This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions
Definition for Code SystemClaimAdjudicationDecisionCodes
@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"] ;
fhir:meta [
fhir:lastUpdated [ fhir:v "2023-12-18T15:12:07.602+11:00" ] ;
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"], [ fhir:v "http://hl7.org/fhir/claim-decision"] ;
fhir:identifier ( [
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.1896" ]
] [
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.1896" ]
] ) ;
fhir:version [ fhir:v "6.0.0-ballot1"], [ fhir:v "6.0.0-ballot1"] ;
fhir:name [ fhir:v "ClaimAdjudicationDecisionCodes"], [ fhir:v "ClaimAdjudicationDecisionCodes"] ;
fhir:title [ fhir:v "Claim Adjudication Decision Codes"], [ fhir:v "Claim Adjudication Decision 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 Claim Adjudication Decision codes."], [ fhir:v "This value set provides Claim Adjudication Decision 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 "denied" ] ;
fhir:display [ fhir:v "Denied" ] ;
fhir:definition [ fhir:v "The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'." ]
] [
fhir:code [ fhir:v "approved" ] ;
fhir:display [ fhir:v "Approved" ] ;
fhir:definition [ fhir:v "The claim, or individual services, are approved as submitted." ]
] [
fhir:code [ fhir:v "partial" ] ;
fhir:display [ fhir:v "Partial" ] ;
fhir:definition [ fhir:v "The claim, or individual services, are approved at an amount less than as submitted." ]
] [
fhir:code [ fhir:v "pending" ] ;
fhir:display [ fhir:v "Pending" ] ;
fhir:definition [ fhir:v "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.