XIG: CodeSystem/PDexPayerAdjudicationStatus

FHIR IG Statistics: CodeSystem/PDexPayerAdjudicationStatus

Package	hl7.fhir.us.davinci-pdex
Resource Type	CodeSystem
Id	PDexPayerAdjudicationStatus
FHIR Version	R4
Source	http://hl7.org/fhir/us/davinci-pdex/https://build.fhir.org/ig/HL7/davinci-epdx/CodeSystem-PDexPayerAdjudicationStatus.html
URL	http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus
Version	2.1.0
Status	active
Date	2025-06-16T14:46:24+00:00
Name	PDexPayerAdjudicationStatus
Title	PDex Payer Adjudication Status
Realm	us
Authority	hl7
Description	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
Copyright	This CodeSystem is not copyrighted.
Content	complete

Resources that use this resource

ValueSet
PDexPayerBenefitPaymentStatus	PDex Payer Benefit Payment Status

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CodeSystem PDexPayerAdjudicationStatus

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

Source

{
  "resourceType": "CodeSystem",
  "id": "PDexPayerAdjudicationStatus",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "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/PDexPayerAdjudicationStatus",
  "version": "2.1.0",
  "name": "PDexPayerAdjudicationStatus",
  "title": "PDex Payer Adjudication Status",
  "status": "active",
  "experimental": false,
  "date": "2025-06-16T14:46:24+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": "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": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "copyright": "This CodeSystem is not copyrighted.",
  "caseSensitive": false,
  "content": "complete",
  "count": 8,
  "concept": [
    {
      "code": "innetwork",
      "display": "In Network",
      "definition": "Indicates the claim or claim line was paid in network.  This does not indicate the contracting status of the provider"
    },
    {
      "code": "outofnetwork",
      "display": "Out Of Network",
      "definition": "Indicates the claim or claim line was paid out of network.  This does not indicate the contracting status of the provider"
    },
    {
      "code": "other",
      "display": "Other",
      "definition": "Indicates other network status or when a network does not apply"
    },
    {
      "code": "contracted",
      "display": "Contracted",
      "definition": "Indicates the provider was contracted for the service"
    },
    {
      "code": "noncontracted",
      "display": "Non-Contracted",
      "definition": "Indicates the provider was not contracted for the service"
    },
    {
      "code": "paid",
      "display": "Paid",
      "definition": "Indicates if the claim was approved for payment"
    },
    {
      "code": "denied",
      "display": "Denied",
      "definition": "Indicates if the claim was denied"
    },
    {
      "code": "partiallypaid",
      "display": "Partially Paid",
      "definition": "Indicates that some line items on the claim were denied"
    }
  ]
}