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 - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "PCTAdjudicationCategoryCS"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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>"
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "fm" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
fhir:v "trial-use" ;
( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
fhir:v "http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct> ] ] ) ]
] ) ; #
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI] ; #
fhir:version [ fhir:v "1.1.0"] ; #
fhir:name [ fhir:v "PCTAdjudicationCategoryCS"] ; #
fhir:title [ fhir:v "PCT Adjudication Category CodeSystem"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v "false"^^xsd:boolean] ; #
fhir:date [ fhir:v "2024-01-03T18:32:02+00:00"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; #
fhir:contact ( [
fhir:name [ fhir:v "HL7 International / Financial Management" ] ;
( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ] ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "fmlists@lists.hl7.org" ] ] )
] ) ; #
fhir:description [ fhir:v "Codes indicating the type of adjudication information provided."] ; #
fhir:jurisdiction ( [
( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ] ] )
] ) ; #
fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; #
fhir:content [ fhir:v "complete"] ; #
fhir:count [ fhir:v "6"^^xsd:nonNegativeInteger] ; #
fhir:concept ( [
fhir:code [ fhir:v "billingnetworkstatus" ] ;
fhir:display [ fhir:v "Billing Network Status" ] ;
fhir:definition [ fhir:v "Indicates the Billing Provider network status in relation to the patient's coverage." ]
] [
fhir:code [ fhir:v "renderingnetworkstatus" ] ;
fhir:display [ fhir:v "Rendering Network Status" ] ;
fhir:definition [ fhir:v "Indicates the Rendering Provider network status in relation to the patient's coverage." ]
] [
fhir:code [ fhir:v "benefitpaymentstatus" ] ;
fhir:display [ fhir:v "Benefit Payment Status" ] ;
fhir:definition [ fhir:v "Indicates the in network or out of network payment status of the claim." ]
] [
fhir:code [ fhir:v "adjustmentreason" ] ;
fhir:display [ fhir:v "Adjustment Reason" ] ;
fhir:definition [ fhir:v "Defines the adjudication slice to identify the adjustment reason" ]
] [
fhir:code [ fhir:v "medicalmanagement" ] ;
fhir:display [ fhir:v "Medical Management" ] ;
fhir:definition [ fhir:v "Defines the adjudication slice to identify medical management" ]
] [
fhir:code [ fhir:v "memberliability" ] ;
fhir:display [ fhir:v "Member Liability" ] ;
fhir:definition [ fhir:v "Defines the adjudication slice to identify member liability" ]
] ) . #
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