PDexPayerAdjudicationStatus

PDex Payer Adjudication Status

activeDa Vinci PDex2.1.0complete8 concepts

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

Metadata

hl7.org/fhir

Canonical URL: http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus
ID: PDexPayerAdjudicationStatus
Version: 2.1.0
Publisher: HL7 International / Financial Management
Case Sensitive: No

Concepts (8)

Code	Display	Definition
`innetwork`	In Network	Indicates the claim or claim line was paid in network. This does not indicate the contracting status of the provider
`outofnetwork`	Out Of Network	Indicates the claim or claim line was paid out of network. This does not indicate the contracting status of the provider
`other`	Other	Indicates other network status or when a network does not apply
`contracted`	Contracted	Indicates the provider was contracted for the service
`noncontracted`	Non-Contracted	Indicates the provider was not contracted for the service
`paid`	Paid	Indicates if the claim was approved for payment
`denied`	Denied	Indicates if the claim was denied
`partiallypaid`	Partially Paid	Indicates that some line items on the claim were denied