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
: PDex Payer Adjudication Status - 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 "PDexPayerAdjudicationStatus"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This case-insensitive code system <code>http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus</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\">innetwork<a name=\"PDexPayerAdjudicationStatus-innetwork\"> </a></td><td>In Network</td><td>Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">outofnetwork<a name=\"PDexPayerAdjudicationStatus-outofnetwork\"> </a></td><td>Out Of Network</td><td>Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider</td></tr><tr><td style=\"white-space:nowrap\">other<a name=\"PDexPayerAdjudicationStatus-other\"> </a></td><td>Other</td><td>Indicates other network status or when a network does not apply</td></tr><tr><td style=\"white-space:nowrap\">contracted<a name=\"PDexPayerAdjudicationStatus-contracted\"> </a></td><td>Contracted</td><td>Indicates the provider was contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">noncontracted<a name=\"PDexPayerAdjudicationStatus-noncontracted\"> </a></td><td>Non-Contracted</td><td>Indicates the provider was not contracted for the service</td></tr><tr><td style=\"white-space:nowrap\">paid<a name=\"PDexPayerAdjudicationStatus-paid\"> </a></td><td>Paid</td><td>Indicates if the claim was approved for payment</td></tr><tr><td style=\"white-space:nowrap\">denied<a name=\"PDexPayerAdjudicationStatus-denied\"> </a></td><td>Denied</td><td>Indicates if the claim was denied</td></tr><tr><td style=\"white-space:nowrap\">partiallypaid<a name=\"PDexPayerAdjudicationStatus-partiallypaid\"> </a></td><td>Partially Paid</td><td>Indicates that some line items on the claim were denied</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/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus"^^xsd:anyURI] ; #
fhir:version [ fhir:v "2.0.0"] ; #
fhir:name [ fhir:v "PDexPayerAdjudicationStatus"] ; #
fhir:title [ fhir:v "PDex Payer Adjudication Status"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v "true"^^xsd:boolean] ; #
fhir:date [ fhir:v "2024-01-06T03:22:26+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 "fm@lists.HL7.org" ] ] )
] [
fhir:name [ fhir:v "Mark Scrimshire (mark.scrimshire@onyxhealth.io)" ] ;
( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "mailto:mark.scrimshire@onyxhealth.io" ] ] )
] [
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:description [ fhir:v "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"] ; #
fhir:jurisdiction ( [
( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ] ;
fhir:display [ fhir:v "United States of America" ] ] )
] ) ; #
fhir:copyright [ fhir:v "This CodeSystem is not copyrighted."] ; #
fhir:caseSensitive [ fhir:v "false"^^xsd:boolean] ; #
fhir:content [ fhir:v "complete"] ; #
fhir:count [ fhir:v "8"^^xsd:nonNegativeInteger] ; #
fhir:concept ( [
fhir:code [ fhir:v "innetwork" ] ;
fhir:display [ fhir:v "In Network" ] ;
fhir:definition [ fhir:v "Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider" ]
] [
fhir:code [ fhir:v "outofnetwork" ] ;
fhir:display [ fhir:v "Out Of Network" ] ;
fhir:definition [ fhir:v "Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider" ]
] [
fhir:code [ fhir:v "other" ] ;
fhir:display [ fhir:v "Other" ] ;
fhir:definition [ fhir:v "Indicates other network status or when a network does not apply" ]
] [
fhir:code [ fhir:v "contracted" ] ;
fhir:display [ fhir:v "Contracted" ] ;
fhir:definition [ fhir:v "Indicates the provider was contracted for the service" ]
] [
fhir:code [ fhir:v "noncontracted" ] ;
fhir:display [ fhir:v "Non-Contracted" ] ;
fhir:definition [ fhir:v "Indicates the provider was not contracted for the service" ]
] [
fhir:code [ fhir:v "paid" ] ;
fhir:display [ fhir:v "Paid" ] ;
fhir:definition [ fhir:v "Indicates if the claim was approved for payment" ]
] [
fhir:code [ fhir:v "denied" ] ;
fhir:display [ fhir:v "Denied" ] ;
fhir:definition [ fhir:v "Indicates if the claim was denied" ]
] [
fhir:code [ fhir:v "partiallypaid" ] ;
fhir:display [ fhir:v "Partially Paid" ] ;
fhir:definition [ fhir:v "Indicates that some line items on the claim were denied" ]
] ) . #
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