Lookup for R5ClaimDecisionReasonForR4B

Extensions for Using Data Elements from FHIR R5 in FHIR R4B
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR R5 in FHIR R4B - Downloaded Version null See the Directory of published versions

The FHIR R5 ValueSet ClaimAdjudicationDecisionReasonCodes has no mapping to FHIR R4B.

Source System Code Display Has XVer Target System Code Display

http://hl7.org/fhir/claim-decision-reason 0001 Not medically necessary Yes

http://hl7.org/fhir/claim-decision-reason 0002 Prior authorization not obtained Yes

http://hl7.org/fhir/claim-decision-reason 0003 Provider out-of-network Yes

http://hl7.org/fhir/claim-decision-reason 0004 Service inconsistent with patient age Yes

http://hl7.org/fhir/claim-decision-reason 0005 Benefit limits exceeded Yes

Source System	Code	Display	Has XVer
`http://hl7.org/fhir/claim-decision-reason`	`0001`	Not medically necessary	Yes
`http://hl7.org/fhir/claim-decision-reason`	`0002`	Prior authorization not obtained	Yes
`http://hl7.org/fhir/claim-decision-reason`	`0003`	Provider out-of-network	Yes
`http://hl7.org/fhir/claim-decision-reason`	`0004`	Service inconsistent with patient age	Yes
`http://hl7.org/fhir/claim-decision-reason`	`0005`	Benefit limits exceeded	Yes

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IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r5.r4b#0.1.0 based on FHIR 4.3.0. Generated 2026-03-20
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