FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions
: Claim Adjudication Decision Codes - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "claim-decision"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p>This code system \n <code>http://hl7.org/fhir/claim-decision</code> defines the following codes:\n </p>\n <table class=\"codes\">\n <tr>\n <td style=\"white-space:nowrap\">\n <b>Code</b>\n </td>\n <td>\n <b>Display</b>\n </td>\n <td>\n <b>Definition</b>\n </td>\n </tr>\n <tr>\n <td style=\"white-space:nowrap\">denied\n <a name=\"claim-decision-denied\"> </a>\n </td>\n <td>Denied</td>\n <td>The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.</td>\n </tr>\n <tr>\n <td style=\"white-space:nowrap\">approved\n <a name=\"claim-decision-approved\"> </a>\n </td>\n <td>Approved</td>\n <td>The claim, or individual services, are approved as submitted.</td>\n </tr>\n <tr>\n <td style=\"white-space:nowrap\">partial\n <a name=\"claim-decision-partial\"> </a>\n </td>\n <td>Partial</td>\n <td>The claim, or individual services, are approved at an amount less than as submitted.</td>\n </tr>\n <tr>\n <td style=\"white-space:nowrap\">pending\n <a name=\"claim-decision-pending\"> </a>\n </td>\n <td>Pending</td>\n <td>The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.</td>\n </tr>\n </table>\n </div>"^^rdf:XMLLiteral
] ; #
fhir:extension ( [
( fhir:extension [
fhir:url [ fhir:v "packageId"^^xsd:anyURI ] ;
fhir:value [
a fhir:id ;
fhir:v "hl7.fhir.uv.xver-r5.r4" ] ] [
fhir:url [ fhir:v "version"^^xsd:anyURI ] ;
fhir:value [
a fhir:string ;
fhir:v "0.0.1-snapshot-2" ] ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/package-source"^^xsd:anyURI ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "fm" ]
] ) ; #
fhir:url [ fhir:v "http://hl7.org/fhir/claim-decision"^^xsd:anyURI] ; #
fhir:version [ fhir:v "5.0.0"] ; #
fhir:name [ fhir:v "ClaimAdjudicationDecisionCodes"] ; #
fhir:title [ fhir:v "Claim Adjudication Decision Codes"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v false] ; #
fhir:date [ fhir:v "2025-09-13T16:55:28-04:00"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "Financial Management"] ; #
fhir:contact ( [
fhir:name [ fhir:v "Financial Management" ] ;
( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ] ] )
] ) ; #
fhir:description [ 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"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ] ] )
] ) ; #
fhir:copyright [ 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." ]
] ) . #
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