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

## : PDex Supporting Info Type - JSON Representation

Page standards status: Trial-use | Maturity Level: 2

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    {
      "resourceType" : "CodeSystem",
      "id" : "PDexSupportingInfoTypeCS",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem PDexSupportingInfoTypeCS</b></p><a name=\"PDexSupportingInfoTypeCS\"> </a><a name=\"hcPDexSupportingInfoTypeCS\"> </a><p>This case-insensitive code system <code>http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexSupportingInfoTypeCS</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\">admissionperiod<a name=\"PDexSupportingInfoTypeCS-admissionperiod\"> </a></td><td>Admission Period</td><td>Dates corresponding with the admission and discharge of the beneficiary to a facility</td></tr><tr><td style=\"white-space:nowrap\">pointoforigin<a name=\"PDexSupportingInfoTypeCS-pointoforigin\"> </a></td><td>Point Of Origin</td><td>UB-04 Source of Admission (FL-15) identifies the place where the patient was identified as needing admission to a facility.</td></tr><tr><td style=\"white-space:nowrap\">admtype<a name=\"PDexSupportingInfoTypeCS-admtype\"> </a></td><td>Admission Type</td><td>UB-04 Priority of the admission (FL-14) indicates, for example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled.</td></tr><tr><td style=\"white-space:nowrap\">billingnetworkcontractingstatus<a name=\"PDexSupportingInfoTypeCS-billingnetworkcontractingstatus\"> </a></td><td>Billing Network Contracting Status</td><td>Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission.</td></tr><tr><td style=\"white-space:nowrap\">brandgenericindicator<a name=\"PDexSupportingInfoTypeCS-brandgenericindicator\"> </a></td><td>Brand Generic Indicator</td><td>NCPDP code indicating whether the plan adjudicated the claim as a brand or generic drug.</td></tr><tr><td style=\"white-space:nowrap\">clmrecvddate<a name=\"PDexSupportingInfoTypeCS-clmrecvddate\"> </a></td><td>Claim Received Date</td><td>Date the claim was received by the payer.</td></tr><tr><td style=\"white-space:nowrap\">compoundcode<a name=\"PDexSupportingInfoTypeCS-compoundcode\"> </a></td><td>Compound Code</td><td>NCPDP code indicating whether or not the prescription is a compound.</td></tr><tr><td style=\"white-space:nowrap\">dawcode<a name=\"PDexSupportingInfoTypeCS-dawcode\"> </a></td><td>DAW (Dispense As Written) Code</td><td>NCPDP code indicating the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication.</td></tr><tr><td style=\"white-space:nowrap\">dayssupply<a name=\"PDexSupportingInfoTypeCS-dayssupply\"> </a></td><td>Days Supply</td><td>NCPDP value indicating the Number of days supply of medication dispensed by the pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">discharge-status<a name=\"PDexSupportingInfoTypeCS-discharge-status\"> </a></td><td>Discharge Status</td><td>UB-04 Discharge Status (FL-17) indicates the patient’s status as of the discharge date for a facility stay.</td></tr><tr><td style=\"white-space:nowrap\">drg<a name=\"PDexSupportingInfoTypeCS-drg\"> </a></td><td>DRG</td><td>DRG (Diagnosis Related Group), including the code system, the DRG version and the code value</td></tr><tr><td style=\"white-space:nowrap\">performingnetworkcontractingstatus<a name=\"PDexSupportingInfoTypeCS-performingnetworkcontractingstatus\"> </a></td><td>Performing Network Contracting Status</td><td>Indicates that the Performing Provider has a contract with the Payer as of the effective date of service or admission.</td></tr><tr><td style=\"white-space:nowrap\">refillnum<a name=\"PDexSupportingInfoTypeCS-refillnum\"> </a></td><td>Refill Number</td><td>NCPDP value indicating the number fill of the current dispensed supply (0, 1, 2, etc.)</td></tr><tr><td style=\"white-space:nowrap\">rxorigincode<a name=\"PDexSupportingInfoTypeCS-rxorigincode\"> </a></td><td>Rx Origin Code</td><td>NCPDP code indicating whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy.</td></tr><tr><td style=\"white-space:nowrap\">servicefacility<a name=\"PDexSupportingInfoTypeCS-servicefacility\"> </a></td><td>Service Facility</td><td>The facility where the service occurred.  Examples include hospitals, nursing homes, laboratories or homeless shelters.</td></tr><tr><td style=\"white-space:nowrap\">typeofbill<a name=\"PDexSupportingInfoTypeCS-typeofbill\"> </a></td><td>Type of Bill</td><td>UB-04 Type of Bill (FL-04) provides specific information for payer purposes.</td></tr><tr><td style=\"white-space:nowrap\">medicalrecordnumber<a name=\"PDexSupportingInfoTypeCS-medicalrecordnumber\"> </a></td><td>Medical Record Number</td><td>Patient Medical Record Number associated with the specific claim.</td></tr><tr><td style=\"white-space:nowrap\">patientaccountnumber<a name=\"PDexSupportingInfoTypeCS-patientaccountnumber\"> </a></td><td>Patient Account Number</td><td>Patient Account Number associated with the specific claim.</td></tr></table></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "fm"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 2,
          "_valueInteger" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "trial-use",
          "_valueCode" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
              }
            ]
          }
        }
      ],
      "url" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexSupportingInfoTypeCS",
      "version" : "2.1.1",
      "name" : "PDexSupportingInfoTypeCS",
      "title" : "PDex Supporting Info Type",
      "status" : "active",
      "experimental" : false,
      "date" : "2025-12-18T03:22:36+00:00",
      "publisher" : "HL7 International / Financial Management",
      "contact" : [
        {
          "name" : "HL7 International / Financial Management",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/fm"
            },
            {
              "system" : "email",
              "value" : "fm@lists.HL7.org"
            }
          ]
        },
        {
          "name" : "Mark Scrimshire (mark.scrimshire@onyxhealth.io)",
          "telecom" : [
            {
              "system" : "email",
              "value" : "mailto:mark.scrimshire@onyxhealth.io"
            }
          ]
        },
        {
          "name" : "HL7 International - Financial Management",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/fm"
            }
          ]
        }
      ],
      "description" : "Claim Information Category - Used as the discriminator for supportingInfo",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "US",
              "display" : "United States of America"
            }
          ]
        }
      ],
      "copyright" : "This CodeSystem is not copyrighted.",
      "caseSensitive" : false,
      "content" : "complete",
      "count" : 18,
      "concept" : [
        {
          "code" : "admissionperiod",
          "display" : "Admission Period",
          "definition" : "Dates corresponding with the admission and discharge of the beneficiary to a facility"
        },
        {
          "code" : "pointoforigin",
          "display" : "Point Of Origin",
          "definition" : "UB-04 Source of Admission (FL-15) identifies the place where the patient was identified as needing admission to a facility."
        },
        {
          "code" : "admtype",
          "display" : "Admission Type",
          "definition" : "UB-04 Priority of the admission (FL-14) indicates, for example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled."
        },
        {
          "code" : "billingnetworkcontractingstatus",
          "display" : "Billing Network Contracting Status",
          "definition" : "Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission."
        },
        {
          "code" : "brandgenericindicator",
          "display" : "Brand Generic Indicator",
          "definition" : "NCPDP code indicating whether the plan adjudicated the claim as a brand or generic drug."
        },
        {
          "code" : "clmrecvddate",
          "display" : "Claim Received Date",
          "definition" : "Date the claim was received by the payer."
        },
        {
          "code" : "compoundcode",
          "display" : "Compound Code",
          "definition" : "NCPDP code indicating whether or not the prescription is a compound."
        },
        {
          "code" : "dawcode",
          "display" : "DAW (Dispense As Written) Code",
          "definition" : "NCPDP code indicating the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication."
        },
        {
          "code" : "dayssupply",
          "display" : "Days Supply",
          "definition" : "NCPDP value indicating the Number of days supply of medication dispensed by the pharmacy."
        },
        {
          "code" : "discharge-status",
          "display" : "Discharge Status",
          "definition" : "UB-04 Discharge Status (FL-17) indicates the patient’s status as of the discharge date for a facility stay."
        },
        {
          "code" : "drg",
          "display" : "DRG",
          "definition" : "DRG (Diagnosis Related Group), including the code system, the DRG version and the code value"
        },
        {
          "code" : "performingnetworkcontractingstatus",
          "display" : "Performing Network Contracting Status",
          "definition" : "Indicates that the Performing Provider has a contract with the Payer as of the effective date of service or admission."
        },
        {
          "code" : "refillnum",
          "display" : "Refill Number",
          "definition" : "NCPDP value indicating the number fill of the current dispensed supply (0, 1, 2, etc.)"
        },
        {
          "code" : "rxorigincode",
          "display" : "Rx Origin Code",
          "definition" : "NCPDP code indicating whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy."
        },
        {
          "code" : "servicefacility",
          "display" : "Service Facility",
          "definition" : "The facility where the service occurred.  Examples include hospitals, nursing homes, laboratories or homeless shelters."
        },
        {
          "code" : "typeofbill",
          "display" : "Type of Bill",
          "definition" : "UB-04 Type of Bill (FL-04) provides specific information for payer purposes."
        },
        {
          "code" : "medicalrecordnumber",
          "display" : "Medical Record Number",
          "definition" : "Patient Medical Record Number associated with the specific claim."
        },
        {
          "code" : "patientaccountnumber",
          "display" : "Patient Account Number",
          "definition" : "Patient Account Number associated with the specific claim."
        }
      ]
    }