Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. 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: 1

Draft

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:

Resource: ExplanationOfBenefit.decision (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.reviewOutcome.decision (CodeableConcept / Example)
Resource: ClaimResponse.decision (CodeableConcept / Example)
Resource: ClaimResponse.item.reviewOutcome.decision (CodeableConcept / Example)

4.4.1.416.1 Definition

This value set includes Claim Adjudication Decision codes.

4.4.1.416.2 Content Logical Definition

Include all codes defined in http://hl7.org/fhir/claim-decision

4.4.1.416.3 Expansion

This expansion generated 26 Mar 2023

This value set contains 4 concepts

Expansion based on Claim Adjudication Decision Codes v5.0.0 (CodeSystem)

Code	System	Display	Definition
denied	http://hl7.org/fhir/claim-decision	Denied	The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.
approved	http://hl7.org/fhir/claim-decision	Approved	The claim, or individual services, are approved as submitted.
partial	http://hl7.org/fhir/claim-decision	Partial	The claim, or individual services, are approved at an amount less than as submitted.
pending	http://hl7.org/fhir/claim-decision	Pending	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:

Lvl

A 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

Source

The source of the definition of the code (when the value set draws in codes defined elsewhere)

Code

The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')

Display

The 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

Definition

An explanation of the meaning of the concept

Comments

Additional notes about how to use the code