Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

## : PCT Adjudication Category CodeSystem - XML Representation

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

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    <CodeSystem xmlns="http://hl7.org/fhir">
      <id value="PCTAdjudicationCategoryCS"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem PCTAdjudicationCategoryCS</b></p><a name="PCTAdjudicationCategoryCS"> </a><a name="hcPCTAdjudicationCategoryCS"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS</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">billingnetworkstatus<a name="PCTAdjudicationCategoryCS-billingnetworkstatus"> </a></td><td>Billing Network Status</td><td>Indicates the Billing Provider network status in relation to the patient's coverage.</td></tr><tr><td style="white-space:nowrap">renderingnetworkstatus<a name="PCTAdjudicationCategoryCS-renderingnetworkstatus"> </a></td><td>Rendering Network Status</td><td>Indicates the Rendering Provider network status in relation to the patient's coverage.</td></tr><tr><td style="white-space:nowrap">benefitpaymentstatus<a name="PCTAdjudicationCategoryCS-benefitpaymentstatus"> </a></td><td>Benefit Payment Status</td><td>Indicates the in network or out of network payment status of the claim.</td></tr><tr><td style="white-space:nowrap">adjustmentreason<a name="PCTAdjudicationCategoryCS-adjustmentreason"> </a></td><td>Adjustment Reason</td><td>Defines the adjudication slice to identify the adjustment reason</td></tr><tr><td style="white-space:nowrap">medicalmanagement<a name="PCTAdjudicationCategoryCS-medicalmanagement"> </a></td><td>Medical Management</td><td>Defines the adjudication slice to identify medical management</td></tr><tr><td style="white-space:nowrap">memberliability<a name="PCTAdjudicationCategoryCS-memberliability"> </a></td><td>Member Liability</td><td>Defines the adjudication slice to identify member liability</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-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"/>
          </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-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"/>
          </extension>
        </valueCode>
      </extension>
      <url
           value="http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.4.16.3"/>
      </identifier>
      <version value="2.0.1"/>
      <name value="PCTAdjudicationCategoryCS"/>
      <title value="PCT Adjudication Category CodeSystem"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2026-03-26T13:47:00+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="fmlists@lists.hl7.org"/>
        </telecom>
      </contact>
      <description
                   value="Codes indicating the type of adjudication information provided. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions."/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
        </coding>
      </jurisdiction>
      <caseSensitive value="true"/>
      <content value="complete"/>
      <count value="6"/>
      <concept>
        <code value="billingnetworkstatus"/>
        <display value="Billing Network Status"/>
        <definition
                    value="Indicates the Billing Provider network status in relation to the patient's coverage."/>
      </concept>
      <concept>
        <code value="renderingnetworkstatus"/>
        <display value="Rendering Network Status"/>
        <definition
                    value="Indicates the Rendering Provider network status in relation to the patient's coverage."/>
      </concept>
      <concept>
        <code value="benefitpaymentstatus"/>
        <display value="Benefit Payment Status"/>
        <definition
                    value="Indicates the in network or out of network payment status of the claim."/>
      </concept>
      <concept>
        <code value="adjustmentreason"/>
        <display value="Adjustment Reason"/>
        <definition
                    value="Defines the adjudication slice to identify the adjustment reason"/>
      </concept>
      <concept>
        <code value="medicalmanagement"/>
        <display value="Medical Management"/>
        <definition
                    value="Defines the adjudication slice to identify medical management"/>
      </concept>
      <concept>
        <code value="memberliability"/>
        <display value="Member Liability"/>
        <definition
                    value="Defines the adjudication slice to identify member liability"/>
      </concept>
    </CodeSystem>