type: codesystemcodesystem: claim-decision

Claim Adjudication Decision Codes

Official URL: http://hl7.org/fhir/claim-decision
Version: 6.0.0
Status: active
Name: ClaimAdjudicationDecisionCodes
Title: Claim Adjudication Decision Codes
Description: This value set provides Claim Adjudication Decision codes.
Case Sensitive: true
Content: complete

Concepts

Code	Display	Definition
denied	Denied	The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.
approved	Approved	The claim, or individual services, are approved as submitted.
partial	Partial	The claim, or individual services, are approved at an amount less than as submitted.
pending	Pending	The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.

CodeSystem XML

<?xml version="1.0" encoding="UTF-8"?>

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="claim-decision"/>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="normative"/>
  </extension>
  <url value="http://hl7.org/fhir/claim-decision"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.4.1896"/>
  </identifier>
  <version value="6.0.0"/>
  <name value="ClaimAdjudicationDecisionCodes"/>
  <title value="Claim Adjudication Decision Codes"/>
  <status value="active"/>
  <experimental value="false"/>
  <description value="This value set provides Claim Adjudication Decision codes."/>
  <copyright value="HL7 Inc."/>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <concept>
    <code value="denied"/>
    <display value="Denied"/>
    <definition value="The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'."/>
  </concept>
  <concept>
    <code value="approved"/>
    <display value="Approved"/>
    <definition value="The claim, or individual services, are approved as submitted."/>
  </concept>
  <concept>
    <code value="partial"/>
    <display value="Partial"/>
    <definition value="The claim, or individual services, are approved at an amount less than as submitted."/>
  </concept>
  <concept>
    <code value="pending"/>
    <display value="Pending"/>
    <definition value="The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information."/>
  </concept>
</CodeSystem>