Patient Cost Transparency Implementation Guide
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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 in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: PCT Adjudication Category CodeSystem - JSON Representation

Page standards status: Trial-use

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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" : "2024-01-03T18:19:28+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"
    }
  ]
}