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Pricing Exception Code

CLM_PRCNG_EXCPTN_CD

The pricing exception code indicating network status.

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.adjudication.where(
  category.coding.where(
    system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator' and
      code = 'benefitpaymentstatus'
  ).exists()
).reason.coding.where(
  system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus'
).code
Coverage / Claim Type
  • Pharmacy
Source View
V2_MDCR_CLM_LINE_RX
Source Column
CLM_PRCNG_EXCPTN_CD
Sources
  • DDPS
Profiles
  • Basis
  • Regular
  • CMS

Example 

outofnetwork

Mappings

CCW
  • PRCNG_EXCPTN_CD

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