Da Vinci Payer Data Exchange
2.1.1 - STU 2.1

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 2.1.1 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: 2.1.1
Standards status: Trial-use | Maturity Level: 2 | 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:

- PDexPayerBenefitPaymentStatus

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

Code | Display | Definition
innetwork | In Network | Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork | Out Of Network | Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other | Other | Indicates other network status or when a network does not apply
contracted | Contracted | Indicates the provider was contracted for the service
noncontracted | Non-Contracted | Indicates the provider was not contracted for the service
paid | Paid | Indicates if the claim was approved for payment
denied | Denied | Indicates if the claim was denied
partiallypaid | Partially Paid | Indicates that some line items on the claim were denied