Definition for Code SystemClaimAdjudicationDecisionCodes
{
"resourceType" : "CodeSystem",
"id" : "claim-decision",
"meta" : {
"lastUpdated" : "2023-03-26T15:21:02.749+11:00",
"profile" : ["http://hl7.org/fhir/StructureDefinition/shareablecodesystem"]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system <code>http://hl7.org/fhir/claim-decision</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">denied<a name=\"claim-decision-denied\"> </a></td><td>Denied</td><td>The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.</td></tr><tr><td style=\"white-space:nowrap\">approved<a name=\"claim-decision-approved\"> </a></td><td>Approved</td><td>The claim, or individual services, are approved as submitted.</td></tr><tr><td style=\"white-space:nowrap\">partial<a name=\"claim-decision-partial\"> </a></td><td>Partial</td><td>The claim, or individual services, are approved at an amount less than as submitted.</td></tr><tr><td style=\"white-space:nowrap\">pending<a name=\"claim-decision-pending\"> </a></td><td>Pending</td><td>The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.</td></tr></table></div>"
},
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "fm"
}],
"url" : "http://hl7.org/fhir/claim-decision",
"identifier" : [{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.4.642.4.1896"
}],
"version" : "5.0.0",
"name" : "ClaimAdjudicationDecisionCodes",
"title" : "Claim Adjudication Decision Codes",
"status" : "active",
"experimental" : false,
"publisher" : "HL7 International",
"description" : "This value set provides Claim Adjudication Decision codes.",
"jurisdiction" : [{
"coding" : [{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001",
"display" : "World"
}]
}],
"copyright" : "HL7 Inc.",
"caseSensitive" : true,
"content" : "complete",
"concept" : [{
"code" : "denied",
"display" : "Denied",
"definition" : "The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'."
},
{
"code" : "approved",
"display" : "Approved",
"definition" : "The claim, or individual services, are approved as submitted."
},
{
"code" : "partial",
"display" : "Partial",
"definition" : "The claim, or individual services, are approved at an amount less than as submitted."
},
{
"code" : "pending",
"display" : "Pending",
"definition" : "The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information."
}]
}
Usage note: every effort has been made to ensure that the
examples are correct and useful, but they are not a normative part
of the specification.