Computable Name: PDexPayerAdjudicationStatus

Copyright/Legal: This CodeSystem is not copyrighted.

Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was contracted or non-contracted for the service

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

This case-insensitive code system http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus defines the following codes:

CodeDisplayDefinition
innetwork In NetworkIndicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork Out Of NetworkIndicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other OtherIndicates other network status or when a network does not apply
contracted ContractedIndicates the provider was contracted for the service
noncontracted Non-ContractedIndicates the provider was not contracted for the service
paid PaidIndicates if the claim was approved for payment
denied DeniedIndicates if the claim was denied
partiallypaid Partially PaidIndicates that some line items on the claim were denied