Da Vinci Payer Data Exchange
2.1.0 - STU2
Da Vinci Payer Data Exchange
2.1.0 - STU2
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
| Page standards status: Trial-use |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="PDexPayerAdjudicationStatus"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><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>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"/>
</extension>
</valueCode>
</extension>
<url
value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus"/>
<version value="2.1.0"/>
<name value="PDexPayerAdjudicationStatus"/>
<title value="PDex Payer Adjudication Status"/>
<status value="active"/>
<experimental value="false"/>
<date value="2024-05-10T16:45:39+00:00"/>
<publisher value="HL7 International / Financial Management"/>
<contact>
<name value="HL7 International / Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fm"/>
</telecom>
<telecom>
<system value="email"/>
<value value="fm@lists.HL7.org"/>
</telecom>
</contact>
<contact>
<name value="Mark Scrimshire (mark.scrimshire@onyxhealth.io)"/>
<telecom>
<system value="email"/>
<value value="mailto:mark.scrimshire@onyxhealth.io"/>
</telecom>
</contact>
<contact>
<name value="HL7 International - Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fm"/>
</telecom>
</contact>
<description
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"/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
<display value="United States of America"/>
</coding>
</jurisdiction>
<copyright value="This CodeSystem is not copyrighted."/>
<caseSensitive value="false"/>
<content value="complete"/>
<count value="8"/>
<concept>
<code value="innetwork"/>
<display value="In Network"/>
<definition
value="Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider"/>
</concept>
<concept>
<code value="outofnetwork"/>
<display value="Out Of Network"/>
<definition
value="Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider"/>
</concept>
<concept>
<code value="other"/>
<display value="Other"/>
<definition
value="Indicates other network status or when a network does not apply"/>
</concept>
<concept>
<code value="contracted"/>
<display value="Contracted"/>
<definition
value="Indicates the provider was contracted for the service"/>
</concept>
<concept>
<code value="noncontracted"/>
<display value="Non-Contracted"/>
<definition
value="Indicates the provider was not contracted for the service"/>
</concept>
<concept>
<code value="paid"/>
<display value="Paid"/>
<definition value="Indicates if the claim was approved for payment"/>
</concept>
<concept>
<code value="denied"/>
<display value="Denied"/>
<definition value="Indicates if the claim was denied"/>
</concept>
<concept>
<code value="partiallypaid"/>
<display value="Partially Paid"/>
<definition
value="Indicates that some line items on the claim were denied"/>
</concept>
</CodeSystem>
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.1.0 based on FHIR 4.0.1. Generated 2024-05-10
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