haau3 FHIR Implementation Guide (HFIG)
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CodeSystem: Plan Benefits Network Status

Official URL: https://haau3.com/fhir/CodeSystem/plan-benefits-network-status Version: 1.0.0
Active as of 2026-10-14 Computable Name: PlanBenefitsNetworkStatusCS

What the CMS National Provider Directory says about one provider and the networks of one plan, for the plan's year: the status codes of the $in-network operation on InsurancePlan. A directory listing is not a statement of a contract, which is why HL7's applicability codes, defined by a contract with the insurer, are not used.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system https://haau3.com/fhir/CodeSystem/plan-benefits-network-status defines the following codes:

CodeDisplayDefinition
in-network In network The directory lists the provider in a network this plan names, for the plan's year, in a practitioner role or an organization affiliation that names the network. A listing, not a statement that the provider has a contract with the plan.
not-found Not found in the network's listings The directory holds the provider, and none of the networks this plan names lists them. The directory's network data is incomplete, so this never means the provider is out of network.
not-in-directory Not in the directory The directory holds no practitioner or organization with this NPI.
no-network-data No network data The directory holds no network data for this plan in the plan's year, so no provider can be checked against it. The answer's reason says why.