{
  "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",
  "date": "2025-06-18T00:57:14+00:00",
  "publisher": "HL7 International / Financial Management",
  "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": "false",
  "resourceType": "CodeSystem",
  "title": "PDex Payer Adjudication Status",
  "package_version": "pdex-2.1.0",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "fm"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 2,
    "_valueInteger": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical": "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
      } ]
    }
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "trial-use",
    "_valueCode": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical": "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
      } ]
    }
  } ],
  "status": "active",
  "id": "32710a73-dde8-48a6-92b1-53d2245da61c",
  "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": "2.1.0",
  "contact": [ {
    "name": "HL7 International / Financial Management",
    "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"
    } ]
  } ]
}