Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

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

Financial Management icon Work Group Maturity Level: 1Draft Use Context: Country: World, Not Intended for Production use
Official URL: http://hl7.org/fhir/ValueSet/claim-decision Version: 5.0.0
draft as of 2023-03-26 Computable Name: ClaimAdjudicationDecisionsCodes
Flags: Experimental OID: 2.16.840.1.113883.4.642.3.2983

This value set is used in the following places:

This value set includes Claim Adjudication Decision codes.


 

This expansion generated 26 Mar 2023


This value set contains 4 concepts

Expansion based on Claim Adjudication Decision Codes v5.0.0 (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