R5 Final QA

This page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - 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

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

Financial Management icon Work Group Maturity Level: 0Informative Use Context: Country: World
Official URL: http://hl7.org/fhir/claim-decision Version: 5.0.0-draft-final
active as of 2023-03-01 Computable Name: ClaimAdjudicationDecisionCodes
Flags: CaseSensitive, Complete OID: 2.16.840.1.113883.4.642.4.1896

This Code system is used in the following value sets:

4.3.2.209.1 Definition

This value set provides Claim Adjudication Decision codes.

4.3.2.209.2 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'.btn btn
approved ApprovedThe claim, or individual services, are approved as submitted.btn btn
partial PartialThe claim, or individual services, are approved at an amount less than as submitted.btn btn
pending PendingThe adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.btn btn

 

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