Definition for Code SystemClaimAdjudicationDecisionReasonCodes

@prefix fhir: <http://hl7.org/fhir/> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .

# - resource -------------------------------------------------------------------

[] a fhir:CodeSystem ;
  fhir:id [ fhir:v "claim-decision-reason"] ;
  fhir:meta [
     fhir:lastUpdated [ fhir:v "2024-08-12T16:52:12.437+08:00" ] ;
     fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ] )
  ] ;
  fhir:text [
     fhir:status [ fhir:v "generated" ]
  ] ;
  fhir:extension ( [
     fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
     fhir:value [ fhir:v "fm" ]
  ] ) ;
  fhir:url [ fhir:v "http://hl7.org/fhir/claim-decision-reason"], [ fhir:v "http://hl7.org/fhir/claim-decision-reason"] ;
  fhir:version [ fhir:v "6.0.0-ballot2"], [ fhir:v "6.0.0-ballot2"] ;
  fhir:name [ fhir:v "ClaimAdjudicationDecisionReasonCodes"], [ fhir:v "ClaimAdjudicationDecisionReasonCodes"] ;
  fhir:title [ fhir:v "Claim Adjudication Decision Reason Codes"], [ fhir:v "Claim Adjudication Decision Reason Codes"] ;
  fhir:status [ fhir:v "active"], [ fhir:v "active"] ;
  fhir:experimental [ fhir:v "false"], [ fhir:v "false"] ;
  fhir:publisher [ fhir:v "HL7 International"], [ fhir:v "HL7 International"] ;
  fhir:description [ fhir:v "This value set provides example Claim Adjudication Decision Reason codes."], [ fhir:v "This value set provides example Claim Adjudication Decision Reason codes."] ;
  fhir:jurisdiction ( [
     fhir:coding ( [
       fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
       fhir:code [ fhir:v "001" ] ;
       fhir:display [ fhir:v "World" ]
     ] )
  ] [
     fhir:coding ( [
       fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
       fhir:code [ fhir:v "001" ] ;
       fhir:display [ fhir:v "World" ]
     ] )
  ] ) ;
  fhir:copyright [ fhir:v "HL7 Inc."], [ fhir:v "HL7 Inc."] ;
  fhir:caseSensitive [ fhir:v "true"] ;
  fhir:content [ fhir:v "complete"] ;
  fhir:concept ( [
     fhir:code [ fhir:v "0001" ] ;
     fhir:display [ fhir:v "Not medically necessary" ] ;
     fhir:definition [ fhir:v "The payer has determined this product, service, or procedure as not medically necessary." ]
  ] [
     fhir:code [ fhir:v "0002" ] ;
     fhir:display [ fhir:v "Prior authorization not obtained" ] ;
     fhir:definition [ fhir:v "Prior authorization was not obtained prior to providing the product, service, or procedure." ]
  ] [
     fhir:code [ fhir:v "0003" ] ;
     fhir:display [ fhir:v "Provider out-of-network" ] ;
     fhir:definition [ fhir:v "This provider is considered out-of-network by the payer for this plan." ]
  ] [
     fhir:code [ fhir:v "0004" ] ;
     fhir:display [ fhir:v "Service inconsistent with patient age" ] ;
     fhir:definition [ fhir:v "The payer has determined this product, service, or procedure is not consistent with the patient's age." ]
  ] [
     fhir:code [ fhir:v "0005" ] ;
     fhir:display [ fhir:v "Benefit limits exceeded" ] ;
     fhir:definition [ fhir:v "The patient or subscriber benefit's have been exceeded." ]
  ] ) .

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