CodeSystem-PDexPayerAdjudicationStatus

Sourcehl7.fhir.us.davinci-pdex#current:Da Vinci Payer Data Exchange (v4.0.1)
resourceTypeCodeSystem
idPDexPayerAdjudicationStatus
canonicalhttp://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus
version2.0.0
statusdraft
publisherHL7 Financial Management Working Group
namePDexPayerAdjudicationStatus
titlePDex Payer Adjudication Status
date2023-08-14T14:40:10+00:00
experimentaltrue
descriptionDescribes 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
copyrightThis CodeSystem is not copyrighted.
jurisdictionsus
caseSensitivefalse
contentcomplete
Usages

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

Produced 08 Sep 2023