This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

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: PCT Adjudication Category CodeSystem - XML Representation

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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>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-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="2.0.0-ballot"/>
  <name value="PCTAdjudicationCategoryCS"/>
  <title value="PCT Adjudication Category CodeSystem"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-04-08T16:53:34+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>