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

4.4.1.451 ValueSet http://hl7.org/fhir/ValueSet/claim-decision

Financial Management icon Work Group Maturity Level: 2Trial Use Use Context: Not yet ready for Production use, Not yet ready for Production use

This is a value set defined by the FHIR project.

Summary

Defining URL:http://hl7.org/fhir/ValueSet/claim-decision
Version:5.0.0-ballot
Name:ClaimAdjudicationDecisionsCodes
Title:Claim Adjudication Decision Codes
Status:draft
Definition:

This value set includes Claim Adjudication Decision codes.

Committee:Financial Management icon Work Group
OID:2.16.840.1.113883.4.642.3.2983 (for OID based terminology systems)
Copyright:

HL7 Inc.

Flags:Experimental

This value set is used in the following places:

4.4.1.451.1 Content Logical Definition

 

4.4.1.451.2 Expansion

This expansion generated 10 Sep 2022

This value set contains 4 concepts

Expansion based on Claim Adjudication Decision Codes v5.0.0-ballot (CodeSystem)

CodeSystemDisplayDefinition
  deniedhttp://hl7.org/fhir/claim-decisionDenied

The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.

  approvedhttp://hl7.org/fhir/claim-decisionApproved

The claim, or individual services, are approved as submitted.

  partialhttp://hl7.org/fhir/claim-decisionPartial

The claim, or individual services, are approved at an amount less than as submitted.

  pendinghttp://hl7.org/fhir/claim-decisionPending

The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

LvlA few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information
SourceThe source of the definition of the code (when the value set draws in codes defined elsewhere)
CodeThe code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
DisplayThe 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
DefinitionAn explanation of the meaning of the concept
CommentsAdditional notes about how to use the code