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 2.2.0 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
: PDex Payer Adjudication Status - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/PDexPayerAdjudicationStatus> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "PDexPayerAdjudicationStatus"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem PDexPayerAdjudicationStatus</b></p><a name=\"PDexPayerAdjudicationStatus\"> </a><a name=\"hcPDexPayerAdjudicationStatus\"> </a><p>This case-insensitive code system <code>http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">innetwork<a name=\"PDexPayerAdjudicationStatus-innetwork\"> </a></td><td>In Network</td><td>Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">outofnetwork<a name=\"PDexPayerAdjudicationStatus-outofnetwork\"> </a></td><td>Out Of Network</td><td>Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">other<a name=\"PDexPayerAdjudicationStatus-other\"> </a></td><td>Other</td><td>Indicates other network status or when a network does not apply</td></tr><tr><td style=\"white-space:nowrap\">contracted<a name=\"PDexPayerAdjudicationStatus-contracted\"> </a></td><td>Contracted</td><td>Indicates the provider was contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">noncontracted<a name=\"PDexPayerAdjudicationStatus-noncontracted\"> </a></td><td>Non-Contracted</td><td>Indicates the provider was not contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">paid<a name=\"PDexPayerAdjudicationStatus-paid\"> </a></td><td>Paid</td><td>Indicates if the claim was approved for payment</td></tr><tr><td style=\"white-space:nowrap\">denied<a name=\"PDexPayerAdjudicationStatus-denied\"> </a></td><td>Denied</td><td>Indicates if the claim was denied</td></tr><tr><td style=\"white-space:nowrap\">partiallypaid<a name=\"PDexPayerAdjudicationStatus-partiallypaid\"> </a></td><td>Partially Paid</td><td>Indicates that some line items on the claim were denied</td></tr></table></div>"
] ;
fhir:DomainResource.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:Extension.valueCode [ fhir:value "fm" ]
], [
fhir:index 1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm" ] ;
fhir:Extension.valueInteger [
fhir:value "2"^^xsd:integer ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
fhir:Extension.valueCanonical [
fhir:value "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex" ;
fhir:link <http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex>
]
]
]
], [
fhir:index 2 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:Extension.valueCode [
fhir:value "trial-use" ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
fhir:Extension.valueCanonical [
fhir:value "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex" ;
fhir:link <http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex>
]
]
]
] ;
fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus"] ;
fhir:CodeSystem.version [ fhir:value "2.2.0"] ;
fhir:CodeSystem.name [ fhir:value "PDexPayerAdjudicationStatus"] ;
fhir:CodeSystem.title [ fhir:value "PDex Payer Adjudication Status"] ;
fhir:CodeSystem.status [ fhir:value "active"] ;
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2026-06-29T15:03:38+00:00"^^xsd:dateTime] ;
fhir:CodeSystem.publisher [ fhir:value "HL7 International / Financial Management"] ;
fhir:CodeSystem.contact [
fhir:index 0 ;
fhir:ContactDetail.name [ fhir:value "HL7 International / Financial Management" ] ;
fhir:ContactDetail.telecom [
fhir:index 0 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/fm" ]
], [
fhir:index 1 ;
fhir:ContactPoint.system [ fhir:value "email" ] ;
fhir:ContactPoint.value [ fhir:value "fm@lists.HL7.org" ]
]
], [
fhir:index 1 ;
fhir:ContactDetail.name [ fhir:value "Mark Scrimshire (mark.scrimshire@onyxhealth.io)" ] ;
fhir:ContactDetail.telecom [
fhir:index 0 ;
fhir:ContactPoint.system [ fhir:value "email" ] ;
fhir:ContactPoint.value [ fhir:value "mailto:mark.scrimshire@onyxhealth.io" ]
]
], [
fhir:index 2 ;
fhir:ContactDetail.name [ fhir:value "HL7 International - Financial Management" ] ;
fhir:ContactDetail.telecom [
fhir:index 0 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/fm" ]
]
] ;
fhir:CodeSystem.description [ fhir:value "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"] ;
fhir:CodeSystem.jurisdiction [
fhir:index 0 ;
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
fhir:Coding.code [ fhir:value "US" ] ;
fhir:Coding.display [ fhir:value "United States of America" ]
]
] ;
fhir:CodeSystem.copyright [ fhir:value "This CodeSystem is not copyrighted."] ;
fhir:CodeSystem.caseSensitive [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.content [ fhir:value "complete"] ;
fhir:CodeSystem.count [ fhir:value "8"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index 0 ;
fhir:CodeSystem.concept.code [ fhir:value "innetwork" ] ;
fhir:CodeSystem.concept.display [ fhir:value "In Network" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider" ]
], [
fhir:index 1 ;
fhir:CodeSystem.concept.code [ fhir:value "outofnetwork" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Out Of Network" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider" ]
], [
fhir:index 2 ;
fhir:CodeSystem.concept.code [ fhir:value "other" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Other" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates other network status or when a network does not apply" ]
], [
fhir:index 3 ;
fhir:CodeSystem.concept.code [ fhir:value "contracted" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Contracted" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates the provider was contracted for the service" ]
], [
fhir:index 4 ;
fhir:CodeSystem.concept.code [ fhir:value "noncontracted" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Non-Contracted" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates the provider was not contracted for the service" ]
], [
fhir:index 5 ;
fhir:CodeSystem.concept.code [ fhir:value "paid" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Paid" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates if the claim was approved for payment" ]
], [
fhir:index 6 ;
fhir:CodeSystem.concept.code [ fhir:value "denied" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Denied" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates if the claim was denied" ]
], [
fhir:index 7 ;
fhir:CodeSystem.concept.code [ fhir:value "partiallypaid" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Partially Paid" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Indicates that some line items on the claim were denied" ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/PDexPayerAdjudicationStatus.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/PDexPayerAdjudicationStatus.ttl> .
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