Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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 Work Group Maturity Level: 0Informative 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:

4.3.2.241.1 Content

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

CodeDisplayDefinitionCopy
denied DeniedThe claim, or individual services, are not approved for any payment. This may also be known as 'rejected'. 
approved ApprovedThe claim, or individual services, are approved as submitted. 
partial PartialThe claim, or individual services, are approved at an amount less than as submitted. 
pending PendingThe 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:

LevelA few code lists that FHIR defines are hierarchical - each code is assigned a level. 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