Patient Cost Transparency Implementation Guide
2.0.0 - STU 2 United States of America flag

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0: STU 2) 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

CodeSystem: PCT Adjudication Category CodeSystem

Official URL: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS Version: 2.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTAdjudicationCategoryCS
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.16.3

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.

This Code system is referenced in the content logical definition of the following value sets:

Changes since version 1.1.0:

  • The resource metadata has changed (description)

    • This case-sensitive code system http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS defines the following codes:

    CodeDisplayDefinition
    billingnetworkstatus Billing Network Status Indicates the Billing Provider network status in relation to the patient's coverage.
    renderingnetworkstatus Rendering Network Status Indicates the Rendering Provider network status in relation to the patient's coverage.
    benefitpaymentstatus Benefit Payment Status Indicates the in network or out of network payment status of the claim.
    adjustmentreason Adjustment Reason Defines the adjudication slice to identify the adjustment reason
    medicalmanagement Medical Management Defines the adjudication slice to identify medical management
    memberliability Member Liability Defines the adjudication slice to identify member liability