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FHIR IG Statistics: CodeSystem/PDexPayerAdjudicationStatus

Packagehl7.fhir.us.davinci-pdex
TypeCodeSystem
IdPDexPayerAdjudicationStatus
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-pdex/https://build.fhir.org/ig/HL7/davinci-epdx/CodeSystem-PDexPayerAdjudicationStatus.html
URLhttp://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus
Version2.1.0
Statusactive
Date2025-06-16T14:46:24+00:00
NamePDexPayerAdjudicationStatus
TitlePDex Payer Adjudication Status
Realmus
Authorityhl7
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.
Contentcomplete

Resources that use this resource

ValueSet
PDexPayerBenefitPaymentStatusPDex 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:

CodeDisplayDefinition
innetwork In NetworkIndicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork Out Of NetworkIndicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other OtherIndicates other network status or when a network does not apply
contracted ContractedIndicates the provider was contracted for the service
noncontracted Non-ContractedIndicates the provider was not contracted for the service
paid PaidIndicates if the claim was approved for payment
denied DeniedIndicates if the claim was denied
partiallypaid Partially PaidIndicates 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"
    }
  ]
}