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 Payer Adjudication Status - TTL Representation

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

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:CodeSystem ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "PDexPayerAdjudicationStatus"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<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>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "fm"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm>     ] ;
    fhir:value [
    a fhir:Integer ;
    fhir:v 2 ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex>         ]       ] )     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "trial-use" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus>
      ] ; #
      fhir:version [ fhir:v "2.1.1"] ; #
      fhir:name [ fhir:v "PDexPayerAdjudicationStatus"] ; #
      fhir:title [ fhir:v "PDex Payer Adjudication Status"] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:experimental [ fhir:v false] ; #
      fhir:date [ fhir:v "2025-12-18T03:22:36+00:00"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; #
      fhir:contact ( [
    fhir:name [ fhir:v "HL7 International / Financial Management" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "fm@lists.HL7.org" ]     ] )
      ] [
    fhir:name [ fhir:v "Mark Scrimshire (mark.scrimshire@onyxhealth.io)" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "mailto:mark.scrimshire@onyxhealth.io" ]     ] )
      ] [
    fhir:name [ fhir:v "HL7 International - Financial Management" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] )
      ] ) ; #
      fhir:description [ fhir:v "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:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ] ;
    fhir:display [ fhir:v "United States of America" ]     ] )
      ] ) ; #
      fhir:copyright [ fhir:v "This CodeSystem is not copyrighted."] ; #
      fhir:caseSensitive [ fhir:v false] ; #
      fhir:content [ fhir:v "complete"] ; #
      fhir:count [ fhir:v "8"^^xsd:nonNegativeInteger] ; #
      fhir:concept ( [
    fhir:code [ fhir:v "innetwork" ] ;
    fhir:display [ fhir:v "In Network" ] ;
    fhir:definition [ fhir:v "Indicates the claim or claim line was paid in network.  This does not indicate the contracting status of the provider" ]
      ] [
    fhir:code [ fhir:v "outofnetwork" ] ;
    fhir:display [ fhir:v "Out Of Network" ] ;
    fhir:definition [ fhir:v "Indicates the claim or claim line was paid out of network.  This does not indicate the contracting status of the provider" ]
      ] [
    fhir:code [ fhir:v "other" ] ;
    fhir:display [ fhir:v "Other" ] ;
    fhir:definition [ fhir:v "Indicates other network status or when a network does not apply" ]
      ] [
    fhir:code [ fhir:v "contracted" ] ;
    fhir:display [ fhir:v "Contracted" ] ;
    fhir:definition [ fhir:v "Indicates the provider was contracted for the service" ]
      ] [
    fhir:code [ fhir:v "noncontracted" ] ;
    fhir:display [ fhir:v "Non-Contracted" ] ;
    fhir:definition [ fhir:v "Indicates the provider was not contracted for the service" ]
      ] [
    fhir:code [ fhir:v "paid" ] ;
    fhir:display [ fhir:v "Paid" ] ;
    fhir:definition [ fhir:v "Indicates if the claim was approved for payment" ]
      ] [
    fhir:code [ fhir:v "denied" ] ;
    fhir:display [ fhir:v "Denied" ] ;
    fhir:definition [ fhir:v "Indicates if the claim was denied" ]
      ] [
    fhir:code [ fhir:v "partiallypaid" ] ;
    fhir:display [ fhir:v "Partially Paid" ] ;
    fhir:definition [ fhir:v "Indicates that some line items on the claim were denied" ]
      ] ) . #