PDex Payer Adjudication Status

{
  "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",
  "date" : "2025-06-18T00:57:14+00:00",
  "publisher" : "HL7 International / Financial Management",
  "jurisdiction" : [ {
    "coding" : [ {
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    } ]
  } ],
  "content" : "complete",
  "property" : null,
  "name" : "PDexPayerAdjudicationStatus",
  "copyright" : "This CodeSystem is not copyrighted.",
  "experimental" : false,
  "resourceType" : "CodeSystem",
  "title" : "PDex Payer Adjudication Status",
  "extension" : [ {
    "valueCode" : "fm",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"
  }, {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 2,
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  }, {
    "valueCode" : "trial-use",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "_valueCode" : {
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    "url" : "http://health-samurai.io/extensions/excised-data"
  }, {
    "url" : "http://health-samurai.io/extensions/source",
    "valueCode" : "db"
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  "status" : "active",
  "id" : "PDexPayerAdjudicationStatus",
  "count" : 8,
  "url" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexPayerAdjudicationStatus",
  "caseSensitive" : false,
  "version" : "2.1.0",
  "contact" : [ {
    "name" : "HL7 International / Financial Management",
    "telecom" : [ {
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/fm"
    }, {
      "system" : "email",
      "value" : "fm@lists.HL7.org"
    } ]
  }, {
    "name" : "Mark Scrimshire (mark.scrimshire@onyxhealth.io)",
    "telecom" : [ {
      "system" : "email",
      "value" : "mailto:mark.scrimshire@onyxhealth.io"
    } ]
  }, {
    "name" : "HL7 International - Financial Management",
    "telecom" : [ {
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/fm"
    } ]
  } ],
  "text" : {
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem PDexPayerAdjudicationStatus</b></p><a name=\"PDexPayerAdjudicationStatus\"> </a><a name=\"hcPDexPayerAdjudicationStatus\"> </a><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>",
    "status" : "generated"
  }
}