Da Vinci Payer Data Exchange
2.0.0 - STU2 United States of America flag

This page is part of the Da Vinci Payer Data Exchange (v2.0.0: STU2) 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

CodeSystem: PDex Payer Adjudication Status (Experimental)

Official URL: http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus Version: 2.0.0
Active as of 2024-01-06 Computable Name: PDexPayerAdjudicationStatus

Copyright/Legal: This CodeSystem is not copyrighted.

Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was contracted or non-contracted for the service

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

This case-insensitive code system http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus defines the following codes:

CodeDisplayDefinition
innetwork In NetworkIndicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetwork Out Of NetworkIndicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
other OtherIndicates other network status or when a network does not apply
contracted ContractedIndicates the provider was contracted for the service
noncontracted Non-ContractedIndicates the provider was not contracted for the service
paid PaidIndicates if the claim was approved for payment
denied DeniedIndicates if the claim was denied
partiallypaid Partially PaidIndicates that some line items on the claim were denied