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

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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"/>
  <version value="1.1.0"/>
  <name value="PCTAdjudicationCategoryCS"/>
  <title value="PCT Adjudication Category CodeSystem"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-01-03T18:19:28+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."/>
  <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>