Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: R5 Ballot - see ballot notes). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

4.3.2.241 CodeSystem http://hl7.org/fhir/claim-decision

Financial Management icon

Work Group

Maturity Level: 0

Informative

Use Context: Any

This is a code system defined by the FHIR project.

Summary

Defining URL: http://hl7.org/fhir/claim-decision

Version: 5.0.0-ballot

Name: ClaimAdjudicationDecisionCodes

Title: Claim Adjudication Decision Codes

Status: draft

Definition:

This value set provides Claim Adjudication Decision codes.

Committee: Financial Management Work Group

OID: 2.16.840.1.113883.4.642.4.1896 (for OID based terminology systems)

Copyright:

HL7 Inc.

Flags: CaseSensitive, Complete

This Code system is used in the following value sets:

ValueSet: Claim Adjudication Decision Codes (This value set includes Claim Adjudication Decision codes.)

4.3.2.241.1 Content

This code system http://hl7.org/fhir/claim-decision defines the following codes:

Code	Display	Definition	Copy
denied	Denied	The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.
approved	Approved	The claim, or individual services, are approved as submitted.
partial	Partial	The claim, or individual services, are approved at an amount less than as submitted.
pending	Pending	The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.

See the full registry of code systems defined as part of FHIR.

Explanation of the columns that may appear on this page:

Level

A few code lists that FHIR defines are hierarchical - each code is assigned a level. See Code System for further information.

Source

The source of the definition of the code (when the value set draws in codes defined elsewhere)

Code

The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')

Display

The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application

Definition

An explanation of the meaning of the concept

Comments

Additional notes about how to use the code