Da Vinci Payer Data Exchange
2.0.0-ballot - ballot US

This page is part of the Da Vinci Payer Data Exchange (v2.0.0-ballot: STU2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

ValueSet: PDex Payer Benefit Payment Status

Official URL: http://hl7.org/fhir/us/davinci-pdex/ValueSet/PDexPayerBenefitPaymentStatus Version: 2.0.0-ballot
Active as of 2022-02-18 Computable Name: PDexPayerBenefitPaymentStatus

Copyright/Legal: This Valueset is not copyrighted.

Indicates the in network or out of network payment status of the claim.

References

Logical Definition (CLD)

 

Expansion

This value set contains 3 concepts

Expansion based on PDex Payer Adjudication Status v2.0.0-ballot (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus

CodeDisplayDefinition
innetworkIn NetworkIndicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
outofnetworkOut Of NetworkIndicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
otherOtherIndicates other network status or when a network does not apply

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code