{ "description": "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", "_filename": "CodeSystem-PDexPayerAdjudicationStatus.json", "package_name": "hl7.fhir.us.davinci-pdex", "date": "2022-02-18T14:02:32+00:00", "publisher": "HL7 Financial Management Working Group", "jurisdiction": [ { "coding": [ { "code": "US", "system": "urn:iso:std:iso:3166", "display": "United States of America" } ] } ], "content": "complete", "name": "PDexPayerAdjudicationStatus", "copyright": "This CodeSystem is not copyrighted.", "type": null, "experimental": null, "resourceType": "CodeSystem", "title": "PDex Payer Adjudication Status", "package_version": "2.0.0-ballot", "status": "active", "id": "2c15040c-a37b-47fb-ab6a-49252e9895fd", "kind": null, "count": 8, "url": "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus", "concept": [ { "code": "innetwork", "display": "In Network", "definition": "Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider" }, { "code": "outofnetwork", "display": "Out Of Network", "definition": "Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider" }, { "code": "other", "display": "Other", "definition": "Indicates other network status or when a network does not apply" }, { "code": "contracted", "display": "Contracted", "definition": "Indicates the provider was contracted for the service" }, { "code": "noncontracted", "display": "Non-Contracted", "definition": "Indicates the provider was not contracted for the service" }, { "code": "paid", "display": "Paid", "definition": "Indicates if the claim was approved for payment" }, { "code": "denied", "display": "Denied", "definition": "Indicates if the claim was denied" }, { "code": "partiallypaid", "display": "Partially Paid", "definition": "Indicates that some line items on the claim were denied" } ], "caseSensitive": false, "version": "2.0.0-ballot", "contact": [ { "name": "HL7 Financial Management Working Group", "telecom": [ { "value": "http://www.hl7.org/Special/committees/fm", "system": "url" }, { "value": "fm@lists.HL7.org", "system": "email" } ] }, { "name": "Mark Scrimshire (mark.scrimshire@onyxhealth.io)", "telecom": [ { "value": "mailto:mark.scrimshire@onyxhealth.io", "system": "email" } ] }, { "name": "HL7 International - Financial Management", "telecom": [ { "value": "http://www.hl7.org/Special/committees/fm", "system": "url" } ] } ] }