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 - XML Representation

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

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    <CodeSystem xmlns="http://hl7.org/fhir">
      <id value="PDexPayerAdjudicationStatus"/>
      <text>
        <status value="generated"/>
        <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>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="fm"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
        <valueInteger value="2">
          <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>
        </valueInteger>
      </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="2.1.1"/>
      <name value="PDexPayerAdjudicationStatus"/>
      <title value="PDex Payer Adjudication Status"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2025-12-18T03:22:36+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>