This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v1.1.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
: PCT Adjudication Category CodeSystem - JSON Representation
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{
"resourceType" : "CodeSystem",
"id" : "PCTAdjudicationCategoryCS",
"text" : {
"status" : "generated",
"div" : "<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>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "fm"
},
{
"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-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS",
"version" : "1.1.0",
"name" : "PCTAdjudicationCategoryCS",
"title" : "PCT Adjudication Category CodeSystem",
"status" : "active",
"experimental" : false,
"date" : "2024-01-03T18:32:02+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" : "fmlists@lists.hl7.org"
}
]
}
],
"description" : "Codes indicating the type of adjudication information provided.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"caseSensitive" : true,
"content" : "complete",
"count" : 6,
"concept" : [
{
"code" : "billingnetworkstatus",
"display" : "Billing Network Status",
"definition" : "Indicates the Billing Provider network status in relation to the patient's coverage."
},
{
"code" : "renderingnetworkstatus",
"display" : "Rendering Network Status",
"definition" : "Indicates the Rendering Provider network status in relation to the patient's coverage."
},
{
"code" : "benefitpaymentstatus",
"display" : "Benefit Payment Status",
"definition" : "Indicates the in network or out of network payment status of the claim."
},
{
"code" : "adjustmentreason",
"display" : "Adjustment Reason",
"definition" : "Defines the adjudication slice to identify the adjustment reason"
},
{
"code" : "medicalmanagement",
"display" : "Medical Management",
"definition" : "Defines the adjudication slice to identify medical management"
},
{
"code" : "memberliability",
"display" : "Member Liability",
"definition" : "Defines the adjudication slice to identify member liability"
}
]
}